Osteochondral Fracture Repair (LFC, PF Shear)

Shear forces within the knee joint occurring during patellofemoral dislocation can generate chondral and osteochondral fracture fragments. The osteochondral junction is a region with a varied response to injury depending on which locations of the knee are involved and at what age the injury occurs. Articular cartilage has limited regenerative healing potential whereas bone has high regenerative healing potential. Throughout skeletal maturation, the interface between cartilage and underlying bone changes as uncalcified cartilage transitions to calcified cartilage. The unique and changing biology of the osteochondral junction is the foundation for the occurrence, management, and treatment of fractures that occur in this region. The surgical management of chondral and osteochondral shear fractures in the patellofemoral joint falls into three general categories: fragment excision with donor site marrow stimulation, fragment removal with donor site cartilage restoration, and fragment fixation. When addressing how to treat an osteochondral fracture with an associated fragment, the size, shape, location, and composition of the fragment as well as the time between injury and surgery should be carefully considered.