Case Report: Isolated osteochondral fracture of the weight-bearing lateral femoral condyle

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Surgical fixation is often recommended, particularly in young, to restore joint congruency and function. Case report We report the case of a 14-year-old boy who presented with isolated weight-bearing OCF of the lateral femoral condyle following a sports injury. Magnetic resonance imaging (MRI) revealed a 30.4 mm osteochondral fragment confirmed by arthroscopy but unsuitable for percutaneous management due to its size and location. Open reduction and internal fixation were performed using headless compression screws, a technique reserved for those cases where based on sufficient detached fragment bone to facilitate secure fixation and bone-to-bone healing. Conclusion This case underscores the importance of prompt diagnosis and individualized treatment to prevent long-term joint damage, contributing valuable insights into the management of pediatric femoral osteochondral fractures. " } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/14-156", "name": "Case Report: Isolated osteochondral fracture of the weight-bearing..." } } ] } Home Browse Case Report: Isolated osteochondral fracture of the weight-bearing... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Almohimeed A, Ferjani MA, Abdullah O et al. Case Report: Isolated osteochondral fracture of the weight-bearing lateral femoral condyle [version 1; peer review: 1 approved with reservations] . F1000Research 2025, 14 :156 ( https://doi.org/10.12688/f1000research.160982.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Case Report Case Report: Isolated osteochondral fracture of the weight-bearing lateral femoral condyle [version 1; peer review: 1 approved with reservations] Abdullah Almohimeed 1 , Mohamed Achraf Ferjani https://orcid.org/0009-0004-0541-7814 2 , Osama Abdullah 1 , Mohamed Ali Bekkay 1 , Khaled Kamoun https://orcid.org/0000-0003-0180-5719 1,2 Abdullah Almohimeed 1 , Mohamed Achraf Ferjani https://orcid.org/0009-0004-0541-7814 2 , [...] Osama Abdullah 1 , Mohamed Ali Bekkay 1 , Khaled Kamoun https://orcid.org/0000-0003-0180-5719 1,2 PUBLISHED 04 Feb 2025 Author details Author details 1 HafrAl-Baten Health Cluster, Hafar Al Batin, Saudi Arabia 2 University of Tunis El Manar Faculty of Medicine of Tunis, Tunis, Tunis, Tunisia Abdullah Almohimeed Roles: Conceptualization, Data Curation, Methodology, Project Administration, Supervision, Validation, Visualization Mohamed Achraf Ferjani Roles: Conceptualization, Data Curation, Investigation, Methodology, Project Administration, Resources, Writing – Original Draft Preparation, Writing – Review & Editing Osama Abdullah Roles: Conceptualization, Investigation, Methodology, Resources Mohamed Ali Bekkay Roles: Data Curation, Investigation, Methodology Khaled Kamoun Roles: Conceptualization, Project Administration, Supervision, Validation, Visualization, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS Abstract Introduction Osteochondral fractures (OCF)s of the femoral condyle are rare in pediatric patients but can have significant implications if missed or left untreated. Surgical fixation is often recommended, particularly in young, to restore joint congruency and function. Case report We report the case of a 14-year-old boy who presented with isolated weight-bearing OCF of the lateral femoral condyle following a sports injury. Magnetic resonance imaging (MRI) revealed a 30.4 mm osteochondral fragment confirmed by arthroscopy but unsuitable for percutaneous management due to its size and location. Open reduction and internal fixation were performed using headless compression screws, a technique reserved for those cases where based on sufficient detached fragment bone to facilitate secure fixation and bone-to-bone healing. Conclusion This case underscores the importance of prompt diagnosis and individualized treatment to prevent long-term joint damage, contributing valuable insights into the management of pediatric femoral osteochondral fractures. READ ALL READ LESS Keywords Osteochondral fracture, Femoral condyle, Pediatric fracture, Arthrotomy, Case report Corresponding Author(s) Mohamed Achraf Ferjani ( [email protected] ) Close Corresponding author: Mohamed Achraf Ferjani Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2025 Almohimeed A et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Almohimeed A, Ferjani MA, Abdullah O et al. Case Report: Isolated osteochondral fracture of the weight-bearing lateral femoral condyle [version 1; peer review: 1 approved with reservations] . F1000Research 2025, 14 :156 ( https://doi.org/10.12688/f1000research.160982.1 ) First published: 04 Feb 2025, 14 :156 ( https://doi.org/10.12688/f1000research.160982.1 ) Latest published: 04 Feb 2025, 14 :156 ( https://doi.org/10.12688/f1000research.160982.1 ) Introduction While osteochondral fractures OCFs have long been recognized, their precise incidence in the pediatric population is not well-established. OCFs around the knee. Typically results from either acute trauma or repetitive microtrauma, such as torsional injuries or patellar dislocations. Radiographic diagnosis can be difficult due to the potentially thin bony component of the osteochondral fragment. 