Early effectiveness of transosseous suture fixation in treatment of recurrent acute patellar dislocation with patellar osteochondral fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIU Junliang , ZHAI Longxiang ^{△并列第一作者} , XU Zhenmu , WU Aoqiu , ZHOU Ding , HE Yuchen , LIU Qian , TANG Qi ,  ZHU Weihong

Department of Orthopedics, the Second Xiangya Hospital of Central South University, Changsha Hunan, 410011, P. R. China;

Corresponding author：

ZHU Weihong, Email: zhuweihong@csu.edu.com

Keywords：

Recurrent patellar dislocation; patellar osteochondral fracture; medial patellofemoral ligament reconstruction; transosseous suture

DOI：

10.7507/1002-1892.202504009

Video：

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Objective To evaluate the early effectiveness of transosseous suture fixation in treating recurrent acute patellar dislocation with patellar osteochondral fractures (OCFs). Methods A retrospective analysis was conducted on 19 patients with recurrent acute patellar dislocation and patellar OCFs, who underwent transosseous suture fixation between January 2018 and December 2022 and were followed up more than 2 years. The cohort included 8 males and 11 females, aged 13-21 years (mean, 16.2 years). Patients experienced 2-5 episodes of patellar dislocation (mean, 3.2). The interval from the last dislocation to operation ranged from 3 to 15 days (mean, 9.6 days). Preoperative imaging revealed the intra-articular osteochondral fragments and medial patellofemoral ligament (MPFL) injury. Clinical outcomes were evaluated using the visual analogue scale (VAS) score for pain, the International Knee Documentation Committee (IKDC) score, the Hospital for Special Surgery (HSS) knee score, the Lysholm score, and the Tegner score pre- and post-operatively. Postoperative complications were recorded. During follow-up, the knee X-ray films, CT, and MRI were taken to evaluate fragment healing, displacement, and the morphology and tension of the MPFL reconstruction graft. Results All incisions healed by first intention, and no complications occurred such as infection, joint stiffness, or recurrent patellar dislocation. Patients were followed up 24-60 months (mean, 43.5 months). At 12 months postoperatively and the last follow-up, significant improvements (P<0.05) were observed in VAS, Lysholm, IKDC, HSS, and Tegner scores compared to preoperative values. Further significant differences (P<0.05) were noted between the 12 months and last follow-up assessments for all functional and pain scores. Imaging studies demonstrated satisfactory osteochondral fragment positioning with stable fixation. At last follow-up, all fragments had healed, and MPFL reconstruction grafts exhibited optimal morphology and tension. No joint adhesion or fragment displacement occurred. Conclusion For recurrent acute patellar dislocation with patellar OCFs, transosseous suture fixation proves to be both safe and effective, achieving satisfactory early effectiveness.

