Long-term outcomes after combined arthroscopic medial reefing and lateral release in patients with recurrent patellar instability – a retrospective analysis

Abstract

Background: There is currently no consensus regarding the optimal surgical treatment method for patients with recurrent patella instability. Our goal was to evaluate the long-term results of combined arthroscopic medial reefing and lateral release, to identify possible risk factors for recurrent dislocations and residual complaints after surgical treatment and to assess functional outcome. Methods: We performed a retrospective study of 38 patients (43 knees) treated with all-inside technique between 2001 and 2010. The functional outcome was evaluated with the Kujala score, while pain intensity was scored on a visual analogue scale (VAS). Contingency tables were analysed with Fisher's exact test. Non-parametric analyses were carried out with the Mann-Whitney U and the Wilcoxon signed-rank test. Survival curves were calculated with the Kaplan-Meier method and compared with the log-rank test. Results: The median age at surgery was 16 years (range, 9-44 years) and the median follow-up amounted to 9.7 years (range, 4.7-14.7 years). Residual complaints were present in 34 cases (79%). Patients with residual complaints had a trend for a higher body mass index (BMI) at surgery (25.7 vs. 21.6, P = .086). Twenty-two cases had recurrent dislocation after a median interval of 30 months. The probability of recurrent dislocations amounted to 16% after 1 year and 52% after 10 years. There were no significant differences in the presence of residual complaints (P = .721) and median VAS score (P = .313) between patients with or without recurrent dislocation. Patients with recurrent dislocations had a trend towards younger age at surgery (15 vs. 18 years, P = .076). The median Kujala score of the affected knee was 81. Patients with recurrent dislocations had a significantly lower score compared to patients without recurrent dislocations (67 vs. 91, P < .001). Conclusions: The combined arthroscopic lateral release with medial reefing does not appear to be an adequate treatment for patients with chronic patellar instability in long-term follow-up. Younger patients might be at a higher risk for recurrent dislocations, while a higher BMI at surgery might be associated with residual complaints.

Development of an innovative measurement method for patellar tracking disorder

“…The mechanism of patellofemoral pain and instability has not yet been clarified. Previous surgical intervention methods focused on the rearrangement of soft tissue structures, such as medial retinaculum compression or lateral retinaculum release, to relieve the pain from the patellofemoral joint [ 20 , 21 ]. The reconstruction of the medial patellofemoral ligament, the first-grade stable structure of the patella, was pivotal in the treatment of patellofemoral joint instability [ 22 ].…”

Sporting activity is reduced following medial reefing performed for patellar dislocation

“…These patients had inferior clinical outcomes (84.1 ± 16.6 points) compared to those in Group 1 and 3. A recent analysis of patient outcomes after medial reefing in combination with lateral release with a median follow-up time of 9.7 years revealed poor results with high failure rates of 42% after 5 years and 52% after 10 years [11]. The Kujala knee scores (88.2 ± 13.5) in 23 knees treated with mini-open medial reefing and arthroscopic lateral release reported by Nam et al [26] were similar to the findings of the present study.…”

“…Operative reconstruction of the medial patellofemoral ligament (MPFL) is widespread following patellar dislocation, and there are many publications about the outcomes of this treatment option [8–10]. In contrast, medial reefing is less evaluated and there is limited data about the patient-specific sporting activity following this procedure [11, 12].…”

Treatment of recurrent patellar dislocation via knee arthroscopy combined with C‑arm fluoroscopy and reconstruction of the medial patellofemoral ligament

“…Acute dislocation is triggered principally by direct trauma; dislocation develops during the application of knee torsion stress over the line of abnormality. The majority of patellar dislocations are lateral (24,25). The MPFL is the most important ligament in terms of medial patellar strength (50-60% of all the strength that is imparted) (26)(27)(28).…”