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.
Associated patellar dislocation
Anterior and lateral flake fractures may be associated with patellar dislocation/subluxation.
Check the retropatellar surface for osteochondral lesions.
Fixation can be achieved using a small fragment screw system (A or B), or absorbable pins (C). In general, screws provide a better compression of the fracture, but require an osteochondral fragment that is sufficiently large to accommodate the screw head.
Cannulated implants are advantageous.
Absorbable pins (C) are preferable for thin and small fragments.
2. Patient preparation and approaches
Place the patient supine on a radiolucent table with a C-arm.