1.	Arendt EA, Fithian DC, Cohen E. Current concepts of lateral patella dislocation. Clin Sports Med, 2002, 21(3): 499-519.
2.	Nietosvaara Y, Aalto K, Kallio PE. Acute patellar dislocation in children: incidence and associated osteochondral fractures. J Pediatr Orthop, 1994, 14(4): 513-515.
3.	Sillanpää P, Mattila VM, Iivonen T, et al. Incidence and risk factors of acute traumatic primary patellar dislocation. Med Sci Sports Exerc, 2008, 40(4): 606-611.
4.	Migliorini F, Marsilio E, Oliva F, et al. Chondral injuries in patients with recurrent patellar dislocation: a systematic review. J Orthop Surg Res, 2022, 17(1): 63. doi: 10.1186/s13018-022-02911-1.
5.	Buckwalter JA, Martin JA, Olmstead M, et al. Osteochondral repair of primate knee femoral and patellar articular surfaces: implications for preventing post-traumatic osteoarthritis. Iowa Orthop J, 2003, 23: 66-74.
6.	Sanders TL, Pareek A, Hewett TE, et al. Incidence of first-time lateral patellar dislocation: a 21-year population-based study. Sports Health, 2018, 10(2): 146-151.
7.	Pedersen ME, DaCambra MP, Jibri Z, et al. Acute osteochondral fractures in the lower extremities-approach to identification and treatment. Open Orthop J, 2015, 9: 463-474.
8.	Buchner M, Baudendistel B, Sabo D, et al. Acute traumatic primary patellar dislocation: long-term results comparing conservative and surgical treatment. Clin J Sport Med, 2005, 15(2): 62-66.
9.	Nietosvaara Y, Aalto K, Kallio PE. Acute patellar dislocation in children: incidence and associated osteochondral fractures. J Pediatr Orthop, 1994, 14(4): 513-515.
10.	Pedersen ME, DaCambra MP, Jibri Z, et al. Acute osteochondral fractures in the lower extremities—Approach to identification and treatment. Open Orthop J, 2015, 9: 463-474.
11.	Trattnig S, Winalski CS, Marlovits S, et al. Magnetic resonance imaging of cartilage repair: A review. Cartilage, 2011, 2(1): 5-26.
12.	Wang A, Torres-Izquierdo B, Nepple JJ. Osteochondral fractures in adolescents with first-time patellar dislocation: three-dimensional characterization and association with radiographic features. Am J Sports Med, 2025, 53(3): 682-689.
13.	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.
14.	Uimonen M, Ponkilainen V, Paloneva J, et al. Characteristics of osteochondral fractures caused by patellar dislocation. Orthop J Sports Med, 2021, 9(1): 2325967120974649. doi: 10.1177/2325967120974649.
15.	Nomura E, Inoue M, Kurimura M. Chondral and osteochondral injuries associated with acute patellar dislocation. Arthroscopy, 2003, 19(7): 717-721.
16.	Luhmann SJ, Schoenecker PL, Dobbs MB, et al. Arthroscopic findings at the time of patellar realignment surgery in adolescents. J Pediatr Orthop, 2007, 27(5): 493-498.
17.	Duthon VB. Acute traumatic patellar dislocation. Orthop Traumatol Surg Res, 2015, 101(1 Suppl): S59-S67.
18.	Aitchison AH, Hidalgo Perea S, Schlichte LM, et al. Medial patellofemoral ligament reconstruction with simultaneous osteochondral fracture fixation is an effective treatment for adolescent patellar dislocation with osteochondral fractures. J Child Orthop, 2022, 16(5): 393-400.
19.	Tanos P, Christofides I, Volpin A. The effectiveness of internal fixation in the management of acute chondral fractures. A systematic review. Knee, 2022, 39: 216-226.
20.	Yip CCH, Yip DKH. Patellar microfracture: internal stabilization house-on-stilts technique to achieve better results. Arthrosc Tech, 2022, 11(4): e531-e536.
21.	Friemert B, Oberländer Y, Schwarz W, et al. Diagnosis of chondral lesions of the knee joint: can MRI replace arthroscopy? A prospective study. Knee Surg Sports Traumatol Arthrosc, 2004, 12(1): 58-64.
22.	Milgram JW, Rogers LF, Miller JW. Osteochondral fractures: mechanisms of injury and fate of fragments. AJR Am J Roentgenol, 1978, 130(4): 651-658.
23.	Schlechter JA, Nguyen SV, Fletcher KL. Utility of bioabsorbable fixation of osteochondral lesions in the adolescent knee: outcomes analysis with minimum 2-year follow-up. Orthop J Sports Med, 2019, 7(10): 2325967119876896. doi: 10.1177/2325967119876896.
24.	Gupta PK, Das AK, Chullikana A, et al. Mesenchymal stem cells for cartilage repair in osteoarthritis. Stem Cell Res Ther, 2012, 3(4): 25. doi: 10.1186/scrt116.
25.	Ha CW, Park YB, Kim SH, et al. Intra-articular mesenchymal stem cells in osteoarthritis of the knee: a systematic review of clinical outcomes and evidence of cartilage repair. Arthroscopy, 2019, 35(1): 277-288.
26.	DePhillipo NN, Hendesi H, Aman ZS, et al. Preclinical use of FGF-18 augmentation for improving cartilage healing following surgical repair: A systematic review. Cartilage, 2023, 14(1): 59-66.
27.	Chen P, Zheng L, Wang Y, et al. Desktop-stereolithography 3D printing of a radially oriented extracellular matrix/mesenchymal stem cell exosome bioink for osteochondral defect regeneration. Theranostics, 2019, 9(9): 2439-2459.
28.	Zheng Z, Yu D, Wang H, et al. Advancement of 3D biofabrication in repairing and regeneration of cartilage defects. Biofabrication, 2025, 17(2). doi: 10.1088/1758-5090/ada8e1.
29.	Dilley JE, Everhart JS, Klitzman RG. Hyaluronic acid as an adjunct to microfracture in the treatment of osteochondral lesions of the talus: a systematic review of randomized controlled trials. BMC Musculoskelet Disord, 2022, 23(1): 313. doi: 10.1186/s12891-022-05236-6.
30.	Karami P, Laurent A, Philippe V, et al. Cartilage repair: Promise of adhesive orthopedic hydrogels. Int J Mol Sci, 2024, 25(18): 9984. doi: 10.3390/ijms25189984.
31.	Woo I, Park JJ, Seok HG. The efficacy of platelet-rich plasma augmentation in microfracture surgery osteochondral lesions of the talus: a systematic review and meta-analysis. J Clin Med, 2023, 12(15): 4998. doi: 10.3390/jcm12154998.
32.	Lee MJ, Jiang J, Kim SH, et al. Second generation multiple channeling using platelet-rich plasma enhances cartilage repair through recruitment of endogenous MSCs in bone marrow. Stem Cells Transl Med, 2024, 13(12): 1213-1227.
33.	Dines JS, Fealy S, Potter HG, et al. Outcomes of osteochondral lesions of the knee repaired with a bioabsorbable device. Arthroscopy, 2008, 24(1): 62-68.
34.	Kjennvold S, Randsborg PH, Jakobsen RB, et al. Fixation of acute chondral fractures in adolescent knees. Cartilage, 2021, 13(1_suppl): 293S-301S.
35.	Rüther H, Seif Amir Hosseini A, Frosch S, et al. Refixation of osteochondral fragments with resorbable polylactid implants: Long-term clincal and MRI results. Unfallchirurg, 2020, 123(10): 797-806.
36.	Alvarez-Lozano E, Martinez-Rodriguez H, Forriol F. Treatment of chondral knee lesions with autologous chondrocytes embedded in a fibrin scaffold. Clinical and functional assessment. Rev Bras Ortop (Sao Paulo), 2021, 56(4): 470-477.
37.	Calvo R, Figueroa D, Figueroa F, et al. Treatment of patellofemoral chondral lesions using microfractures associated with a chitosan scaffold: mid-term clinical and radiological results. Cartilage, 2021, 13(1_suppl): 1258S-1264S.

