[48]. Sagittal MRI images were reexamined 18 months after operation, MRI = magnetic resonance. Acta Orthop Scand 1997;68:4246. Plain radiograph (PDF) Technique for Treatment of Subchondral Compression Fracture of Soft tissues are retracted to . Jain A, Agrawal P, Chadha M, et al. Recently, impaction fractures in the non-weight-bearing area of the lateral femoral condyle were reported in 16 of 6600 patients who underwent knee MRI. [31]. [15,16] These forces cause gross displacement of the condyle, which can not only rupture the quadriceps tendon but also perforate the skin, resulting in an open injury. Bioactive factors for cartilage repair and regeneration: improving delivery, retention, and activity. Internal fixation with lag screws plus an antigliding plate for the, [88]. Open reduction and internal fixation are preferred. Irreducible, incarcerated vertical dislocation of patella into a. FOIA Surgery for patellar dislocation has evolved towards anatomical reconstructions with assessment and treatment of anatomical risk factors. Rue JP, Busam ML, Detterline AJ, et al. Osteochondral fracture of the lateral femoral condyle is a rare intra-articular injury with or without patellar dislocation. [24]. [Resorbable pin refixation of an osteochondral fracture of the lateral femoral condyle due to traumatic patellar dislocation: case management, follow-up and strategy in adolescents]. The plate fit the bone surface well, despite some bending, the clinical and radiological outcomes were good. Furthermore, a Hoffa fracture is associated with cruciate ligament injury. [100,101] To avoid damaging the cartilage in these cases, it is important to reduce the patella early and restore the patellofemoral joint stability by repairing the damaged medial soft tissues. Injury 1989;20:3714. Non-union coronal fracture femoral condyle, sandwich technique: a case report. Hoffa fracture with cruciate ligament, lateral collateral ligament, or meniscus injuries can be treated with arthroscopic surgery,[90] which has the advantages of minimal invasion, less of an effect on blood supply, early postoperative return to functional exercise, and effective prevention of nonunion and joint stiffness. Open bicondylar, [23]. Med Sci Monit, 2012, 18: CS117CS120. [10]. [Patella infera. [78] Previous studies showed the use of many screws to fix the Hoffa fracture, such as cancellous, cannulated, and headless used in a lag technique. [43]. 2020 Jun 15;9 (6):e823-e828. In addition to changes in bone mineral composition and a reduced proportion of bone matrix in patients with osteoporosis, changes in bone microstructure, thinning of bone cortex, and reduction in the number and size of bone trabeculae result in a decreased bone load capacity[26] and an increased risk of a Hoffa fracture with low-energy trauma. In these cases, avulsion of the anterior cruciate ligament along with a large chunk of bone at its insertion[17] can lead to a Hoffa fracture. [11] The presence of a thick ligament in a relatively small femur is also a risk factor for a Hoffa fracture.[2730]. Sasidharan B, Shetty S, Philip S, et al. Nanda R, Yadav RS, Thakur M. Intra-articular dislocation of the patella. McCarthy JJ, Parker RD. Monocondylar fractures of the femur: a review of 13 patients. Anchor absorbable suture bridge fixation is rigid enough, which can avoid second operation, save cost and good outcome could be expected, which is worth exploring; Of course, a large number of clinical data are needed for further comparative study. classification; diagnosis; Hoffa fracture; injury mechanism; treatment. [16]. 1 It has been proved that compression of the posterior border of . Ann Chir 1978;32:2139. [1,2] However, most LFC cartilage injuries are located in the anterior non-weight-bearing area. For more information, please refer to our Privacy Policy. Jarit GJ, Kummer FJ, Gibber MJ, et al. Complained of swelling and pain of the right knee after spraining during sports activities, demonstrated painful limited motion. We do not do patellar medial collateral ligament repair to reduce complications such as knee joint adhesion. [7]. Search for Similar Articles An unusual fracture of the lateral femoral condyle in a child. A modified posterolateral approach for. This approach can also be used to treat comminuted fractures or complex Hoffa fractures.[18]. Clipboard, Search History, and several other advanced features are temporarily unavailable. [60]. [34] The clinical diagnosis of a Hoffa fracture relies on trauma history, physical examination, imaging, and other objective indicators as well as increased suspicion based on the history and positive signs.