FIXATION OF OSTEOCHONDRAL PATELLAR FRACTURE BY TRANSOSSEOUS SUTURE: REPORT OF TWO CASES

Abstract

Objectives The article aims to explore two cases of osteochondral patellar fracture after acute dislocation, emphasizing the importance of appropriate treatment to prevent early progression to patellofemoral osteoarthritis. The study describes a surgical approach involving transosseous suture fixation and fibrin glue adjuvant, presenting it as a potential alternative over existing techniques. Methods Two patients (a 38 years-old male, and a 12 years-old female) with patellar osteochondral fracture due acute patellar dislocation were underwent surgical intervention. The procedure was performed by medial parapatellar arthrotomy and a transosseous suture fixation by high-strength sutures in the male and absorbable sutures in the female, plus use of fibrin glue as an adjuvant in both. Additionally, reconstruction of the medial patellofemoral ligament (MPFL) with the medial third of the patellar tendon was performed in the male and MPFL and medial patellar tibial ligament using hamstrings in the female. Results Postoperative follow-up revealed good clinical and radiographic outcomes. The patients exhibited complete symptom resolution, full ROM, patellar stability and completely cartilage healing on MRI at 3 and 9 months, respectively. The technique showed potential advantages, including simple reproducibility, low cost, and minimal postoperative complications. Conclusion Fixation of osteochondral patellar fracture by transosseous sutures combined with fibrin glue emerges as a reproducible, cost-effective technique with excellent clinical and radiological outcomes. The method displayed advantages over traditional implants, offering a potential alternative for surgeons. Despite the positive results in these cases, the limited literature calls for further research to confirm the technique superiority compared to isolated sutures and other available methods.