TREATMENT OF RECURRENT PATELLAR DISLOCATION ASSOCIATED WITH OLD OSTEOCHONDRAL FRACTURE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

DAIZhu , YOUDi ,  LIAOYing , CHENZhiwei , PENGJiabin

Department of Orthopaedics, the First Affiliated Hospital of University of South China, Hengyang Hunan, 421001, P. R. China;

Corresponding author：

LIAOYing, Email: 13017348952@163.com

Keywords：

Patellar dislocation; Osteochondral fracture; Knee; Arthroscope

DOI：

10.7507/1002-1892.20160003

Video：

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Objective To explore the treatment methed of recurrent patellar dislocation associated with old osteochondral fracture and to evaluate its effectiveness. Methods Between August 2010 and August 2014, 12 cases of recurrent patellar dislocation with old osteochondral fracture were treated. There were 4 males and 8 females with an average age of 18.3 years (range, 15-24 years). The left knee was involved in 7 cases and the right knee in 5 cases. All the patients had a history of patellar dislocation, the average interval from injury to first hospitalization was 7.6 months (range, 6-13 months). At preoperation, the range of motion (ROM) of the injured knee was (89.17±13.11)°; the Lysholm score was 56.67±18.91; the Q-angle was (17.50±5.28)°; and tibial tuberosity-trochlear groove (TT-TG) distance was (18.33±4.03) mm. The Q-angle was more than 20° and TT-TG distance was more than 20 mm in 6 of 12 cases. There were 6 cases of patellar osteochondral fracture, 5 cases of lateral femoral condylar osteochondral fracture, and 1 case of patellar osteochondral fracture combined with lateral femoral condylar osteochondral fracture. After osteochondral fracture fragments were removed under arthroscope, lateral patellar retinaculum releasing and medial patellar retinaculum reefing was performed in 2 cases, medial patellofemoral ligament (MPFL) reconstruction combined with both lateral patellar retinaculum releasing and medial patellar retinaculum reefing in 4 cases, and MPFL reconstruction, lateral patellar retinaculum releasing, medial patellar retinaculum reefing, and tibial tubercle transfer in 6 cases. Results All wounds healed by first intention with no complication of infection, haematoma, skin necrosis, or bone nonunion. All patients were followed up 12-60 months with an average of 24.2 months. At 3 months after operation, all patellar dislocations were corrected; the Q-angle was (13.33±1.37)° and the TT-TG distance was (12.17±1.17) mm in 6 patients undergoing tibial tubercle transfer, showing significant differences when compared with preoperative values[(22.50±2.17)° and (21.33±2.34) mm] (t=15.25, P=0.00; t=8.27, P=0.00). All patients achieved relief of knee pain and knee locking; the knee ROM and the Lysholm score at last follow-up were (120.42±11.57)° and 89.25±9.71, showing significant differences when compared with preoperative ones (t=-11.61, P=0.00; t=-8.66, P=0.00). Conclusion It has satisfactory short-term effectiveness to remove old osteochondral fragments that can not be reset and to correct patellar dislocation for recurrent patellar dislocation with old osteochondral fracture.

Citation： DAIZhu, YOUDi, LIAOYing, CHENZhiwei, PENGJiabin. TREATMENT OF RECURRENT PATELLAR DISLOCATION ASSOCIATED WITH OLD OSTEOCHONDRAL FRACTURE. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(1): 10-14. doi: 10.7507/1002-1892.20160003 Copy