[35,36]. findings identifies vascular segments with diminished flow vascular injury (A) A blurred fracture line can be seen at the fracture of the lateral condyle of the femur. Commonly used classifications include the Letenneur classification, a computed tomography (CT) classification, the AO classification, and modified AO classification. Reconstruction of the anterior cruciate ligament of the knee joint can lead to iatrogenic Hoffa fracture. 2021 Jun;29(6):1944-1951. doi: 10.1007/s00167-020-06277-x. Osteochondral fracture of the lateral femoral condyle is a rare injury of the knee joint, which mostly occurs in adolescence 1.In adolescence, the cartilage-bone interface is the weakest transitional area in the knee joint, and there is no obvious boundary between calcified and uncalcified cartilage 2.The biomechanical strength of immature osteochondral junction was lower than . This patient has no patella alta, well developed femoral trochlea, no obvious increase of TT-TG and no previous patellar instability. Subchondral insufficiency fracture of the knee is not thought to be caused by bone death but instead by osteoporosis and insufficiency fractures, with histopathologically proven origins in weakened trabeculae and applied microtraumatic forces 6,13. Although low bone density may be present concurrently, it is not the underlying cause of subchondral insufficiency fractures in the majority of patients. Arthroscopy 2011;27:81724. The widely known Letenneur classification not only clarifies the relationships between the fracture line and ligaments and soft tissue, but also has significance for clinical treatment and prognosis. Fracture and dislocation compendium: Orthopaedic Trauma Association Committee for Coding and, [35]. For local soft-tissue injuries, external fixation can be used, but this may delay the time to mobility restoration and affect therapeutic efficacy. Zhou et al[26] used suture anchor to treat LFC OCF under arthroscope, and achieved good clinical results. Kapoor et al[74] recommended a direct posterior approach and a lazy S-shaped incision to expose the fracture. Rofo. Intertrochanteric Fractures of the Femur | SpringerLink [10] Werner and Miller[11] reported that iatrogenic injury is a cause of Hoffa fracture that cannot be ignored. PMC [102] Therefore, open reduction and internal fixation is recommended to minimize cartilage damage and allow appropriate treatment of the bone and soft tissues. For tibial fractures, the use of bone plates or intramedullary nails is recommended if the condition of the local soft tissue is suitable. Bali K, Mootha AK, Krishnan V, et al. Anchor absorbable suture bridge fixation for this kind of OCF is not only effective, but also economical. [53]. 2003;19:71721. [102]. Antigliding plating for Letenneur type I Hoffa fractures. J Orthop Trauma 2002;16:17881. [41]. Report of 20 cases [in French]. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). [20]. (A) Through the hollow needle channel of the femoral intercondylar fossa, the folding corner of the PDS line are exposed to the knee joint cavity through the bone canal. Meyer C, Enns P, Alt V, et al. At present, open reduction is often used to treat osteochondral fractures. Intertrochanteric femoral fractures account for 3.13% of total adult fractures, 24.56% of femoral fractures, and 50% of proximal femoral fractures (Koval et al. Careers. Epub 2020 Sep 18. [11,12] The bone marrow edema at the posterolateral aspect of the LFC suggest that the knee joint is highly flexed during patellar dislocation. [15,1720] The fracture line its inclination angle of a Hoffa fracture depend on the degree of knee joint flexion at the time of trauma[18]; as the angle of knee flexion increases, the fracture line will occur farther from the posterior cortex of the femoral-condyle. [19]. The https:// ensures that you are connecting to the The use of several 3.5-mm-diameter screws is recommended to fix the fractures. Screws inserted from anterior to posterior induce less soft tissue dissection and carry no risk of damaging the posterior neurovascular structures. 