Original Articles
Arthroscopic patella realignment: An all-inside technique*

https://doi.org/10.1053/jars.2001.28980Get rights and content

Abstract

Purpose: Many methods of realigning the patella have been described. Most techniques for proximal realignment involve an open medial reefing or advancement of the vastus medialis obliquus. Arthroscopically assisted methods have been described, but these all involve the need for a medial incision to tie sutures. This article describes an entirely arthroscopic technique for proximal realignment that eliminates the need for an incision, and reports the 2-year follow-up results using this technique. Type of Study: Retrospective review. Methods: Over a 5-year period, 26 patients (29 knees) with patellar instability were treated with an outpatient arthroscopic all-inside medial reefing and lateral release. Arthroscopic reefing was performed by percutaneous passage of suture followed by arthroscopic retrieval and knot tying inside the joint. Before knot tying, a healing response was initiated along the medial retinaculum by either gentle shaving with a whisker blade or by radiofrequency thermal response. Rehabilitation consisted of 1 week of immobilization followed by an accelerated program of range of motion exercises and vastus medialis obliquus strengthening. Results: At follow-up, 93% of patients reported significant subjective improvement. The average Lysholm score improved from 41.5 to 79.3 (P <.05). Preoperative and postoperative radiographs were measured for congruence angle, lateral patellofemoral angle, and lateral patella displacement, and all showed significant improvement postoperatively (P <.05). There were no complications and no redislocations. Patients reported a significant improvement in pain, swelling, stair climbing, crepitus, and ability to return to sports (P <.05). Conclusions: Arthroscopic patella realignment is a viable technique that offers results comparable or superior to published results for open or arthroscopically assisted realignment.

Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 9 (November-December), 2001: pp 940–945

Section snippets

Methods

Only patients with patellar instability were included in this study: 41 patients (45 knees) with a history of patellar instability underwent surgery for arthroscopic realignment between 1994 and 1999; 26 patients (29 knees) were available for follow up. Of the 29 knees, 23 were actual dislocators and 6 were subluxators. This procedure was not performed for simple malalignment and those patients were not included in this study. The criteria for surgery were either recurrent

Lysholm score:

The Lysholm score improved from 41.5 preoperatively to 79.3 postoperatively (P <.05)

Discussion

Long-term results suggest that the natural history of nonoperative treatment of patellar instability is poor. In a group of 20 patients with acute dislocations treated conservatively, Hawkins et al.8 reported a 20% incidence of ongoing instability, and a 15% incidence of pain and crepitus. In their series of 48 patients with acute dislocations, Cofield and Bryan9 reported a 44% incidence of redislocation; 27% of these patients went on to subsequent surgery and, taking into account subjective

Conclusion

Realignment of the patella can be performed as an arthroscopic all-inside technique with overall excellent results. This method eliminates the need for an incision and produces results comparable if not superior to those previously reported for open and arthroscopically assisted techniques.

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Address correspondence and reprint requests to Jeffrey L. Halbrecht, M.D., 2100 Webster St, Suite 331, San Francisco, CA 94115, U.S.A. E-mail: [email protected]

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Copyright © 2001 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.