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Orthopaedic Sports Medicine


Answer 4
  1. Attempted repair of the osteochondral fragment and direct repair of the medial structures. Appropriate treatment for this patient should include removal of the mechanical block to extension, which is likely the osteochondral fragment in the intracondylar notch. Additionally, the treatment of large osteochondral fractures includes attempted repair when possible.7 Likely sources of these large osteochondral fragments include the medial facet of the patella as well as the lateral aspect of the trochlear groove and lateral femoral condyle.8 Medialization of the tibial tubercle in a skeletally immature patient risks growth plate disturbance when there is significant subluxation. At the time of repair of the osteochondral fragment, medial repair is reasonable to restore patellofemoral congruence.

    REFERENCES
    7.
     Arendt EA, Fithian DC, Cohen E. Current concepts of lateral patellar dislocation. Clin Sports Med 2002;21:499-519.

    8. 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;21:228-32.

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