1. Arendt EA, Fithian DC, Cohen E. Current concepts of lateral patella dislocation. Clin Sports Med, 2002, 21(3): 499-519.
2. Nietosvaara Y, Aalto K, Kallio PE. Acute patellar dislocation in children: incidence and associated osteochondral fractures. J Pediatr Orthop, 1994, 14(4): 513-515.
3. Sillanpää P, Mattila VM, Iivonen T, et al. Incidence and risk factors of acute traumatic primary patellar dislocation. Med Sci Sports Exerc, 2008, 40(4): 606-611.
4. Migliorini F, Marsilio E, Oliva F, et al. Chondral injuries in patients with recurrent patellar dislocation: a systematic review. J Orthop Surg Res, 2022, 17(1): 63. doi: 10.1186/s13018-022-02911-1.
5. Buckwalter JA, Martin JA, Olmstead M, et al. Osteochondral repair of primate knee femoral and patellar articular surfaces: implications for preventing post-traumatic osteoarthritis. Iowa Orthop J, 2003, 23: 66-74.
6. Sanders TL, Pareek A, Hewett TE, et al. Incidence of first-time lateral patellar dislocation: a 21-year population-based study. Sports Health, 2018, 10(2): 146-151.
7. Pedersen ME, DaCambra MP, Jibri Z, et al. Acute osteochondral fractures in the lower extremities-approach to identification and treatment. Open Orthop J, 2015, 9: 463-474.
8. Buchner M, Baudendistel B, Sabo D, et al. Acute traumatic primary patellar dislocation: long-term results comparing conservative and surgical treatment. Clin J Sport Med, 2005, 15(2): 62-66.
9. Nietosvaara Y, Aalto K, Kallio PE. Acute patellar dislocation in children: incidence and associated osteochondral fractures. J Pediatr Orthop, 1994, 14(4): 513-515.
10. Pedersen ME, DaCambra MP, Jibri Z, et al. Acute osteochondral fractures in the lower extremities—Approach to identification and treatment. Open Orthop J, 2015, 9: 463-474.
11. Trattnig S, Winalski CS, Marlovits S, et al. Magnetic resonance imaging of cartilage repair: A review. Cartilage, 2011, 2(1): 5-26.
12. Wang A, Torres-Izquierdo B, Nepple JJ. Osteochondral fractures in adolescents with first-time patellar dislocation: three-dimensional characterization and association with radiographic features. Am J Sports Med, 2025, 53(3): 682-689.
13. 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.
14. Uimonen M, Ponkilainen V, Paloneva J, et al. Characteristics of osteochondral fractures caused by patellar dislocation. Orthop J Sports Med, 2021, 9(1): 2325967120974649. doi: 10.1177/2325967120974649.
15. Nomura E, Inoue M, Kurimura M. Chondral and osteochondral injuries associated with acute patellar dislocation. Arthroscopy, 2003, 19(7): 717-721.
16. Luhmann SJ, Schoenecker PL, Dobbs MB, et al. Arthroscopic findings at the time of patellar realignment surgery in adolescents. J Pediatr Orthop, 2007, 27(5): 493-498.
17. Duthon VB. Acute traumatic patellar dislocation. Orthop Traumatol Surg Res, 2015, 101(1 Suppl): S59-S67.
18. Aitchison AH, Hidalgo Perea S, Schlichte LM, et al. Medial patellofemoral ligament reconstruction with simultaneous osteochondral fracture fixation is an effective treatment for adolescent patellar dislocation with osteochondral fractures. J Child Orthop, 2022, 16(5): 393-400.
19. Tanos P, Christofides I, Volpin A. The effectiveness of internal fixation in the management of acute chondral fractures. A systematic review. Knee, 2022, 39: 216-226.
20. Yip CCH, Yip DKH. Patellar microfracture: internal stabilization house-on-stilts technique to achieve better results. Arthrosc Tech, 2022, 11(4): e531-e536.
21. Friemert B, Oberländer Y, Schwarz W, et al. Diagnosis of chondral lesions of the knee joint: can MRI replace arthroscopy? A prospective study. Knee Surg Sports Traumatol Arthrosc, 2004, 12(1): 58-64.
