Authors of section

Authors

Arnold Besselaar, Daniel Green, Andrew Howard

Executive Editor

James Hunter

General Editor

Fergal Monsell

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Excision

1. General considerations

Reconstruction vs excision

A loose small osteochondral fragment in the knee may cause more symptoms than a small articular defect.

Reasonable attempts should be made to repair the articular surface but there may be small osteochondral defects that are not reconstructable.

Specialist techniques to reconstruct the articular surface are available and include osteochondral autograft and allograft transfer.

Flake fracture of the distal femur with small osteochondral fragment

Associated patellar dislocation

Anterior and lateral osteochondral fractures may be associated with patellar dislocation/subluxation.

Check the retropatellar surface for osteochondral lesions.

2. Patient preparation and approaches

Patient positioning

Place the patient supine on a radiolucent table with a C-arm.

Supine patient position

Approaches

When appropriate resources are available, arthroscopically assisted excision is recommended.

If arthroscopy is not available, osteochondral fractures can be excised via a parapatellar approach.

Arthroscopically assisted excision of osteochondral fragment

3. Excision

Fragment removal assisted by arthroscopy

Identify and grasp the fragment under arthroscopic control.

Removal of osteochondral fragment

Intraoperative image of articular surface after excision

Intraoperative image of articular surface after excision

4. Final assessment

Carefully examine the range of motion and ligament stability.

5. Aftercare

Immediate postoperative care

The patient should get out of bed and begin ambulation with crutches on the day of surgery or the first postoperative day.

In most cases the postoperative protocol will be protected weight bearing in a hinged knee brace.

Hinged knee brace

In some situations, the use of continuous passive motion may be useful.

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Analgesia

Routine pain medication is prescribed for 3–5 days postoperatively.

Discharge care

Discharge from hospital follows local practice and is usually possible after 1–3 days.

Follow-up

Routine clinical follow-up is undertaken, and physiotherapy may be necessary to accelerate recovery.