Arthroscopic proximal realignment for recurrent patellar instability

Abstract

Introduction Patellar instability is a common cause of knee pain and disability. It can be managed with conservative treatment. Patients in whom conservative treatment fails, usually some form of surgical realignment procedure is performed. Treatment of recurrent patellar instability is a source of much controversy. The operative procedures commonly used include lateral retinaculum release, proximal realignment, distal realignment, or combined procedures. The aim of this study was to evaluate the results of all-inside arthroscopic proximal realignment for recurrent patellar instability. Patients and methods Twenty-six patients (16 female and 10 male patients) undergoing proximal realignment procedure were treated with all-arthroscopic lateral release and medial plication. The patients were operated on under general anesthesia and tourniquet control. Postoperatively, a brace was locked in full extension for 1 week, followed by physical therapy for 2 months. All patients were assessed 6 months postoperatively on the basis of the Lysholm knee scoring scale. Results The mean follow-up period was 37 months (range, 29-48 months). The mean Lysholm knee scoring scale improved significantly from a mean of 55.4 points preoperatively to a mean of 91.2 points postoperatively. There was good improvement as regards pain, stability, ability to climb stairs, and confidence in the operated knees. Conclusion Arthroscopic proximal realignment for recurrent patellar instability is a minimally invasive procedure with minimal complications. It is associated with less morbidity. The period of rehabilitation is relatively shorter, and the results are comparable to those of the established open surgical techniques for this condition.