1 Despite numerous publications describing various surgical techniques for OCFs, a consensus on the optimal approach remains elusive. Historically, surgical management often involved fragment removal unless sufficient subchondral bone was present for anchoring. 2 Here, we report good radiological and excellent functional outcomes at 18 months postoperatively following fragment fixation of a lateral femoral condyle OCF in a pediatric patient. Case report Patient and observation Patient information: A 14-year-old boy with no significant medical history presented to the emergency department with left knee pain and swelling following a sport injury. Clinical findings: Initial examination of the left knee revealed swelling, pain, and a positive patellar tap, with no skin lesions observed. Three days post-injury, the patient continued to experience the same symptoms, with increased severity of knee pain. Timeline of current episode: In May 2023, following a sports-related injury with an unknown mechanism, a child presented with a closed left knee trauma characterized by functional impairment, pain, and swelling, but no skin lesions. Initial radiographs were unremarkable, and the patient was treated symptomatically. Three days later, the child returned with persistent symptoms and increased pain. MRI revealed an osteochondral fracture. Surgical intervention occurred seven days post-injury, initially planned arthroscopically. However, due to the lesion’s inaccessibility, an open approach with ORIF using two headless compression screws was performed via a lateral parapatellar incision. Post-operatively, the patient followed a three-month rehabilitation program, including 45 days of non-weight-bearing. At 18 months follow-up, the patient demonstrated excellent results with full range of motion and good quadriceps strength. Diagnostic assessment: Initial physical examination revealed a painful knee with functional impairment but no deformity or skin lesions. Initial radiographs did not demonstrate any osseous abnormalities ( Figure 1 ). Figure 1. (A) and (B) Radiograph of the left knee showing no detectable abnormalities. Due to persistent symptoms, MRI was performed, which revealed a 30.4mm osteochondral fracture ( Figure 2 ). Figure 2. (A) Frontal and (B) sagittal MRI images of the osteochondral fracture of the lateral condyle. A key diagnostic challenge in such cases is considering the possibility of an osteochondral lesion, especially when initial radiographs are negative, as these fractures can be subtle or even invisible on plain films if the bony component is small. 1 Diagnosis: The final diagnosis was an osteochondral fracture of the lateral femoral condyle. Other diagnoses considered, prior to MRI confirmation, included meniscal tear and ligament sprain. Therapeutic interventions: The patient underwent arthroscopy to visualize the osteochondral fragment and assess for associated ligamentous or meniscal injuries. Arthroscopy confirmed the osteochondral defect and the absence of associated injuries ( Figure 3 ). Figure 3. (A) and (B) loose osteochondral fragment overlying the lateral tibial plateau , (C) without associated lesions. However, due to the size and location of the fragment, arthroscopic fixation was deemed infeasible. The procedure was converted to an open approach via a lateral parapatellar incision. Open reduction and internal fixation (ORIF) was then performed using two headless compression screws ( Figure 4 ). Figure 4. (A) The debrided defect, (B) temporary fixation of the fragment, (C) fixation with headless screw. Postoperatively, the patient began immediate mobilization with a non-weight-bearing protocol for 45 days, followed by continued physiotherapy for a total of three months. Follow-up and outcome of interventions: At 18 months post-operatively, the patient demonstrated excellent clinical results with a pain-free, stable, and non-effused knee. Full range of motion was achieved. Radiographs also confirmed excellent results with no evidence of arthritic changes ( Figure 5 ). Figure 5. (A) and (B) The fracture is healing with no evidence of arthritic changes. The patient returned to sports. Patient perspective: “After my knee injury, I was worried I wouldn’t be able to play sports again. The initial pain and swelling were really bad. I was glad when the surgery was over, but the recovery was tough. But it was worth it. My knee feels great now, and I’m back playing with my friends. I’m so grateful to the doctors and physiotherapists who helped me get better.” Discussion Traumatic OCFs of the distal femur are relatively uncommon compared to other femoral injuries. The concept of traumatic OCF was first detailed by Milgram in 1943. 3 It is important to differentiate a recent fracture from osteochondritis dissecans (OCD) based on the presence of a trauma-related incident. Recent fractures typically result in fragments that are well-suited for fixation techniques. 