Patellar Microfracture: Internal Stabilization House-on-Stilts Technique to Achieve Better Results

Microfractures are the common first choice for the treatment of osteochondral lesions, because of their high efficacy and low cost and operating time compared with other surgical techniques. Results of microfractures for retropatellar chondral defects are subpar compared with other compartments of the knee, despite the patellofemoral compartment being the second most common compartment for such lesions. One major reason for the inferiority is the mobility of the patella, which is most prominent when the patient’s knee is extended, as is the case in this type of surgery. Traditionally, this obstacle was dealt with by applying manual pressure, which is unreliable and prone to technical difficulties, such as skiving of the awl and a narrowed operating view, as well as complications such as fractures. This Technical Note introduces a new technique, which we have named “house-on-stilts,” that uses multiple Kirschner wire fixations through the patella and femur to immobilize the patella and is essentially an internal stabilization. This technique aids not only the microfracturing process but also the preceding debridement stage, at no increased cost or operating time.