Late repair of an osteochondral fracture of the patella.

Acute patellar dislocations are a common injury in young patients. Osteochondral fractures are commonly associated with this injury, frequently necessitating surgical treatment. This article presents a case of a 23-year-old woman who sustained a large osteochondral fracture of the medial facet of the patella during a first-time acute patellar dislocation. The patient was lost to follow-up; consequently, surgical treatment was not performed until 8 weeks after injury. Diagnostic arthroscopy demonstrated a large osteochondral fragment in the suprapatellar pouch and a defect on the medial facet of the patella with early fibrocartilage growth. Using an open approach, the osteochondral fracture was fixed with headless screws buried beneath the cartilage. After fracture fixation, continued lateral subluxation of the patella was present; therefore, to improve patellar tracking and protect our fracture fixation, a Fulkerson tibial tubercle osteotomy (including a lateral release) and a medial patellofemoral ligament repair were performed. At the conclusion of the surgery, we had achieved rigid fixation of the fracture and normalized patellofemoral tracking.At 1 year post-injury, the patient has achieved union of her patellar osteochondral fracture and tibial tubercle osteotomy. She has full range of motion and minimal anterior knee pain and has not experienced further episodes of patellar instability. Even in patients who present in a delayed fashion, consideration should be given to the repair of patellar osteochondral fractures and, if necessary, realignment of the extensor mechanism. Copyright 2010, SLACK Incorporated.