Mini-Open Medial Reefing and Arthroscopic Lateral Release for the Treatment of Recurrent Patellar Dislocation

Abstract

Background: Although recurrent patellar dislocations are not uncommon, their pathophysiology and treatment are controversial. Hypothesis Stabilization of recurrent patellar dislocations can be successfully managed with a mini-open approach. Study Design Case series; Level of evidence, 4. Methods Twenty-two patients (23 knees) underwent a mini-open medial reefing and arthroscopic lateral release for the treatment of recurrent patellar dislocations with an average follow-up of 4.4 years (range, 1.4-14 years). The average age at the first dislocation was 15 years (range, 5-26 years), and the average age at surgery was 23 years (range, 12-65 years). Results There was 1 postoperative dislocation (4%) and 1 recurrent subluxation (4%). The average Kujala knee score was 88.2 ± 13.5, with overall good scores in each category. The lowest scores involved squatting (5.7), abnormal painful kneecap movements (subluxations) (7.1), and jumping (7.9). Overall, there was a statistically significant improvement in the Tegner score from 3.7 ± 1.8 before surgery to 6.9 ± 2.0 after surgery (P<. 001). Six knees (26%) were rated subjectively as excellent, 15 (65%) as good, 2 (9%) as fair, and 0 (0%) as poor. All 22 patients (100%) stated that the procedure was worthwhile. Radiographically, there was a statistically significant improvement in the congruence angle (normal, –8.0°± 6.0°) from 15.7°± 12.6° (range, 0.0° to +44.0°) before surgery to –11.5°± 8.7° (range, –20.0° to +10.0°) after surgery (P<. 001) and in the lateral patellofemoral angle (normal, > 0°) from –0.2°± 6.4° (range, –10° to +8°) before surgery to 7.9°± 2.6° (range, 0.0° to +11.0°) after surgery (P<. 001). Conclusion Our mini-open technique provides anatomical restoration with limited morbidity and cosmetically appealing results. Furthermore, our redislocation rates compare favorably with traditional, more extensile open approaches.