4 OCFs commonly occur on the articular surfaces of bones frequently involved in trauma, such as the glenoid, femur, patella, and talus. The mechanism of injury can vary based on lesion location. Common causes include shearing, rotational or impaction forces, and excessive tangential loading of the articular surface. 5 The precise incidence of OCFs around the knee remains uncertain. Current evidence suggests a higher frequency in pediatric patients compared to adults. 6 – 8 Generalized joint laxity and patellar dislocation are often associated with OCFs. 8 , 9 In patellar dislocations, the contracted quadriceps can exert high pressure on the lateral femoral condyle during patellar reduction, frequently resulting in OCFs. 5 Studies have shown that the osteochondral unit in adolescents has lower resistance to shear forces, 10 while adults exhibit greater fracture resistance at the osteochondral junction. 11 Diagnosing OCFs in pediatric patients around the knee can be particularly challenging. Small bony fragments may be overlooked, and the actual size of the cartilage component might be underestimated or misinterpreted as an accessory bone. MRI is the preferred imaging modality for evaluating osteochondral injuries, 12 , 13 while radiographs or computed tomography (CT) scans are more useful for evaluating the bony component of the fragment. The management of chondral injuries with tissue loss remains a significant challenge. Recent studies suggest that innovative techniques offer promising results for cartilage repair and improved clinical outcomes. However, a universally accepted treatment approach has yet to be established. 14 , 15 Key factors influencing the management of pediatric knee osteochondral lesions include lesion location, size, stability, and symptom severity. 16 While fragment fixation is generally considered the gold standard treatment for OCFs, the impact of patient age, fragment size, and the interval between injury and diagnosis on surgical success remains unclear. 17 Current literature supports operative intervention for osteochondral injuries, particularly those involving weight-bearing surfaces, lesions larger than 2 cm 2 , and those causing mechanical symptoms. 18 Surgical fixation of acute OCFs in pediatric patients has demonstrated favorable clinical and radiological outcomes, 8 , 16 , 19 likely due to the superior regenerative capacity of pediatric cartilage, facilitated by bony union and chondral extensions from the fragment. 7 , 11 Historically, fragment excision was often performed in late-diagnosed cases, treating the fragment as a loose body. 6 , 20 However, this approach can lead to early degenerative changes in the knee due to the resulting defect. 21 , 22 Similarly, untreated intra-articular fragments can cause further cartilage damage and arthritis. Therefore, even in neglected or late-diagnosed cases, fixation remains the preferred treatment strategy. Bioabsorbable pins offer the advantage of postoperative MRI compatibility. While multiple pins can enhance rotational stability, they may limit compression of the lesion. Screws, conversely, provide immediate compression and, when used in multiples, rotational stability. 23 Postoperatively, patients can begin rehabilitation and undergo follow-up imaging with CT or MRI. The literature provides limited guidance on the minimum bony component size required for OCF fixation. Fabricant et al. 24 reported a 90% success rate in young athletes with chondral-only shear fractures treated with bioabsorbable implants or sutures. Other studies suggest fibrin sealant or tissue glue can be effective for larger fragments lacking sufficient bone for implant fixation. 25 , 26 Schlechter et al. 16 demonstrated good outcomes with bioabsorbable fixation in OCFs with a mean lesion size of 299 mm 2 . Hsu et al. 27 recommended headless cannulated screws for fragments larger than 3 cm 2 in a pediatric case. These findings suggest that while overall osteochondral fragment size helps determine whether surgical or conservative treatment is warranted, the size of the bony component dictates the specific fixation method (headless screws, adhesives, rods, or sutures). Untreated osteochondral defects in children can enlarge with skeletal growth. Furthermore, fibrotic tissue formation on the bony component can reduce fragment size after debridement, potentially leading to incongruity between the fragment and the defect, hindering anatomical reduction. In this case, complete anatomical reduction was achieved, resulting in excellent outcomes at 18 months postoperatively. While the literature suggests eventual removal of metallic implants, 28 we are conducting annual follow-up to monitor for potential articular cartilage damage and to guide the decision regarding implant removal. This case contributes to the limited literature on isolated, weight-bearing lateral femoral condyle OCFs in pediatric patients, demonstrating the potential for successful outcomes with careful surgical management and emphasizing the need for individualized treatment approaches. Conclusion