1.	郑娟,李国平,肖左功,等.急性髌骨脱位后骨软骨骨折的MRI表现.中国运动医学杂志, 2011, 30(10):899-904.
2.	Lording T, Lustig S, Servien E, et al. Chondral injury in patellofemoral instability. Cartilage, 2014, 5(3):136-144.
3.	Lee BJ, Christino MA, Daniels AH, et al. Adolescent patellar osteochondral fracture following patellar dislocation. Knee Surg Sports Traumatol Arthrosc, 2013, 21(8):1856-1861.
4.	Seeley MA, Knesek M, Vanderhave KL. Osteochondral injury after acute patellar dislocation in children and adolescents. J Pediatr Orthop, 2013, 33(5):511-518.
5.	Nomura E, Inoue M, Kurimura M. Chondral and osteochondral injuries associated with acute patellar dislocation. Arthroscopy, 2003, 19(7):717-721.
6.	Weber O, Goost H, Kabir K, et al. Osteochondral fractures of the distal femur. Z Orthop Unfall, 2007, 145(4):436-440.
7.	Nakagawa S, Arai Y, Inoue H, et al. Two patients with osteochondral injury of the weight-bearing portion of the lateral femoral condyle associated with lateral dislocation of the patella. Case Rep Orthop, 2014, 2014:876410.
8.	Jalan D, Morey VM, Mittal R, et al. Transient patellar dislocation resulting in simultaneous osteochondral fractures of patella and lateral femoral condyle-a case report. J Clin Diagn Res, 2014, 8(10):LD04-06.
9.	Mashoof AA, Scholl MD, Lahav A, et al. Osteochondral injury to the mid-lateral weight-bearing portion of the lateral femoral condyle associated with patella dislocation. Arthroscopy, 2005, 21(2):228-232.
10.	Chotel F, Knorr G, Simian E, et al. Knee osteochondral fractures in skeletally immature patients:French multicenter study. Orthop Traumatol Surg Res, 2011, 97(8 Suppl):S154-159.
11.	喻长纯,杨明路,王战朝.习惯性髌骨脱位合并髌骨骨软骨骨折的手术治疗.中国矫形外科杂志, 2006, 14(11):870-871.
12.	Hoshino CM, Thomas BM. Late repair of an osteochondral fracture of the patella. Orthopedics, 2010, 33(4):270-273.
13.	Hartmann F, Dietz SO, Rommens PM, et al. Long-term outcome after operative treatment of traumatic patellar dislocation in adolescents. J Orthop Trauma, 2014, 28(3):173-180.
14.	王志杰,陈游,李安平,等.不同状态下Q角对复发性髌骨脱位的临床意义.中国修复重建外科杂志, 2014, 28(1):17-20.
15.	尹力,尹宗生,王伟. TT-TG间距在指导单侧复发性髌骨不稳诊疗中的价值.临床骨科杂志, 2015, 18(2):184-186.
16.	Mani S, Kirkpatrick MS, Saranathan A, et al. Tibial tuberosity osteotomy for patellofemoral realignment alters tibiofemoral kinematics. Am J Sports Med, 2011, 39(5):1024-1031.
17.	Saranathan A, Kirkpatrick MS, Mani S, et al. The effect of tibial tuberosity realignment procedures on the patellofemoral pressure distribution. Knee Surg Sports Traumatol Arthrosc, 2012, 20(10):2054-2061.
18.	张磊,李智尧,刘劲松,等.内侧髌骨股骨韧带的概念及临床意义.中国骨伤, 2010, 23(3):189-193.
19.	Weber-Spickschen TS, Spang J, Kohn L, et al. The relationship between trochlear dysplasia and medial patellofemoral ligament rupture location after patellar dislocation:an MRI evaluation. Knee, 2011, 18(3):185-188.
20.	Zheng L, Shi H, Feng Y, et al. Injury patterns of medial patellofemoral ligament and correlation analysis with articular cartilage lesions of the lateral femoral condyle after acute lateral patellar dislocation in children and adolescents:An MRI evaluation. Injury, 2015, 46(6):1137-1144.
21.	Buckwalter JA, Brown TD. Joint injury, repair, and remodeling:roles in post-traumatic osteoarthritis. Clin Orthop Relat Res, 2004, (423):7-16.

