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Fragment excision

If it is appreciated at the time of arthrotomy or arthroscopy that the fragment(s) is too small to reattach it should be removed.

The approach is usually lateral by mini-arthrotomy, but arthroscopy is an alternative.

Multiple fragments might be present and preoperative MRI can help to determine their location. All substantial cartilagenous fragments should be excised.

If the fragment bed is not fresh (osteochondritis dissecans) it may be debrided and then treated with drilling or micro-fractures.