Osteochondral knee fracture and Medial patellofemoral ligament injury

Case contributed by Bálint Botz
Diagnosis certain

Presentation

Knee sprain while walking, with transient patellar dislocation (patella undisplaced during initial physical exam). Presents with painful swelling of the joint.

Patient Data

Age: 10 years
Gender: Female

Thin, crescentic cortical flake adjacent to the lateral femoral condyle anteriorly, well depicted on both views. Thickened suprapatellar soft tissue suggestive of joint effusion. Skyline view (not shown) is undiagnostic due to limited range of motion.  

Altogether findings are in line with osteochondral fracture. 

The joint was fixated in lightweight cast, and an MRI was requested. 

MRI performed five days later shows an about 20 mm osteochondral defect of the lateral femoral condyle, and a matching thin articular loose body on the border of the lateral recess, best depicted in the coronal plane. 

Substantial inhomogeneous joint effusion indicating hemarthrosis. 

Case Discussion

Arthroscopic fixation of the detached osteochondral fragment and MPFL repair was performed. 

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