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Clinical Orthopaedics and Related Research®

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01-09-2008 | Surgical Technique

Suture Bridge Fixation of a Femoral Condyle Traumatic Osteochondral Defect

Authors: Andrea L. Bowers, MD, G. Russell Huffman, MD, MPH

Published in: Clinical Orthopaedics and Related Research® | Issue 9/2008

Abstract

Internal fixation of a traumatic osteochondral defect presents a challenge in terms of obtaining anatomic reduction, fixation, and adequate compression for healing. Fixation with countersunk intraarticular screws, Herbert screws, bioabsorbable screws and pins, mini-cancellous screws, and glue tissue adhesive have been reported with varying results. We present an alternative fixation method used in two patients for femoral condylar defects that achieved anatomic reduction with compression via a cruciate-shaped suture bridge construct tied down over a bony bridge. This fixation method allowed early passive range of motion and permitted high-quality MRI for followup of fracture healing and articular cartilage integrity. Arthroscopic examination of one of two patients at 6 months followup showed the gross appearance of a healed, anatomically reduced fracture. With 1 year followup for one patient and 2 years for the other, the patients have resumed activity as tolerated with full, painless range of motion at the knee. Longer-term outcomes are unknown. However, the suture bridge is an alternative means of fixation with encouraging early results for treatment of traumatic osteochondral fragments in the knee.

Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Ahstrom JP Jr. Osteochondral fracture in the knee joint associated with hypermobility of the patella: report of eighteen cases. J Bone Joint Surg Am. 1965;47:1491–1502.PubMed

Binnet MS, Gurkan I, Karakascedil A, Yilmaz C, Erekul S, Cetin C. Histopathologic assessment of healed osteochondral fractures. Arthroscopy. 2001;17:278–285.PubMed

Braune C, Rehart S, Kershbaumer F, Jager A. [Resorbable pin refixation of an osteochondral fracture of the lateral femoral condyle due to traumatic patellar dislocation: case management, follow-up and strategy in adolescents][in German]. Z Orthop Ihre Grenzgeb. 2004;142:103–108.PubMedCrossRef

Dhawan A, Hospodar PP. Suture fixation as a treatment for acute traumatic osteochondral lesions. Arthroscopy. 1999:15:307–311.PubMed

Frisbie DD, Oxford JT, Southwood L, Trotter GW, Rodkey WG, Steadman JR, Goodnight JL, McIlwraith CW. Early events in cartilage repair after subchondral bone microfracture. Clin Orthop Relat Res. 2003;407:215–227.PubMedCrossRef

Frisbie DD, Trotter GW, Powers BE, Rodkey WG, Steadman JR, Howard RD, Park RD, McIlwraith CW. Arthroscopic subchondral bone plate microfracture technique augments healing of large chondral defects in the radial carpal bone and medial femoral condyle of horses. Vet Surg. 1999;28:242–255.PubMed

Fuchs M, Vosshenrich R, Dumont C, Sturmer KM. [Refixation of osteochondral fragments using absorbable implants: first results of a retrospective study][in German]. Chirurg. 2003;74:554–561.PubMedCrossRef

Gobbi A, Nunag P, Malinowski K. Treatment of full thickness chondral lesions of the knee with microfracture in a group of athletes. Knee Surg Sports Traumatol Arthrosc. 2005;13:213–221.PubMedCrossRef

Gul R, Khan F, Maher Y, O’Farrell D. Osteochondral fractures in the knee treated with butyl-2-cyanoacrylate glue: a case report. Acta Orthop Belg. 2006;72:641–643.PubMed

10.

Hofmann GO, Wagner FD. New implant designs for bioresorbable devices in orthopaedic surgery. Clin Mater. 1993;14:207–215.PubMedCrossRef

11.

Kish G, Modis L, Hangody L. Osteochondral mosaicplasty for the treatment of focal chondral and osteochondral lesions of the knee and talus in the athlete: rationale, indications, techniques, and results. Clin Sports Med. 1999;18:45–66, vi.PubMedCrossRef

12.

Knutsen G, Engebretsen L, Ludvigsen TC, Drogset JO, Grontvedt T, Solheim E, Strand T, Roberts S, Isaksen V, Johansen O. Autologous chondrocyte implantation compared with microfracture in the knee: a randomized trial. J Bone Joint Surg Am. 2004;86:455–464.PubMed

13.

Lai SY, Becker DG. Sutures and needles. E-medicine.com. Available at: http://www.emedicine.com/ent/topic38.htm. Accessed January 7, 2008.

14.

Lange RH, Vanderby R Jr, Engber WD, Glad RW, Purnell ML. Biomechanical and histological evaluation of the Herbert screw. J Orthop Trauma. 1990;4:275–282.PubMed

15.

Larsen MW, Pietrzak WS, DeLee JC. Fixation of osteochondritis dissecans lesions using poly(l-lactic acid)/poly(glycolic acid) copolymer bioabsorbable screws. Am J Sports Med. 2005;33:68–76.PubMedCrossRef

16.