1986;14:11720. Jain A, Aggarwal P, Pankaj A. Concomitant ipsilateral proximal tibia and femoral Hoffa fractures. However, Gavaskar et al[2] argued that no evidence confirms this correlation. By definition, secondary osteonecrosis of the knee occurs secondary to an insult. [21] In contrast to unicondylar Hoffa fracture, a bicondylar Hoffa fracture is caused by a posterior and upward directed force and is not associated with knee valgus. The funding sources have no role in study design, literature collection, review, data analysis, and manuscript preparation. A rare case of unicondylar medial, [24]. Your message has been successfully sent to your colleague. (LTC, Lateral Tibial Condyle.) [2,77] The heads of screws placed through the articular cartilage are countersunk to prevent damage to the cartilage. [7] The development of trochlear sulcus of femur was classified as type A according to Dejour et al,[8] and the TT-TG[9] was 15mm. Management of any globe injury generally takes precedence over fractures 1. [59]. [82]. Reconstruction of Large Osteochondral Lesions in the Knee: Focus on Fixation Techniques. The treatment options for OCF of LFC include: loose body removal, microfracture, open reduction and internal fixation, cartilage transplantation, autologous or allogeneic osteochondral transplantation, etc. Autologous Osteoperiosteal Transplantation for the Treatment of Large Cystic Talar Osteochondral Lesions. ASER Core Curriculum Illustration Project: coronal femoral condyle (Hoffa) fracture. Two cartilage masses can be seen during the operation. Iwai T, Hamada M, Miyama T, et al. [54] However, popliteal and gastrocnemius muscle traction and foot or ankle movement can lead to fracture redisplacement,[5557] which can cause delayed fracture healing, nonunion, traumatic arthritis, knee dysfunction, and other complications. Gesslein M, Merkl C, Bail HJ, et al. In this paper, three cases of osteochondral fracture of lateral femoral condyle were treated with arthroscopic TWINFIX Ti suture anchor internal fixation, and good results were obtained. Shah JN, Howard JS, Flanigan DC, et al. Nondisplaced Hoffa fractures can be treated with cylindrical plaster cast immobilization with the knee in 10 of flexion. A case report. Depression Of more than 5 mm in a type 3 fracture can treated by elevation from below and (d' supported by bone grafts and fixation. Surgical treatment of femoral medial condyle fracture with lag screws MRI reexamination at 18 months after operation showed that the osteochondral mass healed well (Figs. When the patient has patellar dislocation with OCF in the weight-bearing area of LFC, surgical treatment and internal fixation is the treatment of choice if the OCF can be fixed. eCollection 2020 Jun. Ozturk A, Ozkan Y, Ozdemir RM. Recurrence after patellar dislocation. Incarcerated patellar tendon in. Potini VC, Gehrmann RM. Seventy-three patients (age range, 19-95) were included after excluding patients with post-traumatic fractures . Int Orthop. Coronal MRI images were reexamined 18 months after operation, MRI = magnetic resonance. lateral femoral condyle fractures in 80% Angiography indications ankle-brachial index (ABI) <0.9 obvious signs of vascular injury i.e., hard and soft signs (pulselessness, rapidly expanding hematoma, massive bleeding, etc.) Pa a et al[17] reported that 10 patients with patellar osteochondral mass less than 2.7mm2 caused by patellar dislocation still achieved good function only by taking out the loose body, and no patellar dislocation was found. Agarwal S, Giannoudis PV, Smith RM. The white arrow indicate the defect area. [50]. Osteochondral Fracture Lateral Femoral Condyle Treated with - Hindawi In contrast, type II fractures have a high risk of nonhealing or delayed healing because of poor adhesion and poor blood supply. Transverse Hoffa's or deep osteochondral fracture? Get new journal Tables of Contents sent right to your email inbox, http://creativecommons.org/licenses/by-nc-nd/4.0, Hoffa fracture of the femoral condyle: Injury mechanism, classification, diagnosis, and treatment, Articles in Google Scholar by Yabin Zhou, MD, Other articles in this journal by Yabin Zhou, MD, Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures: A meta-analysis of randomized controlled trails, Hoffa fracture combined with rotational dislocation of the knee joint: A novel case report, PET/CT-negative malignant spine tumor with pathologic fracture: A case report of malignant solitary bone plasmacytoma, Prognostic factors to survival of patients with chondroblastic osteosarcoma, Ankle joint dislocation treating dislocated trimalleolar fractures accompanied with the complex posterior malleolus fracture without separation of the tibiofibular syndesmosis, Privacy Policy (Updated December 15, 2022). -. Data is temporarily unavailable. Goel A, Sabat D, Agrawal P. Arthroscopic-assisted fixation of, [13]. [1]. Improving the accuracy and timeliness of Hoffa fracture diagnosis and improving minimally invasive treatment outcomes remain the focus of orthopedic surgeons. Coronal fractures of the medial femoral condyle: a series of 6 cases and review of literature. In anterior cruciate ligament reconstruction, an anterior medial approach to the femoral tunnel allows restoration of the position of the tendon graft and increases rotation stability when an expanded bone tunnel is used for the graft. 