Post-operative Diagnosis:
Left knee Knee osteochondral fracture of the patella

Procedure Performed:
Open reduction internal fixation of left knee osteochondral patellar fragment, microfracture of
patella, removal of loose bodies from knee, repair of medial retinaculum.

The patient was identified and brought to the operating room. After general anesthesia the
knee was examined under anesthesia was no significant ligamentous instability. Midline
incision was made and the skin was mobilized to view the joint capsule. Initially there was no
obvious tear in the medial retinaculum. A median parapatellar approach was utilized to
expose the patella and during this it was noted that there was a tear in the medial retinaculum
that we utilized to open the joint. The joint was then exposed and the patella was inverted.
The large osteochondral fragment was identified in the lateral gutter and removed. There
was a smaller osteochondral fragment that had very little bone on it that was also found in the
intercondylar notch. The rest of the joint was visualized after a thorough irrigation and there
was no further fragments were visualized. First the patella was examined and it was noted
that the majority of the cartilage that had sheared off came off of the inferior half of the patella
and was primarily on the medial side. This area was then curetted to remove any hematoma
and the large fragment was then placed in the position and fit excellently. This was secured
with 2, 2.5 mm screws that were countersunk down to the subchondral bone. A 1.5 mm
screw was also placed to further secure the fragment. Excellent fixation was obtained. On
the medial side of the patella there was bare spot where the smaller fragment came from.
This piece was not repairable therefore a 1 mm drill was utilized to perform a microfracture in
the area. At this point the wound was irrigated copiously.