Lewis PL, Foster BK. Herbert screw fixation of osteochondral fractures about the knee. Aust NZ J Surg. 1990;60:511–513.CrossRef

17.

Makin M. Osteochondral fracture of the lateral femoral condyle. J Bone Joint Surg Am. 1951;33:262–264.PubMed

18.

Mashoof AA, Scholl MD, Lahav A, Greis PE, Burks RT. Osteochondral injury to the mid-lateral weight-bearing portion of the lateral femoral condyle associated with patella dislocation. Arthroscopy. 2005;21:228–232.PubMedCrossRef

19.

Matthewson MH, Dandy DJ. Osteochondral fractures of the lateral femoral condyle: a result of indirect violence to the knee. J Bone Joint Surg Br. 1978;60:199–202.PubMed

20.

Mbubaegbu CE, Percy AJ. Femoral osteochondral fracture: a non-contact injury in martial arts? A case report. Br J Sports Med. 1994;28:203–205.PubMedCrossRef

21.

Potter HG, Foo LF. Magnetic resonance imaging of articular cartilage: trauma, degeneration, and repair. Am J Sports Med. 2006;34:661–677.PubMedCrossRef

22.

Potter HG, Linklater JM, Allen AA, Hannafin JA, Haas SB. Magnetic resonance imaging of articular cartilage in the knee: an evaluation with use of fast-spin-echo imaging. J Bone Joint Surg Am. 1998;80:1276–1284.PubMed

23.

Pritsch M, Velkes S, Levy O, Greental A. Suture fixation of osteochondral fractures of the patella. J Bone Joint Surg Br. 1995:77:154–155.PubMed

24.

Recht M, Bobic V, Burstein D, Disler D, Gold G, Gray M, Kramer J, Lang P, McCauley T, Winalski C. Magnetic resonance imaging of articular cartilage. Clin Orthop Relat Res. 2001;391(suppl):S379–S396.PubMedCrossRef

25.

Rorabeck C, Bobechko W. Acute dislocation of the patella with osteochondral fracture: a review of eighteen cases. J Bone Joint Surg Br. 1976;58:237–240.PubMed

26.

Rosenberg NJ. Osteochondral fractures of the lateral femoral condyle. J Bone Joint Surg Am. 1964;46:1013–1026.PubMed

27.

Shindle MK, Foo LF, Kelly BT, Khanna AJ, Domb BG, Farber A, Wanich T, Potter HG. Magnetic resonance imaging of cartilage in the athlete: current techniques and spectrum of disease. J Bone Joint Surg Am. 2006;88(suppl 4):27–46.PubMedCrossRef

28.

Sledge SL. Microfracture techniques in the treatment of osteochondral injuries. Clin Sports Med. 2001;20:365–377.PubMedCrossRef

29.

Smillie IS. Osteochondritis Dissecans. Loose Bodies in Joints: Etiology, Pathology, Treatment. Baltimore, MD: The Williams and Wilkins Co; 1960.

30.

Sodl JF, Ricchetti ET, Huffman GR. Acute osteochondral shear fracture of the capitellum in a 12-year-old patient: a case report. J Bone Joint Surg Am. 2008;90:629–633.PubMedCrossRef

31.

Steadman JR, Briggs KK, Rodrigo JJ, Kocher MS, Gill TJ, Rodkey WG. Outcomes of microfracture for traumatic chondral defects of the knee: average 11-year follow-up. Arthroscopy. 2003;19:477–484.PubMed

32.

Steadman JR, Miller BS, Karas SG, Schlegel TF, Briggs KK, Hawkins RJ. The microfracture technique in the treatment of full-thickness chondral lesions of the knee in National Football League players. J Knee Surg. 2003;16:83–86.PubMed

33.

Steadman JR, Rodkey WG, Rodrigo JJ. Microfracture: surgical technique and rehabilitation to treat chondral defects. Clin Orthop Relat Res. 2001;391(suppl):S362–S369.PubMedCrossRef

34.

Steadman JR, Rodkey WG, Singleton SB, Briggs KK. Microfracture technique for full-thickness chondral defects: technique and clinical results. Oper Tech Orthop. 1997;7:300–304.CrossRef

35.

Taitsman LA, Frank JB, Mills WJ, Barei DP, Nork SE. Osteochondral fracture of the distal lateral femoral condyle: a report of two cases. J Orthop Trauma. 2006;20:358–362.PubMedCrossRef

Title: Suture Bridge Fixation of a Femoral Condyle Traumatic Osteochondral Defect
Authors: Andrea L. Bowers, MD
G. Russell Huffman, MD, MPH
Publication date: 01-09-2008
Publisher: Springer-Verlag
Published in: Clinical Orthopaedics and Related Research® / Issue 9/2008
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-008-0357-6

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Suture Bridge Fixation of a Femoral Condyle Traumatic Osteochondral Defect

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