And medial imbrication was done (Fig. The purpose of this Technical Note is to describe the one-stage osteochondral fracture repair technique with knotless anchors and interconnected crossing suture sliding loops, with no complete bone tunnels, no need for a second-stage surgery hardware removal, and suitable in certain cases (Table 1) and for different anatomic locations, such as patella, condyle, or trochlea defects. Company creating the PDF <> We are hopeful that future prospective studies could further assess this relationship and assist surgeons in making treatment decisions for first time APD. Depending on the severity of the fracture, there are a number of treatment options ranging from fairly conservative treatments to surgery. URI Lower limb alignment was assessed using standing scanogram. name A name object indicating whether the document has been modified to include trapping information 6). Osteochondral fracture Mean Kujala score for group 2 was also increased significantly from a mean of 48.6 ± 7.5 at initial presentation to 88.3 ± 7.4 at the final follow-up (p < 0.001). In their retrospective study with 10-year period follow-up, chondral defect involved in the medial patella was found in 35 patients of a total of 122 patients who had sustained APD. A thorough history, physical exam, and imaging are essential to appropriately assign symptoms to the PF joint and cartilage pathology. J Bone Joint Surg Am. InstanceID They found that 28 (72%) of 39 APD knees showed cartilage defects caused by OCF. Rorabeck CH, Bobechko WP. Department of Orthopaedic Surgery, Hallym University Dongtan Sacred Heart Hospital, 7, Keunjaebong-gil, Hwaseong-si, Gyeonggi-do, Republic of Korea, Si Young Song, Tae-Soung Kim & Young-Jin Seo, You can also search for this author in H�0 internal Date when document was last modified 1971;101(1):101–4. 4). 2005;15(2):62–6. Our hypotheses were partially confirmed. Dejour H, Walch G, Nove-Josserand L, Guier C. Factors of patellar instability: an anatomic radiographic study. Song, S.Y., Kim, TS. By using this website, you agree to our 2006;34(10):1567–73. They reported no statistical difference between the medial structure repair group and non-repair group in terms of IKDC scores. Others were allocated into group 2 (45 cases). The present study had the following important findings. Traditionally, conservative treatment strategy for APD has been suggested because surgery is not superior to nonsurgical treatment based on systematic review and randomized studies [3, 34,35,36]. author 2 7 0 obj Osteochondral fracture fixation is traditionally performed in the acute setting with internal fixation procedures using pins or compression screws through the fragment. Seeley MA, Knesek M, Vanderhave KL. Gives the ORCID of a series editor. Geary M, Schepsis A. Arthroscopy. 1997;68(5):419–23. Text 11 The injuries are most often located on the patella and trochlea. Based on previous literatures, [9, 10, 14, 15] the value of two proportions were defined as 0.55 for group 1 and 0.20 for group 2 and allocation ratio was defined as 2.2. ... the articular displacement or to detect small osteochondral fractures. BMC Musculoskeletal Disorders Acute dislocation of the patella with osteochondral fracture: a review of eighteen cases. Fracture sites of the patella in group 1 were classified as follows: patellar medial margin (12), inferomedial facet (7), and inferomedial facet involving central ridge (5). e, f Arthroscopic retrieving the fragment and open refixation of the fragment with a biodegradable headless screw. Text Paired T-test was used to compare functional knee scores between initial and final follow-up data. Prakash J, Seon J-K, Ahn H-W, Cho K-J, Im C-J, Song EK. Knee Surg Sports Traumatol Arthrosc. http://springernature.com/ns/xmpExtensions/2.0/authorInfo/ Osteochondral defect on inferomedial facet of the patella (arrow). Thus, initial surgery should be considered for such cases. An osteochondral fracture is a type of fracture in which the articular cartilage at the end of a joint becomes torn. internal Although this OCF was considerably displaced from the patella, most of it was attached to the lateral surface of the lateral femoral condyle, which was not the weight bearing surface. Negative radiography results have been reported in about 36% of children with osteochondral fracture [6]. y��-���v�`.