Letter to the Editor regarding “Clinical efficacy of absorbable cartilage screw fixation for osteochondral fracture caused by patellar dislocation”

Dear Editor,

We read with great interest the article by Wang et al. exploring the use of absorbable cartilage screws for osteochondral fracture (OCF) fixation performed concurrently with medial patellofemoral ligament reconstruction (MPFLR). ¹ The study’s effort to analyze outcomes across a 4-year institutional cohort and employ multiple validated functional measures—such as the Kujala, Lysholm, International Knee Documentation Committee (IKDC), and Tegner scores—provides valuable data on this increasingly common combined surgical strategy. The consistent improvement in postoperative range of motion (ROM) and visual analogue scale (VAS) pain scores further supports the feasibility of absorbable fixation in this context. However, several methodological and interpretive concerns merit discussion.

First, the study’s retrospective design lacks a comparator arm using metal fixation or suture techniques, making it impossible to discern whether the observed gains derive from the absorbable material itself or from concurrent MPFLR rehabilitation protocols. Given that bioabsorbable screws differ in degradation kinetics and mechanical stability depending on polymer composition, absence of a control group limits attribution of clinical efficacy to the fixation device. ² Future prospective randomized studies comparing absorbable screws with metal or hybrid systems would clarify relative advantages, especially concerning cartilage preservation and secondary surgery rates.

Second, the reliance on magnetic resonance imaging (MRI) to confirm healing without quantitative criteria for osteochondral integration introduces subjectivity. The description of “good healing” lacks objective radiologic thresholds or interobserver validation, which may lead to interpretive bias. ³ A standardized scoring system, such as the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score, would allow reproducibility and facilitate comparison across studies.

Third, although functional improvement was statistically significant, the clinical context remains uncertain without reporting the minimal clinically important difference (MCID) for each scoring system. A statistically significant rise in Kujala or IKDC scores may not necessarily translate to a perceptible functional gain for young athletes resuming sport. ⁴ Incorporating MCID-based interpretation would enhance clinical relevance and align with contemporary orthopedic outcome reporting standards.

Finally, the cohort’s mean age of 18 years suggests a predominance of skeletally immature or near-mature patients, yet the study does not discuss the implications of physeal status, bone density, or activity level on fixation stability and resorption behavior. Given that patellar dislocation patterns and rehabilitation responses differ between adolescents and adults, ⁵ age-stratified analysis could refine patient selection criteria for absorbable fixation.

In conclusion, the work contributes meaningful preliminary evidence that absorbable cartilage screw fixation can achieve favorable outcomes when combined with MPFLR. Nevertheless, controlled comparative trials with standardized imaging and clinically anchored outcome interpretation are warranted to define its precise therapeutic role.