This case highlights the diagnostic challenges associated with isolated OCFs of the weight-bearing portion of the lateral femoral condyle. The subtle radiographic findings in such fractures underscore the importance of advanced imaging, such as MRI, when clinical suspicion remains high despite normal initial radiographs. Furthermore, this case demonstrates the efficacy ORIF when arthroscopic management is not feasible due to fragment size or location. Prompt and appropriate surgical intervention can effectively restore joint congruity and facilitate optimal healing in these challenging pediatric knee injuries. Ethics Ethical approval was not required for the Case report. Consent to publish Written informed consent for publication of their clinical details and/or clinical images was obtained from the patient’s parents. Data availability Underlying data No data are associated with this article. References 1. Jehan S, Loeffler MD, Pervez H: Osteochondral fracture of the lateral femoral condyle involving the entire weight bearing articular surface fixed with biodegradable screws. J. Pak. Med. Assoc. 2010; 60 : 400–401. PubMed Abstract 2. Giffin JR, Annunziata CC, Vogrin TM, et al. : Primary repair of osteochondral and chondral injury. Oper. Tech. Orthop. 2001; 11 (2): 83–89. Publisher Full Text 3. Milgram JE: Tangential osteochondral fracture of the patella. J. Bone Joint Surg. 1943; 25 : 271–280. 4. Gracitelli GC, Tirico LE, McCauley JC, et al. : Fresh osteochondral allograft transplantation for fractures of the knee. Cartilage. 2017; 8 (2): 155–161. PubMed Abstract | Publisher Full Text | Free Full Text 5. 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PubMed Abstract | Publisher Full Text | Free Full Text Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 04 Feb 2025 ADD YOUR COMMENT Comment Author details Author details 1 HafrAl-Baten Health Cluster, Hafar Al Batin, Saudi Arabia 2 University of Tunis El Manar Faculty of Medicine of Tunis, Tunis, Tunis, Tunisia Abdullah Almohimeed Roles: Conceptualization, Data Curation, Methodology, Project Administration, Supervision, Validation, Visualization Mohamed Achraf Ferjani Roles: Conceptualization, Data Curation, Investigation, Methodology, Project Administration, Resources, Writing – Original Draft Preparation, Writing – Review & Editing Osama Abdullah Roles: Conceptualization, Investigation, Methodology, Resources Mohamed Ali Bekkay Roles: Data Curation, Investigation, Methodology Khaled Kamoun Roles: Conceptualization, Project Administration, Supervision, Validation, Visualization, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (1) version 1 Published: 04 Feb 2025, 14:156 https://doi.org/10.12688/f1000research.160982.1 Copyright © 2025 Almohimeed A et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Almohimeed A, Ferjani MA, Abdullah O et al. Case Report: Isolated osteochondral fracture of the weight-bearing lateral femoral condyle [version 1; peer review: 1 approved with reservations] . F1000Research 2025, 14 :156 ( https://doi.org/10.12688/f1000research.160982.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 04 Feb 2025 Views 0 Cite How to cite this report: Soubih HO. Reviewer Report For: Case Report: Isolated osteochondral fracture of the weight-bearing lateral femoral condyle [version 1; peer review: 1 approved with reservations] . F1000Research 2025, 14 :156 ( https://doi.org/10.5256/f1000research.176952.r396094 ) The direct URL for this report is: https://f1000research.com/articles/14-156/v1#referee-response-396094 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 21 Aug 2025 Hesham Ossama Soubih , Ain Shams University, Cairo, Cairo Governorate, Egypt Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.176952.r396094 1- The author presented the case plain X-ray in figure 1 with the comment " Radiograph of the left knee showing no detectable abnormalities.". The plain X-ray shows a shell of bone separated from the lateral condyle in the lateral view. ... Continue reading READ ALL 1- The author presented the case plain X-ray in figure 1 with the comment " Radiograph of the left knee showing no detectable abnormalities.". The plain X-ray shows a shell of bone separated from the lateral condyle in the lateral view. So, it is not correct to comment " no detectable abnormalities". The figure comment and other relevant data in the text should be revised. 2- In the discussion section, the author should mention the number or range of the osteochondral fractures incidence in the literature. This is important to justify presenting the case as a case report rather than a case series or any other study design 3- Regarding the management, the author used two headless metal screws. These screws can be at the level of the articular cartilage or better to be at the level of the subchondral bone. The screws are prominent in the X-ray. I understand why the author chose to leave the screws at the level of the articular cartilage because there is no sufficient subchondral bone to hold a secure fixation. At this case it is recommended to remove the screws to prevent cartilage damage. The author can not guarantee the survival of the cartilage around the screw head. It can be damaged by the initial trauma, the drill pit or future degenerative changes. A prominent screw can lead to unacceptable damage of the cartilage that may appear late in the X-ray after the compartment has ended in arthrosis, So as the author mentioned in the discussion, the screw should be removed. 