2012;40:191623. This system allows the classification of comminuted femoral condyle fractures. femoral shaft fracture presentation The knee joint is placed in flexion during surgery,[65,66] placing the joint capsule and gastrocnemius in a relaxed state, which reduces the traction on the fracture and is conducive to fracture repair. Am J Sports Med. Internal fixation with headless compression screws and back buttress plate for. In the type II (bicondylar Hoffa fracture), both condyles are fixed with anteroposterior screws. Busam ML, Provencher MT, Bach BR. The tears of the lateral meniscus and medial meniscus were detected during arthroscopy. Research Article: Systematic Review and Meta-Analysis. Matthewson et al[10] believe OCF in weight-bearing area of LFC with patellar dislocation is caused by the shearing forces between the LFC and the lateral tibial plateau as they pivot under load. Impaction Fracture of the Medial Femoral Condyle assessment of the anterior cruciate liga- ment with the anterior drawer and Lach- man tests was negative for laxity. J Knee Surg 2013;26(Suppl 1):S8993. [61]. Nakagawa S, Arai Y, Inoue H, et al. [64]. Subchondral insufficiency fracture of the knee - Radiopaedia Unauthorized use of these marks is strictly prohibited. Somford et al[65] showed that the repair strength of absorbable screw fixation is weak, knee joint activity produces greater shear stress, and there is a risk of screw breakage; thus, careful selection of the surgical plan is recommended. Impaction Fracture of the Medial Femoral Condyle 1). Active and passive knee flexion exercise of the right knee was gradually strengthened 6 weeks after operation. Zeebregts CJ, Zimmerman KW, ten Duis HJ. Lewis SL, Pozo JL, Muirhead-Allwood WF. [5] Viskontas et al[69] reported an extensile medial subvastus approach that allows better exposure of the surgical field and protects the blood supply of the bones comparing with the medial parapatellar approach. -, Patel JM, Saleh KS, Burdick JA, Mauck RL. This rare lesion is diagnostically challenging and requires an adapted and prompt treatment. The main cause of a Hoffa fracture is a high-energy injury such as those sustained in traffic collisions (80.5% of cases) and falls (9.1% of cases). What is an Impact Fracture? - Definition from Corrosionpedia Comminuted fractures are caused by severe traumas like car accidents. 5cm cartilage mass was stripped from nonweight-bearing area of the LFC, and no osteochondral mass was found at the medial edge of patella (Fig. official website and that any information you provide is encrypted In these cases, magnetic resonance imaging (MRI) can show a lateral femoral notch sign: a depression in the lateral femoral condyle, which could indicate an ACL tear . modify the keyword list to augment your search. After 1 year follow-up, good functional and radiographic outcome were obtained. [59] For children and individuals with osteoporosis, low-energy trauma can also lead to a Hoffa fracture. Arthroscopy. 2). Patellar dislocation with OCF in weight-bearing area of LFC is a rare injury in adolescents. [47]. Atesok K, Doral MN, Whipple T, et al. Meta plate and cannulated screw fixation for, [86]. In some cases, the Letenneur II fragment is small but essential for the knee join when flexed at 90 because it ensures the articular surface integrity. The Authors. MRI of Osteochondral Defects of the Lateral Femoral Condyle: Incidence Wu P, WB, Kong LC, et al. J Bone Joint Surg Am 2005;87:5649. The patient was a 20-year-old man who sustained a noncontact left knee hyperextension injury while playing soccer. Hoffa fractures are most commonly caused by traffic accidents, especially motorcycle accidents. [89]. Medial and lateral buttressing may be required if either fracture extends proximally in the same plane. [8]. [97]. Maenpaa H, Huhtala H, Lehto MU. (B) BULLET fixed at the entrance of the lateral bone canal of the distal femur. A comparison of the clinical effect of two fixation methods on Hoffa fractures. Am J Sports Med. Emerg Radiol 2015;22:3378. Arthrosc Tech 2015;4:e299303. Gerdy's tubercle osteotomy for the, [69]. to maintaining your privacy and will not share your personal information without An impact fracture is a form of failure where a metal separates into fragments due to a stress applied at a temperature below the metal's melting point. * Correspondence: Lijiang He, Department of Orthopedic Surgery, Second Peoples Hospital of Yuhang District, Hangzhou, Hangzhou, Zhejiang 311121, China (e-mail: [emailprotected]). In these cases, the associated patellar fracture results from a combination of forces: direct trauma causing the Hoffa fracture and possible indirect injuries from sudden contraction of the quadriceps muscle causing a vertical patellar fracture.