1. 郑娟,李国平,肖左功,等.急性髌骨脱位后骨软骨骨折的MRI表现.中国运动医学杂志, 2011, 30(10):899-904.
2. Lording T, Lustig S, Servien E, et al. Chondral injury in patellofemoral instability. Cartilage, 2014, 5(3):136-144.
3. Lee BJ, Christino MA, Daniels AH, et al. Adolescent patellar osteochondral fracture following patellar dislocation. Knee Surg Sports Traumatol Arthrosc, 2013, 21(8):1856-1861.
4. Seeley MA, Knesek M, Vanderhave KL. Osteochondral injury after acute patellar dislocation in children and adolescents. J Pediatr Orthop, 2013, 33(5):511-518.
5. Nomura E, Inoue M, Kurimura M. Chondral and osteochondral injuries associated with acute patellar dislocation. Arthroscopy, 2003, 19(7):717-721.
6. Weber O, Goost H, Kabir K, et al. Osteochondral fractures of the distal femur. Z Orthop Unfall, 2007, 145(4):436-440.
7. Nakagawa S, Arai Y, Inoue H, et al. Two patients with osteochondral injury of the weight-bearing portion of the lateral femoral condyle associated with lateral dislocation of the patella. Case Rep Orthop, 2014, 2014:876410.
8. Jalan D, Morey VM, Mittal R, et al. Transient patellar dislocation resulting in simultaneous osteochondral fractures of patella and lateral femoral condyle-a case report. J Clin Diagn Res, 2014, 8(10):LD04-06.
9. Mashoof AA, Scholl MD, Lahav A, et al. Osteochondral injury to the mid-lateral weight-bearing portion of the lateral femoral condyle associated with patella dislocation. Arthroscopy, 2005, 21(2):228-232.
10. Chotel F, Knorr G, Simian E, et al. Knee osteochondral fractures in skeletally immature patients:French multicenter study. Orthop Traumatol Surg Res, 2011, 97(8 Suppl):S154-159.
11. 喻长纯,杨明路,王战朝.习惯性髌骨脱位合并髌骨骨软骨骨折的手术治疗.中国矫形外科杂志, 2006, 14(11):870-871.
12. Hoshino CM, Thomas BM. Late repair of an osteochondral fracture of the patella. Orthopedics, 2010, 33(4):270-273.
13. Hartmann F, Dietz SO, Rommens PM, et al. Long-term outcome after operative treatment of traumatic patellar dislocation in adolescents. J Orthop Trauma, 2014, 28(3):173-180.
14. 王志杰,陈游,李安平,等.不同状态下Q角对复发性髌骨脱位的临床意义.中国修复重建外科杂志, 2014, 28(1):17-20.
15. 尹力,尹宗生,王伟. TT-TG间距在指导单侧复发性髌骨不稳诊疗中的价值.临床骨科杂志, 2015, 18(2):184-186.
16. Mani S, Kirkpatrick MS, Saranathan A, et al. Tibial tuberosity osteotomy for patellofemoral realignment alters tibiofemoral kinematics. Am J Sports Med, 2011, 39(5):1024-1031.
17. Saranathan A, Kirkpatrick MS, Mani S, et al. The effect of tibial tuberosity realignment procedures on the patellofemoral pressure distribution. Knee Surg Sports Traumatol Arthrosc, 2012, 20(10):2054-2061.
18. 张磊,李智尧,刘劲松,等.内侧髌骨股骨韧带的概念及临床意义.中国骨伤, 2010, 23(3):189-193.
19. Weber-Spickschen TS, Spang J, Kohn L, et al. The relationship between trochlear dysplasia and medial patellofemoral ligament rupture location after patellar dislocation:an MRI evaluation. Knee, 2011, 18(3):185-188.
20. Zheng L, Shi H, Feng Y, et al. Injury patterns of medial patellofemoral ligament and correlation analysis with articular cartilage lesions of the lateral femoral condyle after acute lateral patellar dislocation in children and adolescents:An MRI evaluation. Injury, 2015, 46(6):1137-1144.
21. Buckwalter JA, Brown TD. Joint injury, repair, and remodeling:roles in post-traumatic osteoarthritis. Clin Orthop Relat Res, 2004, (423):7-16.

Chinese Journal of Reparative and Reconstructive Surgery

TREATMENT OF RECURRENT PATELLAR DISLOCATION ASSOCIATED WITH OLD OSTEOCHONDRAL FRACTURE

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