Article
Clinical and magnetic resonance imaging results after acute patella dislocation with chondral flake fractures: Autologous chondrocyte implantation versus flake refixation
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Authors
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Yannick Ehmann
- Abteilung für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, München, Germany
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Lea Zuche
- Abteilung für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, München, Germany
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Alexander Otto
- Klinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Augsburg, Augsburg, Germany
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Andreas Schmitt
- Abteilung für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, München, Germany
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Andreas B. Imhoff
- Klinikum rechts der Isar TU München, Direktor/Chefarzt Abteilung für Sportorthopädie, München, Germany
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Julian Mehl
- Abteilung für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, München, Germany
| Published: | October 26, 2021 |
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Outline
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Objectives: The purpose of the present study was to investigate the clinical and magnetic resonance imaging (MRI) results of patients undergoing surgical patella stabilization in combination with either flake refixation or ACI after acute patella dislocation with osteo-/chondral flake fractures. The hypothesis was that flake refixation will lead to better clinical and MRI results than ACI in a medium term.
Methods: All patients who were surgically treated between Jan/2012 and Dec/2018 with soft tissue patella stabilization and either flake refixation (RF-group) or ACI (ACI-group) because of osteo-/chondral flake fractures following acute patella dislocation were retrospectively included. Patients < 12 years or> 40 years and patients with previous knee surgeries were excluded. The postoperative results were assessed at least 24 months after surgery by means of a standardized clinical examination and questionnaires including the Tegner activity score, the Kujala score, the subjective IKDC score and the KOOS. Additionally, MRI of the affected knee joint was performed in order to assess the repaired cartilage using the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) 2.0 knee score.
Results and Conclusion: A total of 28 patients were included in the study with 14 patients in each group. The demographic data did not show significant differences between the RF-group (7 female, 7 male; age mean 26.9± SD 5.9 years; BMI 24.2 ± 2.8 kg/m2) and the ACI-group except for the BMI (9 female, 5 male; age 25.8 ± 5.1 years; BMI 21.5 ± 2.2 kg/m2 (p=0.016)). Both groups had similar defect locations (RF: 11 x patella and 3 x lateral femoral condyle; ACI: 12 x patella and 2 x lateral femoral condyle; p > 0.05).
At the postoperative follow-up investigation (RF-group: 56.3 ± 17.5 months; ACI-group: 51.1 ± 17.6 months; p > 0.05) there was no statistical significant group difference for any of the clinical outcome scores (RF-group vs. ACI-group: Tegner activity score 5.1 ± 1.4 vs. 5.2 ± 1.8; Kujala score 84.9 ± 9.4 vs. 85.3 ± 12.9; IKDC score 83.4 ± 11.1 vs. 81.9 ± 15.6; total KOOS 82.4 ± 11.4 vs. 82.3 ± 14.8). One patient in each group suffered a patella dislocation again and needed revision surgery.
The MRI evaluation of the repaired cartilage using the MOCART 2.0 score showed better results for the RF-group (70 ± 13.1) in comparison with the ACI-group (58.8 ± 18.4). However, the difference did not reach statistical significance (p=0.073).
Surgical soft tissue patella stabilization after acute patella dislocation with osteo-/chondral flake fractures led to good clinical results in a medium term showing no significant differences between refixation of the fragment and ACI of the cartilage defect. There was a trend towards better results in the MRI evaluation after fragment refixation.
