Arthroscopic patella realignment: An all-inside technique

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.

Retrospective review.

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.

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).

Arthroscopic patella realignment is a viable technique that offers results comparable or superior to published results for open or arthroscopically assisted realignment.