Arthroscopically assisted medial reefing without routine lateral release for patellar instability

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Knee Biomechanics

Background:

• Patellofemoral instability with normal alignment is often treated with medial reefing and lateral release.
• Recent evidence suggests lateral release may be unnecessary in cases without excessive patellar tilt.

Purpose of the Study:

• To evaluate the efficacy of arthroscopically assisted medial reefing without lateral release for treating patellofemoral instability in patients with normal alignment.

Main Methods:

• A case series (Level of evidence, 4) of 24 patients (25 knees) followed for an average of 60 months.
• Preoperative and postoperative assessments included physical examinations, radiographic evaluations, Lysholm and Tegner scores, and subjective questionnaires.
• Statistical analysis compared preoperative and postoperative scores (P < .05).

Main Results:

• 96% of patients were satisfied and would repeat the procedure.
• Significant improvements were observed in Lysholm scores (54 to 91) and Tegner activity levels (3.3 to 6.2).
• Radiographic measures showed improved congruence angles, lateral patellofemoral angles, and lateral patellar displacement; no recurrent dislocations occurred.

Conclusions:

• Arthroscopically assisted medial reefing, when performed without a lateral release, is a safe and effective treatment for recurrent patellofemoral instability in patients with normal alignment.
• This technique offers significant functional and subjective improvements for patients.