Transosseous Suture Repair of an Osteochondral Patellar Fracture Following an Acute Patellar Dislocation

Background: Osteochondral fractures of the patella resulting from an acute patellar instability event may undergo fixation in the acute setting. Transosseous suture fixation may be advantageous in certain instances in comparison to other modalities by minimizing further violation of the articular cartilage and by helping to achieve adequate compression of thin and broad fragments. Indications: A 35-year-old man with a large osteochondral patella fracture in the setting of an acute, traumatic lateral patellar dislocation event. Technique Description: Diagnostic arthroscopy is performed. The donor site is identified and prepared, and the osteochondral fragment is removed. A medial parapatellar approach is utilized to expose the patella for medial patellofemoral ligament (MPFL) graft fixation and to allow for eversion and access to the articular surface of the patella. The osteochondral fragment is sized relative to the donor site. Metal, headless, cannulated screws are employed for the fixation of suitable areas of the osteochondral fragment. Vicryl sutures are shuttled through transosseous tunnels and tied over the anterior patella to achieve appropriate compression of the thin, broad peripheral area of the osteochondral fragment and augment the stability of the fixation construct. MPFL reconstruction is completed. Results: There were no immediate complications following surgery. Surgical management led to improvement of the patient's clinical function and patellar stability. The patient returned for second-look arthroscopy and removal of hardware at 3 months postoperatively, at which time the fragment demonstrated early healing and the Vicryl sutures had resorbed. Discussion/Conclusion: The senior author's preferred technique for transosseous suture fixation of an osteochondral patella fracture is presented. Transosseous suture fixation may be used in isolation or to augment fixation where sufficient implant purchase or fragment compression may not be obtained with other fixation modalities. Further clinical study is needed to investigate long-term clinical outcomes with this technique. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.