Suture Bridge Fixation of a Femoral Condyle Traumatic Osteochondral Defect

Internal fixation of a traumatic osteochondral defect presents a challenge in terms of obtaining anatomic reduction, fixation, and adequate compression for healing. Fixation with countersunk intraarticular screws, Herbert screws, bioabsorbable screws and pins, mini-cancellous screws, and glue tissue...

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Bibliographic Details
Published in:Clinical orthopaedics and related research 2008-09, Vol.466 (9), p.2276-2281
Main Authors: Bowers, Andrea L., Huffman, G. Russell
Format: Article
Language:English
Subjects:
Adult
Arthroscopy
Biological and medical sciences
Cartilage - injuries
Conservative Orthopedics
Diseases of the osteoarticular system
Female
Femoral Fractures - surgery
Fracture Fixation, Internal - methods
Humans
Injuries of the limb. Injuries of the spine
Knee Injuries - surgery
Magnetic Resonance Imaging
Male
Medical sciences
Medicine
Medicine & Public Health
Orthopedics
Sports Medicine
Surgery
Surgical Orthopedics
Surgical Technique
Suture Techniques
Traumas. Diseases due to physical agents
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Summary:Internal fixation of a traumatic osteochondral defect presents a challenge in terms of obtaining anatomic reduction, fixation, and adequate compression for healing. Fixation with countersunk intraarticular screws, Herbert screws, bioabsorbable screws and pins, mini-cancellous screws, and glue tissue adhesive have been reported with varying results. We present an alternative fixation method used in two patients for femoral condylar defects that achieved anatomic reduction with compression via a cruciate-shaped suture bridge construct tied down over a bony bridge. This fixation method allowed early passive range of motion and permitted high-quality MRI for followup of fracture healing and articular cartilage integrity. Arthroscopic examination of one of two patients at 6 months followup showed the gross appearance of a healed, anatomically reduced fracture. With 1 year followup for one patient and 2 years for the other, the patients have resumed activity as tolerated with full, painless range of motion at the knee. Longer-term outcomes are unknown. However, the suture bridge is an alternative means of fixation with encouraging early results for treatment of traumatic osteochondral fragments in the knee. Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
ISSN:0009-921X
1528-1132
DOI:10.1007/s11999-008-0357-6