case_images: PMC6144581_01
case_images: A, Preoperative AP and lateral radiographs of the left knee showed osteoporotic status. In lateral view, discontinuity of subchondral bone line is observed at the notch. B, Coronal section in CT showed fracture line from intercondylar notch to the lateral wall of medial femoral condyle (left). In sagittal section, displaced fragment is demonstrated (middle). Axial section showed 2 bony fragments at the femoral attachment of the PCL (right). C, Three-dimensional image of the left knee demonstrated 2 bony fragments and their displacement. CT indicates computed tomography; PCL, posterior cruciate ligament.
case_images: 10.1177_2151459318798179-fig1.jpg
case_images: PMC6144581_01_10.1177_2151459318798179-fig1.jpg
case_images: fig1-2151459318798179
case_images: Radiographs demonstrated a discontinuity of subchondral bone line at the notch in lateral view (Figure 1A). Plain computed tomography (CT) scans clearly demonstrated 2 parts of bony fragment and their displacement from the original position (Figure 1B and C).
case_images: A, Arthroscopic images demonstrated osteochondral fragment and its displacement with intact PCL. B and C, The defect was filled with clot and scar tissue. Lesion bed was refreshed until bleeding was confirmed. D, The osteochondral fragment was reduced and temporally fixed with two 2.4-mm passing pins. E, The ultratape was passed to the bone tunnels. F, Then, osteochondral fragment was fixed under arthroscopic guiding with Endobutton. G, Postoperative radiographs demonstrated the Endobutton at the surface of the medial femoral condyle. PCL indicates posterior cruciate ligament.
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case_images: PMC6144581_01_10.1177_2151459318798179-fig2.jpg
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case_images: The lesion bed was refreshed with curettage and the osteochondral fragment was reduced by probe (Figure 2C). Keeping this reduced position, osteochondral fragment was fixed temporally with two 2.4-mm passing pins with eyelets (Smith & Nephew, Andover, Massachusetts) that inserted in parallel manner from the anterolateral portal (Figure 2D) and confirmed both of pin and fragment positions with fluoroscope. Then, a suture tape, 2-mm Ultratape (Smith & Nephew), was passed to the medial side using passing pins (Figure 2E). Then, the stability of osteochondral fragment was confirmed during full range of motion arthroscopically (Figure 2F and G).
case_images: A, Postoperative radiographs taken at 6 months after surgery. The continuity of subchondral bone line at the notch was observed. B, Computed tomography scans obtained at 6 months after surgery demonstrated consolidation of the fragments, although osteoporotic status is still observed. C, Three-dimensional images presented consolidation of fragments and Endobutton without critical displacement.
case_images: 10.1177_2151459318798179-fig3.jpg
case_images: PMC6144581_01_10.1177_2151459318798179-fig3.jpg
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case_images: At 6 months after surgery, plain X-ray and CT scans demonstrated consolidation of osteochondral fragment (Figure 3A, B, and C).