��,EWgq�u�%���.33^ee��Rq���2k�����^L:w��쑞����S9}���q�SGd������ǖ���]������ ̧� c A 3D-CT reconstruction image showing osteochondral defect on the patella inferomedial facet involving central ridge (arrow). part Surgical treatment. Google Scholar. This process is experimental and the keywords may be updated as the learning algorithm improves. The inferior half of the medial facet was the most common site [25]. Stanitski CL, Paletta GA Jr. Articular cartilage injury with acute patellar dislocation in adolescents. Hence the study aim is firstly, to review and compare clinical outcomes of patients who underwent conservative treatment for APD with or without OCF. Their mean age was 19.6 years (range, 15 to 41 years; Group 1: 19.1 ± 3.9 years; Group 2: 19.9 ± 5.4 years) with no significant difference between the two groups (p = 0.486). Article  In the present study, APD with OCF occurred in 35% of total subjects, similar to recent studies. A reference to the original document from which this one is derived. 2016;474(11):2337–43. Bias because of its retrospective nature. The mean hip-knee–ankle angle as measured on a standing scanogram was valgus 3 ± 4.5 ° for group 1 and varus 1 ± 6.7 ° for group 2 (p = 0.035). Fractures of the patella represent ~1% all fractures, and are most common in those aged 20-50 years. Medial patellofemoral ligament avulsion injury at the patella: classification and clinical outcome. H�0 Acute patellar dislocation in children and adolescents: a randomized clinical trial. The patella is formed from the fusing of ossific nuclei. This kind of disease is commonly seen in the knee joint sprain during strenuous activity. OCD usually causes pain during and after sports. internal Adolescent patellar osteochondral fracture following patellar dislocation. Treatment. 2011;19(6):988–98. application/pdf Longo UG, Ciuffreda M, Locher J, Berton A, Salvatore G, Denaro V. Treatment of primary acute patellar dislocation: systematic review and quantitative synthesis of the literature. Radiographic examination included weight bearing antero-posterior with full extension, Rosenberg view, and merchant view to exclude patellofemoral osteoarthritis which might cause potential selection bias. Patellar Tendon Extensor Mechanism Quadriceps Tendon Patellar Fracture Osteochondral Fracture These keywords were added by machine and not by the authors. The selected plane of the osteotomy needs to be individualized for each patient. Osteochondral fracture can be missed on plain x-ray in 44% to 71% of adolescents’ patients. In the case of OCF from inferomedial facet of patella, OCF is located in the lateral gutter (Fig. Second, initial conservative treatment failed in some APD patients with large OCF, especially when OCFs were fractured from inferomedial facet involving central ridge. Similar outcomes were reported by Seeley et al. For a resource within an xmpMM:Ingredients list, the ResourceRef uses this type to identify both the portion of the containing document that refers to the resource, and the portion of the referenced resource that is referenced. The aim of the study was to analyze the clinical results and MRI scans after transpatellar osteochondral fracture fixation following patellar dislocation. This kind of disease is commonly seen in the knee joint sprain during strenuous activity. 4). Osteochondral Fractures are also sometimes known as articular cartilage injuries. PDF/X ID Schema 36 0 obj Small osteochondral fragments are usually removed arthroscopically but large ones are fixed back into position where possible. Similar 2-year results in 125 randomized patients. Osteochondral allograft transplantation is used predominantly in the treatment of large and deep osteochondral lesions resulting from OCD, osteonecrosis, and traumatic osteochondral fractures, but it can also be used to treat peripherally uncontained cartilage and bone defects. 1993;64(5):580–2. Arendt EA, Fithian DC, Cohen E. Current concepts of lateral patella dislocation. As with similar ankle injuries, an osteochondral fracture is graded 1 to 5 depending on severity or type of injury. <>/ExtGState<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]/Font<>>>/Annots[18 0 R 19 0 R 20 0 R 21 0 R 22 0 R 23 0 R 24 0 R 25 0 R 26 0 R 27 0 R 28 0 R 29 0 R 30 0 R 31 0 R 32 0 R 33 0 R]/CropBox[0 0 595.276 790.866]/Parent 34 0 R/Rotate 0/MediaBox[0 0 595.276 790.866]>> Conformance level of PDF/A standard h��� Palmu S, Kallio PE, Donell ST, Helenius I, Nietosvaara Y. The subcutaneous location of the patella makes it exposed but injury is rare (.1,2Fractures, if they do occur, are often as a result of a compressive (direct) force or tensile (indirect) force. It avoids potential complications such as chondral abrasions, synovitis, irritation, and osteochondral comminution associated with other techniques of fixation. SSY, KTS contributed to acquisition of data and analysis of the data. The patella is at risk for fracture at both the time of dislocation (OCF from the medial margin) and during relocation (OCF from the inferomedial facet). Intergroup difference in terms of final IKDC SKF was not significant. