Arthroscopic-assisted Herbert screw fixation for medial femoral condyle osteochondral fracture with anterior cruciate ligament rupture: A case report

Osteochondral injuries of the medial femoral condyle (MFC) are uncommon in anterior cruciate ligament (ACL) ruptures, as the typical mechanism predominantly affects the lateral femoral condyle (LFC). Proper fixation of MFC osteochondral fractures is essential to ensure joint stability and long-term function. We present a case of a 24-year-old male with an ACL rupture and a displaced MFC osteochondral fracture sustained during a basketball-related injury. The patient underwent arthroscopic ACL and anterolateral ligament reconstruction, along with arthroscopically assisted harvesting and mini-open fixation of the osteochondral fragment using a Herbert screw. Postoperatively, a structured rehabilitation protocol was followed. At 6 months, magnetic resonance imaging confirmed fragment healing after which screw removal was done, and at 1-year follow-up, the patient had restored knee function and a full return to sports. This case highlights the rarity of MFC osteochondral fractures in ACL injuries and presents a novel hybrid fixation technique combining arthroscopic harvesting and mini-open Herbert screw fixation. The approach provided anatomic reduction, stable fixation, and early mobilization, making it a viable option for similar injuries.