22. Milgram JW, Rogers LF, Miller JW. Osteochondral fractures: mechanisms of injury and fate of fragments. AJR Am J Roentgenol, 1978, 130(4): 651-658.
23. Schlechter JA, Nguyen SV, Fletcher KL. Utility of bioabsorbable fixation of osteochondral lesions in the adolescent knee: outcomes analysis with minimum 2-year follow-up. Orthop J Sports Med, 2019, 7(10): 2325967119876896. doi: 10.1177/2325967119876896.
24. Gupta PK, Das AK, Chullikana A, et al. Mesenchymal stem cells for cartilage repair in osteoarthritis. Stem Cell Res Ther, 2012, 3(4): 25. doi: 10.1186/scrt116.
25. Ha CW, Park YB, Kim SH, et al. Intra-articular mesenchymal stem cells in osteoarthritis of the knee: a systematic review of clinical outcomes and evidence of cartilage repair. Arthroscopy, 2019, 35(1): 277-288.
26. DePhillipo NN, Hendesi H, Aman ZS, et al. Preclinical use of FGF-18 augmentation for improving cartilage healing following surgical repair: A systematic review. Cartilage, 2023, 14(1): 59-66.
27. Chen P, Zheng L, Wang Y, et al. Desktop-stereolithography 3D printing of a radially oriented extracellular matrix/mesenchymal stem cell exosome bioink for osteochondral defect regeneration. Theranostics, 2019, 9(9): 2439-2459.
28. Zheng Z, Yu D, Wang H, et al. Advancement of 3D biofabrication in repairing and regeneration of cartilage defects. Biofabrication, 2025, 17(2). doi: 10.1088/1758-5090/ada8e1.
29. Dilley JE, Everhart JS, Klitzman RG. Hyaluronic acid as an adjunct to microfracture in the treatment of osteochondral lesions of the talus: a systematic review of randomized controlled trials. BMC Musculoskelet Disord, 2022, 23(1): 313. doi: 10.1186/s12891-022-05236-6.
30. Karami P, Laurent A, Philippe V, et al. Cartilage repair: Promise of adhesive orthopedic hydrogels. Int J Mol Sci, 2024, 25(18): 9984. doi: 10.3390/ijms25189984.
31. Woo I, Park JJ, Seok HG. The efficacy of platelet-rich plasma augmentation in microfracture surgery osteochondral lesions of the talus: a systematic review and meta-analysis. J Clin Med, 2023, 12(15): 4998. doi: 10.3390/jcm12154998.
32. Lee MJ, Jiang J, Kim SH, et al. Second generation multiple channeling using platelet-rich plasma enhances cartilage repair through recruitment of endogenous MSCs in bone marrow. Stem Cells Transl Med, 2024, 13(12): 1213-1227.
33. Dines JS, Fealy S, Potter HG, et al. Outcomes of osteochondral lesions of the knee repaired with a bioabsorbable device. Arthroscopy, 2008, 24(1): 62-68.
34. Kjennvold S, Randsborg PH, Jakobsen RB, et al. Fixation of acute chondral fractures in adolescent knees. Cartilage, 2021, 13(1_suppl): 293S-301S.
35. Rüther H, Seif Amir Hosseini A, Frosch S, et al. Refixation of osteochondral fragments with resorbable polylactid implants: Long-term clincal and MRI results. Unfallchirurg, 2020, 123(10): 797-806.
36. Alvarez-Lozano E, Martinez-Rodriguez H, Forriol F. Treatment of chondral knee lesions with autologous chondrocytes embedded in a fibrin scaffold. Clinical and functional assessment. Rev Bras Ortop (Sao Paulo), 2021, 56(4): 470-477.
37. Calvo R, Figueroa D, Figueroa F, et al. Treatment of patellofemoral chondral lesions using microfractures associated with a chitosan scaffold: mid-term clinical and radiological results. Cartilage, 2021, 13(1_suppl): 1258S-1264S.

Chinese Journal of Reparative and Reconstructive Surgery

Latest ArticlesEarly effectiveness of transosseous suture fixation in treatment of recurrent acute patellar dislocation with patellar osteochondral fractures

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