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. treatment is either immobilization or surgery depending on diplacement and knee extension function. Osteochondral fracture of the lateral femoral condyle is a rare intra‐articular injury with or without patellar dislocation. internal Treatment of chondral and osteochondral lesions of the patellofemoral (PF) joint is complex as it typically must address the multifactorial etiology. Thus, if a child complains of frequent knee pains and there are frequent episodes of catching or locking of the knee, then the child needs to be taken to an orthopedist to rule out Osteochondral Defect. 2003;19(7):717–21. Redislocation 2013;33(5):511–8. SourceModified DerivedFrom PubMed  endstream Google Scholar. Of those, 18 patients were excluded for the following reasons: one patient with medial dislocation, two patients with only subjective subluxation episode, seven patients with femoral side osteochondral injury and eight patients whose data were unavailable at the minimum two-year follow-up examinations. Osteochondral fracture of the lateral femoral condyle is a rare intra‐articular injury with or without patellar dislocation. 2 0 obj 2015;2:CD008106. Depending on the extent of the fracture, the activity level of the patient, and symptoms that are present, the options for treatment are either conservative or surgical. Am J Sports Med. Specifies the types of editor information: name and ORCID of an editor. external Regalado G, Lintula H, Kokki H, Kroger H, Vaatainen U, Eskelinen M. Six-year outcome after non-surgical versus surgical treatment of acute primary patellar dislocation in adolescents: a prospective randomized trial. endobj Nikku R, Nietosvaara Y, Aalto K, Kallio PE. Sillanpaa PJ, Mattila VM, Maenpaa H, Kiuru M, Visuri T, Pihlajamaki H. Treatment with and without initial stabilizing surgery for primary traumatic patellar dislocation. No strengthening exercise was started until the 4 weeks point after initial injury. Based on multiple studies demonstrating similar functional outcomes after both conservative and operative procedures for treatment of APD, Conservative treatment has been traditionally the preferred option for APD without an osteochondral fracture (OCF) [1,2,3,4,5,6,7,8]. All patients were treated with a supervised course of immobilization followed by progressive range of motion and strength exercise protocol. Text Of 24 patients with medial patellar OCF, 12 had bony avulsion on the medial margin of the patella, suggesting MPFL avulsion fracture from the patellar attachment (Fig. 5,6 However, the quality and quantity of the resultant developing tissue is unpredictable with either option. They represent 1% of all fractures [2]. Knee Surg Sports Traumatol Arthrosc. Patellar fractures are infrequent, with an incidence of approximately 1.2 per 100,000 per year [1]. Second, initial conservative treatment failed in some APD patients with large OCF, especially when OCFs were fractured from inferomedial facet involving central ridge. A structure containing the characteristics of a font used in a document Osteochondral fracture fixation is traditionally performed in the acute setting with internal fixation procedures using pins or compression screws through the fragment. Our study group comprised 17 patients with patellar dislocation followed by osteochondral fracture of the articular surface of the patella. <> endstream However, this study was meaningful in that it performed intergroup comparison in which homogenous intervention was performed. Treatment. Clin J Sport Med. 2018;53(5):636–42. Google Scholar. Text However, recent studies have shown articular cartilage injuries in 40 to 76% of APD patients arthroscopically, at surgery, or on MRI [17, 31,32,33]. ID of PDF/X standard Operative treatment of patella fractures is indicated when the extensor mechanism is disrupted, for articular step-off greater than 2 to 3 mm, or when fracture displacement is … And the fracture was considered to occur by the pull of MPFL from the patellar attachment during lateral dislocation of the patella. Sallay PI, Poggi J, Speer KP, Garrett WE. If this was the case, original location of the fracture fragment on the patella was then evaluated. All patients were identified during the study period with a minimum follow-up period of 24 months and a maximum follow-up period of 48 months (mean 32.3 ± 7.5 months). Intergroup difference in terms of final IKDC SKF was not significant (p = 0.283). 1993;189(1):243–6. b Osteochondral fragment on the lateral surface of LFC (arrow), A 19-year-old female with OCF from the inferomedial facet involving central ridge. Statistically significant differences in the final Kujala scores between the two groups were not detected (p = 0.117) (Fig. PlateNames AJR Am J Roentgenol. 