The effectiveness of internal fixation in the management of acute chondral fractures. A systematic review.

Introduction: Chondral defects can be a particularly challenging clinical presentation. Because damaged cartilage does not heal itself, an evolution of multiple new surgical treatments designed specifically for cartilage repair and restoration have been introduced. Internal fixation has demonstrated good benefits in case reports and small qualitative studies. Our systematic review aimed to evaluate the effectiveness of internal fixation in the management of acute chondral fractures.

Methods: A comprehensive search strategy was carried out using the NICE Healthcare Databases Advanced Search. The systematic review was prospectively registered with PROSPERO (CRD42022302976) and was performed in accordance with the PRISMA guidelines.

Results: Eleven studies consisting of fifty patients were included in this systematic review. Seventy-eight percent of patients showed good results and twenty-two percent of the cases had excellent results. Ninety-two percent of patients returned to preoperative level of sport activities at the end of the follow-up period. All of them returned to the original activity level without pain, stiffness, or restriction of movement after 1 year latest. The majority of patients had no complications at all, good recovery time and satisfactory outcomes for pain and activity level. The only complications presented were patella instability and quadriceps weakness.

Conclusion: Internal fixation for acute chondral fractures is an effective method to treat acute chondral fractures in both adolescents and young adults that want to get back to an active lifestyle. However, more data examining the long-term functional status, quality of life (QoL), recovery post-injury and pain free sports activity involvement are needed.