Osteochondral Fragment from the Lateral Femoral Condyle in an Adult after Patellar Dislocation: A Surgical Challenge.

INTRODUCTION: Osteochondral lesions of the lateral femoral condyle (LFC) following patellar dislocation are relatively rare and typically observed in the adolescent population. In adults, such injuries-especially involving a large osteochondral fragment from the posterolateral aspect of the condyle-are exceedingly uncommon and pose both diagnostic and therapeutic challenges.

CASE REPORT: We present the case of a 20-year-old male who sustained a traumatic right knee injury while playing basketball. Clinical examination and imaging revealed a large osteochondral fragment (2.5 × 2.5 cm) originating from the posterolateral aspect of the LFC, accompanied by a complete tear of the medial patellofemoral ligament (MPFL). Notably, the patient demonstrated generalized joint hypermobility (Beighton score 6/9) and patellar maltracking features, including patella alta and increased tibial tubercle-trochlear groove distance. The patient underwent combined arthroscopic and open surgical management. Diagnostic arthroscopy confirmed an intra-articular floating osteochondral fragment, which was removed, anatomically reduced, and fixed using bioabsorbable pins and headless compression screws through a lateral parapatellar arthrotomy. Concurrently, MPFL reconstruction was performed using a semitendinosus and gracilis autograft fixed with suture anchors and an endobutton system.

CONCLUSION: This case underscores the importance of high clinical suspicion for osteochondral injury in adult patellar dislocation, especially in patients with underlying joint hypermobility or anatomical predispositions.