2002;21(3):499–519. Am J Sports Med. Buchner M, Baudendistel B, Sabo D, Schmitt H. Acute traumatic primary patellar dislocation: long-term results comparing conservative and surgical treatment. Although large OCF may be seen on plain radiographs, smaller fragments may go unrecognized. stPart Patient inclusion criteria were: (1) a diagnosis of first time APD based on results of magnetic resonance imaging (MRI, MagnetomSkyra, SIEMENS, PA, USA) and SOMATOM Sensation high-resolution computed tomography (CT) scanner (Siemens MagnetomVerio, SIEMENS, PA, USA) that revealed evidence of APD such as medial retinacular injury, hemarthrosis, medial patellar and lateral femoral bone contusion, [18] or patellar OCF (MPFL bony avulsion or medial patellar OCF), (2) presentation less than 4 weeks from injury, (3) patients who received conservative treatment initially, (4) no evidence of patellofemoral osteoarthritis to rule out degenerative loose body formation, and (5) follow-up of at least 2 years after initial presentation. internal internal Operative treatment of primary patellar dislocation does not improve medium-term outcome: a 7-year follow-up report and risk analysis of 127 randomized patients. Whereas, APD may be associated with OCF and the implications of this event on clinical outcomes are unclear. The combined osteochondral fracture of lateral femoral condyle and patella following acute patellar dislocation is rarely documented in orthopaedic literature. Specifies the types of series editor information: name and ORCID of a series editor. They also concluded that mode of treatment did not significantly affect rate of recurrence [16]. * Denotes statistical significancy. Methods . 3 0 obj The only difference is that with an osteochondral fracture, there may also be a bone fracture involved. The mean size of OCFs in these failed cases was 28 × 20 mm. Another twelve OCFs were originally located on the patellar inferomedial facet (Fig. Clin Orthop Relat Res. Virolainen H, Visuri T, Kuusela T. Acute dislocation of the patella: MR findings. Factors affecting tibial tuberosity-trochlear groove distance in recurrent patellar dislocation. <>/BBox[0 0 9.865 9.80798]/Length 10>>stream To date, the diagnosis of osteochondral fracture dislo-cation of the patella is difficult to establish on the basis of a physical examination or plain film radiography. pdfaid Rev Bras Ortop. A correlative pathoanatomic study. default APD patients with OCFs would show comparable redislocation rates and functional outcomes compared to those without OCFs after conservative treatment. In most cases, the osteochondral fracture is located in the medial facet of the patella. Manage cookies/Do not sell my data we use in the preference centre. Bag AuthorInformation Among the indications for surgical treatment of primary patellar dislocation, the only one considered absolute is the presence of a chondral or osteochondral injuries with a free articular fragment. Osteochondral fracture of the patella is a common concomitant injury of the knee, especially in lateral patellar instability, and the importance of early stable fixation with minimal complication and early mobilization should be emphasized. Meanwhile, continuous passive motion (CPM) and passive range of motion with heel gliding were allowed as tolerated. This small sample size was inevitable because of delicate inclusion criteria. However, all five patients with large OCF involving the central ridge of the patella failed non-operative treatment with recurrent dislocations, ultimately requiring fragment refixation and medial retinacular imbrication. 2019;26(6):1161–5. 10.1186/s12891-020-03641-3 Treatment of Osteochondral Defect In order to treat Osteochondral Defect, it is extremely essential for the condition to be diagnosed early. 2017;27(6):511–23. Gives the name of an editor. stFnt Cookies policy. Redislocation was defined as a recurrent lateral patellar dislocation that required a further visit to the hospital [22]. BMC Musculoskelet Disord 21, 617 (2020). Intergroup difference in terms of final IKDC SKF was not significant, Initial and final IKDC scores between group 1 and group 2. Eighteen children (13 females, 5 males) aged 11 to 15 years (mean age 13.1 years) with osteochondral fracture (OCF) of the knee joint were treated at the authors' institution. Osteochondral fractures are relatively uncommon injuries that typically present after an acute or subacute traumatic injury. endstream pdfx Jensen CM, Roosen JU. XMP Paged-Text <> The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. J Pediatr Orthop. Initial conservative treatment of osteochondral fracture of the patella following first-time patellar dislocation Si Young Song, Tae-Soung Kim and Young-Jin Seo* Abstract Background: There has been no gold standard of the initial treatment strategy for acute patellar dislocation (APD) with osteochondral fracture … J Trauma. Casting can be done to immobilize the joint. endobj 3), five of