[23]. The work cannot be changed in any way or used commercially without permission from the journal. Based on plate position, screws can be combined with a lateral antigliding plate[84] or a posterior antigliding plate.[55,87]. This approach fully exposes the fracture and does not risk damaging the nerves and blood vessels,[67] making the operation simple and safe. Unable to load your collection due to an error, Unable to load your delegates due to an error. Wolters Kluwer Health For bicondylar fractures, a median parapatellar incision can be used. Frangakis EK. Matthewson MH, Dandy DJ. Fracture of the Lateral Femoral Condyle | Journal of Orthopaedic Guo H, Chen Z, Wei Y, Chen B, Sun N, Liu Y, Zeng C. Orthop Surg. The exposed fracture line is initially fixed with a k-wire and screws are placed perpendicular to the fracture surface. FIGURE 1. FIGURE 2. Intra-operative fractures during primary total knee arthroplasty are rare with higher risk associated with osteoporosis, rheumatoid arthritis, advanced age, female gender, chronic steroid use, metabolic bone disorders, PS type of femoral implant and difficult surgical exposure of the knee joint due to severe deformities. 2013;37:238594. J Orthop Surg 2017;25:17. Hawkins et al[18] found that the recurrent dislocation rate of patients with primary patellar dislocation is related to congenital femoral trochlear dysplasia, high patellar position and large TT-TG. Bauer KL. Nomura E, Inoue M, Kurimura M. Chondral and osteochondral injuries associated with acute patellar dislocation. government site. This kind of disease is commonly seen in the knee joint sprain during strenuous activity. J Knee Surg. One hundred five relevant articles were reviewed, and the clinical knowledge base was summarized. Epub 2007 Mar 23. [7]. 1994;2:1926. Postoperative reexamination of computed tomography scan showed that the bone block was well reduced. [7] Nondisplaced Hoffa fractures are difficult to visualize on anterior and lateral radiographs of the knee. Acta Chir Orthop Traumatol Cech. Screw pullout strength: a biomechanical comparison of large-fragment and small-fragment fixation in the tibial plateau. [96,97] Thus, closed reduction is recommended when Hoffa fracture is accompanied by patella dislocation. Papadopoulos AX, Panagopoulos A, Karageorgos A, et al. Knee Surg Sports Traumatol Arthrosc. [18]. Fractures of the distal femur typically occur in the axial and sagittal planes. The term comminuted fracture refers to a bone that is broken in at least two places. Medicine (Baltimore). Dhillon MS, Mootha AK, Bali K, et al. Distal Femur Fractures - Trauma - Orthobullets Methods All patients with post-injury bi-plane radiographs and MRI images after sustaining a tear to the anterior cruciate ligament were included. Zhou, Yabin MDa,b; Pan, Ying MDc; Wang, Qingxian MDa; Hou, Zhiyong MDa; Chen, Wei MDa,, aDepartment of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Orthopedic Research Institution of Hebei Province, Key Laboratory of Biomechanics of Hebei Province, bDepartment of Orthopedic Surgery, Shijiazhuang The Third Hospital. The patient had no previous history of patella dislocation and pain around the knee. After operation, the fracture of femoral condyle healed well and the function of knee joint recovered gradually. Medicine 2022;101:50(e32104). Injury 2015;46:41921. Liebergall M, Wilber JH, Mosheiff R, et al. During the operation, we found that 2.5*2. J Clin Orthop Trauma 2015;6:4650. 