Osteochondral Fragment Repair Using Knotless All-Suture Anchor Technique Within Patellofemoral Joint

Background: The optimal technique for fixation of osteochondral fragments sustained after traumatic patellar dislocations remains controversial, with several described techniques in the literature—including screws, pins, anchors, and suture-based techniques. All-suture anchor fixation utilizes a small-caliber unicortical drill hole, minimizing the creation of bony defects and the disruption of healthy cartilage by the fixation construct. Indications: In this study, we present a male patient with a history of acute left knee pain after a patellar dislocation who was found to have a large osteochondral fragment within the patellofemoral joint. After extensive discussion regarding the treatment options, the patient was indicated for knee arthroscopy with loose-body removal, open osteochondral fragment repair, and medial patellofemoral ligament reconstruction. For this video, we focus on the open osteochondral fragment repair portion of the procedure. Technique Description: The procedure begins by preparing both the fragment and the chondral defect for repair by debridement of fibrous tissue. The periphery is trimmed to stable cartilage edges of matching size and shape. The repair surface is roughened to promote bleeding of the subchondral bone and facilitate healing. All-suture anchors are placed around the periphery of the repair. The osteochondral fragment is secured within the defect using sutures tensioned between the anchors. A layer of fibrin glue is used to finalize the repair. Results: Open osteochondral repair using an all-suture fixation is a viable technique for stable cartilage repair. Although outcomes data are sparse, studies have demonstrated chondral healing with modern repair techniques similar to the one described in this demonstration. Discussion/Conclusion: Many fixation techniques are possible for osteochondral fragments after traumatic patellar dislocations. We demonstrate a novel technique using an all-suture fixation construct with stable fragment fixation, focusing on technical tips and outlining a postoperative rehabilitation protocol. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.