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This Article Full Text Full Text (PDF) All Versions of this Article: 33/2/220    most recent 0363546504267803v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Request Reprints Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (4) Citing Articles via Google Scholar Google Scholar Articles by Nam, E. K. Articles by Karzel, R. P. Search for Related Content PubMed PubMed Citation Articles by Nam, E. K. Articles by Karzel, R. P. Related Collections Dislocations Knee Operative

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

A Medium-Term Follow-up

Ellis K. Nam, MD^,* and Ronald P. Karzel

From Chicago Orthopaedics & Sports Medicine, S.C., Chicago, Illinois, and the Southern California Orthopaedic Institute, Van Nuys, California

^* Address correspondence to Ellis K. Nam, MD, Chicago Orthopaedics & Sports Medicine, S.C., 104 S. Michigan Avenue, Suite 316, Chicago, IL 60603.

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.

Key Words: knee • patella • dislocation • instability

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