2021. Pathology The likely mechanism is a hyperextension or impaction injury with a collision of the femoral condyle and the posterior tibial plateau during the rotational movement responsible for injuring the ACL, most commonly the pivot-shift. Intra-articular corrective osteotomy for malunited. Lee SY, Niikura T, Iwakura T, et al. Difficulties involved in the Hoffa fractures [in German]. [55] Onay et al[79] performed a long-term follow-up study of Hoffa fracture patients treated with screws and observed that the screws provided sufficient biomechanical stability until the fractures were healed. [2]. Blood investigations reported low vitamin D and testosterone levels with elevated alkaline phosphatase. [29]. [19]. Knee flexion was limited less than 60 within 8 weeks after operation, partial weight-bearing was allowed at 8 weeks, followed by full weight bearing from 12 weeks after operation. eCollection 2021 Jan. Uimonen MM, Repo JP, Huttunen TT, Nurmi H, Mattila VM, Paloneva J. Knee Surg Sports Traumatol Arthrosc. [20]. Nonunion of a. On lateral radiographs, the normal femoral condyles overlap, and bone cortex interruption may not be visible. -, Biau DJ, Schranz PJ. Treatment options include loose body removal, microfracture, multiple internal fixation and so on. Femoral Condyle Fractures are a painful condition which can result from trauma injuries to the thigh bone and/or knee. [82,83] A biomechanical study by Li et al[84] demonstrated that plates combined with screws more firmly fixed the femoral condyle, reducing the probability of fracture displacement. 0cm osteochondral mass was stripped from the weight-bearing area of the LFC, 2.0*0. We report a case of patellar dislocation with OCF in the weight-bearing area of LFC. [100]. osteochondral impaction fracture postsurgical (e.g. Introduction. Li et al[25] used absorbable suture to treat OCF caused by patellar dislocation and achieved good medium-term results. Marzouki A, Zizah S, Benabid M, et al. Lian and Zeng[85] and Zhao et al[86] treated Hoffa fracture patients with plates combined with screws and achieve good results. Medline, Embase, the Cochrane Library, Google Scholar, the China National Knowledge Infrastructure, and the China Biology Medicine disc were searched for relevant articles. 4). For simple fractures of the medial condyle, a medial parapatellar surgical approach is most commonly used. Please try again soon. Acta Orthop Belg 2001;67:1328. Am J Sports Med 2008;36:37994. Disclaimer. Please enable scripts and reload this page. The patellar height was in the normal range (Caton-Deschamp index 1.0). Buttress plating for a rare case of comminuted medial condylar. (A) MRI examination of the right knee joint: the bone continuity at the edge of the lateral condyle of the right femur was poor, the patchy high signal intensity was seen in the bone marrow cavity of the lateral condyle of the femur, and the local cartilage became thinner in the corresponding area. [79]. Springerplus 2016;5:1164. Treatment of osteochondral fracture of lateral femoral : Medicine normal vital signs. Intertrochanteric femoral fractures occur mostly in the elderly, and the average age of onset is 66-76 years. J Bone Joint Surg Br 1989;71:11820. During complete anterior cruciate ligament (ACL) tears in pivoting mechanisms, the area of the lateral femoral condyle (LFC) localized just above the anterior third of the lateral meniscus (LM) impacts the posterior border of the lateral tibial plateau (LTP), which may result in a subchondral compression fracture. Fractures of the thighbone that occur just above the knee joint are called distal femur fractures. avulsion fracture of the anterior cruciate ligament attachment to the On The 1st postoperative day, the injured limb should be mobilized on a continuous passive motion device. This study aimed to systematically review the clinical knowledge base of Hoffa fractures to facilitate the diagnosis and management of such injuries. [92]. Knee Surg Sports Traumatol Arthrosc. Pitfalls associated with fixation of osteochondritis dissecans fragments using bioabsorbable screws. [5-9] For children and individuals with osteoporosis, low-energy trauma can also lead to a Hoffa fracture. [10,38] Local manifestations of a Hoffa fracture include knee swelling, pain, skin color changes (with or without skin defects), limited knee mobility, and a positive floating patella test. A review of 23 patients. The swashbuckler: a modified anterior approach for fractures of the distal femur. The patient was evaluated by the physical therapist 2 days after his injury. [56]. [72]. In reviewing left knee radiographs that had previously been interpreted as normal, the physical therapist noted an abnormally deep depression of the medial condylopatellar sulcus, which was concerning for a possible impacted osteochondral fracture. Surgical diagrams (A: osteochondral fracture of the lateral femoral condyle; B: fixation of fracture block with Kirschner wire; C: fixation of fracture block with anchor; D: preparation of bone tunnel; E: penetration of PDS line and PDS guidance of anchor suture to the outer entrance of femoral tunnel; F: Operation completion diagram). Knee flexion angle is more important than guidewire type in preventing posterior femoral cortex blowout: a cadaveric study.