Open Reduction Internal Fixation of Isolated Chondral Fragments Without Osseous Attachment in the Knee

Abstract

Background: Isolated chondral fractures of the knee are a rare and challenging problem, typically occurring with an acute traumatic event such as dislocation of the patella or ligamentous injury. Historically, repair of unstable chondral fragments without osseous attachment has not been recommended due to concerns about the limited healing potential of cartilage. Purpose: To describe a technique for fixation of large isolated chondral fractures of the knee and present 3 cases where large chondral fragments without osseous attachment were fixed successfully with chondral darts and biologic adhesive. Study Design: Case series; Level of evidence, 4. Methods: The senior author reviewed his case logs for all patients on whom he performed open reduction and internal fixation on large isolated cartilage fragments without osseous attachment. Three were extracted from his review. The clinical and radiographic outcomes were retrospectively reviewed. Results: Successful results and complete healing was obtained in all 3 patients. This procedure can be done in the setting of concurrent injury, such as anterior cruciate ligament tear, using single- or multistaged chondral repair and ligament reconstruction techniques. Conclusion: Isolated chondral fragment repair techniques provide the orthopaedic surgeon an additional option for treating these challenging injuries. Primary fixation can be accomplished for what have been historically considered “unsalvageable” fragments.