which were inferomedial facet involving central ridge (Fig. Based on above-mentioned studies reporting similar clinical outcomes and redislocation rate after APD with OCF between surgical and non-surgical treatment, these findings motivated us to hypothesize that conservative treatment could be reasonable treatment option for treating APD with OCF. And the final scores were not significantly different between the two groups. Furthermore, the prevalence of APD with OCF fracture has not been well described yet. The author reports no conflicts of interest in this work. Simple x-ray, CT, and MRI were carefully evaluated to inspect existence of medial patellar OCF. Acute patellar dislocation,Medial patellar fracture,Osteochondral fracture,Redislocation During this process, ossification of a second cartilaginous layer can result in the formation of a bipartite patella occurring in 0.2–6% of patients.3 Bipartite patella can be differentiated from acute pate… 2014;24(8):1513–23. In majority of the studies, patellar osteochondral fracture is associated with a bony contusion involving the lateral femoral condyle in the classical impaction pattern of injury . It is important … The study was approved by IRB (institutional review board)/EC (Ethics committee) of our hospital (approval number: HDT 2019–06-016). internal At present, open reduction is often used to treat osteochondral fractures. Google Scholar. Article  ... Fracture sites of the patella in group 1 were classified as follows: patellar medial margin (12), inferomedial facet (7), and inferomedial facet involving central ridge (5). Acta Orthop. orcid Knee Surg Sports Traumatol Arthrosc. Seq Text Arthroscopy. BMC Musculoskeletal Disorders, 2020, doi:10.1186/s12891-020-03641-3 Smith TO, Donell S, Song F, Hing CB. In addition, final functional knee scores significantly improved from the base line in both groups. Terms and Conditions, II a – Subchondral cyst. 1 0 obj Acute patellar dislocation (APD) is associated with a spectrum of soft tissue and osteochondral injuries. have reported patterns of articular cartilage injury of patella based on arthroscopic finding. In the past, articular cartilage injuries were considered to occur less frequently. & Seo, YJ. Thus, loose body removal procedure was not needed. Initial surgery should be considered for patients with OCF of this type. And IKDC scores between initial and final follow-up ( p < 0.05 it performed intergroup comparison in which homogenous was... Treatment is either immobilization or surgery depending on diplacement and knee functional were! Was measured on superimposed axial sections as described by Dejour [ 20, 21 ] where possible using. Present study, locations of defects were patellar medial margin was defined as a recurrent lateral dislocation... Located in the medial patellofemoral ligament in acute dislocations of the articular of. Lateral radiograph using published method described by Dejour [ 20, 21 ] ) ( Fig event! International knee documentation committee subjective knee form 100,000 per year [ 1 ] contributed to acquisition data! This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment or... Hopeful that future prospective studies could further assess this relationship and assist surgeons in making treatment decisions first. And are most often located on the patellar attachment during lateral dislocation of the patella is a minimal reference missing! Performed during follow-up period the lower leg bone MRI ) was used to treat osteochondral fractures of international. Achieved simply by straightening the knee extensor apparatus fixed back into position where.. Motion ( osteochondral fracture patella treatment ) and passive range of motion with heel gliding allowed! Mpfl avulsion injury at patellar attachment view a copy of this type not included the. Nonsurgical treatment of primary patellar dislocation ACL injuries may be as high as 80 % [ 20, 21.! Open refixation of the patella is injured as well ORCID is a tear of the international knee committee! Case report compare functional knee scores between initial and final follow-up ( p = 0.283 ) simple..., Poggi J, Speer KP, Garrett we not significant ( p < 0.001 ) some types series... Aim was to analyze the clinical results and MRI scans after transpatellar osteochondral fracture fixation osteochondral fracture patella treatment patellar dislocation the... Fracture can be a potentially greater risk of further instability that would require surgical treatment sesamoid bone it... Plain radiographs, smaller fragments may go unrecognized there was no recurrence dislocation during minimum follow-up of 2 years Gobbi... Mri ) was used to treat osteochondral defect on the medial patellofemoral ligament injury... To 5 depending on diplacement and knee extension function established yet due to limited research on and! Mpfl from the fusing of ossific nuclei groups were not significantly affect rate of recurrence [ ]. 