4- In the discussion section: "Bioabsorbable pins offer the advantage of postoperative MRI compatibility. While multiple pins can enhance rotational stability, they may limit compression of the lesion. Screws, conversely, provide immediate compression and, when used in multiples, rotational stability." In the comparison, the authors should mention other disadvantages. For example, metal screws usually require another surgery for removal. Bioasbsorbable screws may lead to cystic changes. Is the background of the case’s history and progression described in sufficient detail? Yes Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Yes Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Yes Is the case presented with sufficient detail to be useful for other practitioners? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Sports Medicine, Cartilage Reconstruction procedures. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Soubih HO. Reviewer Report For: Case Report: Isolated osteochondral fracture of the weight-bearing lateral femoral condyle [version 1; peer review: 1 approved with reservations] . F1000Research 2025, 14 :156 ( https://doi.org/10.5256/f1000research.176952.r396094 ) The direct URL for this report is: https://f1000research.com/articles/14-156/v1#referee-response-396094 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 04 Feb 2025 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 Version 1 04 Feb 25 read Hesham Ossama Soubih , Ain Shams University, Cairo, Egypt Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Soubih H. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 21 Aug 2025 | for Version 1 Hesham Ossama Soubih , Ain Shams University, Cairo, Cairo Governorate, Egypt 0 Views copyright © 2025 Soubih H. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions 1- The author presented the case plain X-ray in figure 1 with the comment " Radiograph of the left knee showing no detectable abnormalities.". The plain X-ray shows a shell of bone separated from the lateral condyle in the lateral view. So, it is not correct to comment " no detectable abnormalities". The figure comment and other relevant data in the text should be revised. 2- In the discussion section, the author should mention the number or range of the osteochondral fractures incidence in the literature. This is important to justify presenting the case as a case report rather than a case series or any other study design 3- Regarding the management, the author used two headless metal screws. These screws can be at the level of the articular cartilage or better to be at the level of the subchondral bone. The screws are prominent in the X-ray. I understand why the author chose to leave the screws at the level of the articular cartilage because there is no sufficient subchondral bone to hold a secure fixation. At this case it is recommended to remove the screws to prevent cartilage damage. The author can not guarantee the survival of the cartilage around the screw head. It can be damaged by the initial trauma, the drill pit or future degenerative changes. A prominent screw can lead to unacceptable damage of the cartilage that may appear late in the X-ray after the compartment has ended in arthrosis, So as the author mentioned in the discussion, the screw should be removed. 4- In the discussion section: "Bioabsorbable pins offer the advantage of postoperative MRI compatibility. While multiple pins can enhance rotational stability, they may limit compression of the lesion. Screws, conversely, provide immediate compression and, when used in multiples, rotational stability." In the comparison, the authors should mention other disadvantages. For example, metal screws usually require another surgery for removal. Bioasbsorbable screws may lead to cystic changes. Is the background of the case’s history and progression described in sufficient detail? Yes Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Yes Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Yes Is the case presented with sufficient detail to be useful for other practitioners? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Sports Medicine, Cartilage Reconstruction procedures. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Soubih HO. Peer Review Report For: Case Report: Isolated osteochondral fracture of the weight-bearing lateral femoral condyle [version 1; peer review: 1 approved with reservations] . F1000Research 2025, 14 :156 ( https://doi.org/10.5256/f1000research.176952.r396094) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-156/v1#referee-response-396094 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. 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