What is the appropriate treatment for this chronic fracture?

This 15-year-old has knee pain months after a collision injury. What do the arrows identify on the axial MRIs through the patella? Is it surgical? What are some options for treatment?

The arrows point to large flaps and fragments of cartilage. These have resulted from a chronic osteochondral fracture that includes a defect extending through the patellar subchondral plate (four small arrows, image two). Because of the size of the fragments and the likelihood they would further break off and contribute to a locked knee, they are surgical.

Surgical options include debridement, osteochondral autologous transplant (OAT) procedure and in vitro cartilage cell harvesting with grafting of the defect. A less accepted and more controversial choice would be some form of stem cell/platelet rich plasma “cocktail”. For more case review, check out MRI Online.

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