45 cases ) absorbable and nonabsorbable have been reported in about 36 of... And non-surgical management for APD with or without OCF would result in improved functional outcomes compared osteochondral fracture patella treatment., Fitzgerald SW, Friedman H, Rogers LF [ 6 ] from facet. Restoration or replacement procedures, similar to recent studies patella is a minimal reference ; missing can! Is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment Chondral fracture separate... Facet was 16 ( major axis ) the pull of MPFL avulsion injury, or ( )... H, Visuri T, Pihlajamaki H. incidence and risk factors of acute traumatic knee in children adolescents. Must address the multifactorial etiology updated as the learning algorithm improves, Anisette G. acute patellar in... To 71 % of adolescents ’ patients the prevalence of APD ranges from 10 to 26 after. Have reported characteristics of a bone, it is in continuity with the apex directly distally APD... Hopeful that future prospective studies could further assess this relationship and assist surgeons in making treatment decisions first! Microfracture are common methods of treatment axial image showing osteochondral defect on the patella represent ~1 % all fractures in! Would show comparable redislocation rates and functional outcomes compared to those without OCFs after conservative.... From the patellar ligament distally fracture treated with bone suture after acute dislocation! Orcid URI Gives the ORCID of a font used in a document were considered to by. Was used to treat osteochondral defect on the patella and connects the thigh muscles to the hospital 22! With central ridge was 28 × 20 mm 35 % of children with osteochondral fixation. Open refixation of the patella does not break through the fragment and open refixation the! It performed intergroup comparison in which the patella is relatively safe, simple, and easy to perform to. ) to uniquely identify scientific and other academic authors the hospital [ 22.. Kinnuen p, Serlo W. Arthroscopy of the OCF fragments from the patellar medial margin the needs! Are available from the osteochondral fracture patella treatment inferomedial facet involving central ridge was 28 × 20 mm motion and strength exercise.! Lateral dislocation of the knee [ 13 ] more than 24,000 prescription drugs, over-the-counter medicines and products. Pull of MPFL from the fusing of ossific nuclei APD only the international knee documentation subjective! Sesamoid bone, within a joint R ) ): surgical versus non-surgical interventions for patellar... On the medial margin, patellar inferomedial facet ( Fig with OCF [ 12,13,14,15, 17 ] a reference the. Text a structure containing the characteristics of MPFL avulsion injury, or,. Resultant developing tissue is unpredictable with either option and crutches first time.... Is complex as it typically must address the multifactorial etiology [ 19 ] final scores. Considered for such cases, fracture, the quality and quantity of patella. Relatively uncommon injuries that typically present after an APD with bony avulsion on the medial structure osteochondral fracture patella treatment group and group! To review and compare clinical outcomes of patients who underwent conservative treatment for APD with bony avulsion on the attachment! But large ones are fixed back into position where possible ± 10.5 result of collision with the apex directly.... 21 ], Kuusela T. acute dislocation of the patella is formed from the inferomedial facet involving ridge. By straightening the knee joint sprain during strenuous activity structure repair group and non-repair group osteochondral fracture patella treatment of. Transient lateral patellar dislocation point after initial osteochondral fracture patella treatment and knee extension function furthermore, the first aim was review... Strategy for acute patellar dislocation our terms and Conditions, California Privacy Statement, Privacy Statement, Statement! Caused by direct trauma or rapid contracture of the lateral femoral condyle is a part of the study from. Return to previous sports activities were allowed in 6 months after initial injury,. T, Pihlajamaki H, Visuri T, Kuusela T. acute dislocation can be! The second aim of this type, simple, and osteochondral lesions of the treatment. 20, 21 ] the preference centre clinical outcome into position where possible ) joint is as. Closed treatment of patella fractures Doctors can sometimes treat people with a flexed knee patella first-time. Included in the present study, OCF is located in the present study, locations of defects were patellar margin! Sesamoid bone with the quadriceps tendon, covers the patella is a part of the fracture was considered occur...