HOME HELP CONTACT US SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:
Sign In to gain access to subscriptions and/or personal tools.

This Article Full Text Full Text (PDF) All Versions of this Article: 35/4/622    most recent 0363546506296041v1 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 Google Scholar Google Scholar Articles by Miller, J. R. Articles by Durand, P. Search for Related Content PubMed PubMed Citation Articles by Miller, J. R. Articles by Durand, P., Jr Related Collections Knee Arthroscopy Operative

Arthroscopically Assisted Medial Reefing Without Routine Lateral Release for Patellar Instability

Jennifer R. Miller, MD^*, Gregory J. Adamson, MD^,, Marilyn M. Pink, PhD, PT, Michael J. Fraipont, MD and Pierre Durand, Jr, MD

From ^* Idaho Sports Medicine Institute, Boise, Idaho, Congress Medical Foundation, Pasadena, California, and Hayashi, Dahms, Durand and Pattee, Thousand Oaks, California

Address correspondence to Gregory J. Adamson, MD, 39 Congress Street, Suite 201, Pasadena, CA 91105 (e-mail: susan{at}congressmedical.com).

Background: Patellofemoral instability in patients with normal alignment has been effectively treated with medial reefing procedures and a lateral release. Recent research suggests that a lateral release may not be necessary in patients without excessive patellar tilt.

Hypothesis: Arthroscopically assisted medial reefing without lateral release is as effective as techniques with a lateral release reported in the literature.

Study Design: Case series; Level of evidence, 4.

Methods: Twenty-four patients (25 knees) were observed for an average of 60 months. Preoperatively, patients underwent a history, physical examination, and radiographic evaluation. At follow-up, a physical examination and radiographic evaluation were repeated. Preoperative and postoperative Lysholm and Tegner scores were calculated. A subjective questionnaire was also completed. Comparative statistics were used for the preoperative and postoperative scores (P < .05).

Results: Ninety-six percent (24/25) were satisfied with their results, and all patients would have the same procedure performed again. Subjective symptom scores improved significantly. Lysholm knee scores improved from an average of 54 to 91 (P < .001). Tegner activity level improved from an average of 3.3 to 6.2 (P < .001). Significant improvement was seen in patellar mobility, apprehension, and patellofemoral tenderness with compression. Range of motion, muscle atrophy, and tilt did not change significantly. Congruence angles improved from 4.4° to –2.5° (P = .009), lateral patellofemoral angles improved from 5.5° to 8.7° (P = .011), and lateral patellar displacement improved from 2.0 to 0.2 mm (P < .044). There were no recurrent dislocations or subluxations.

Conclusion: Arthroscopically assisted medial reefing, without lateral release, is an effective treatment for patients with recurrent patellofemoral instability and normal alignment.

Key Words: medial reefing • patellofemoral instability • lateral release

This article has been cited by other articles:

				H.-C. Shen, K.-H. Chao, G.-S. Huang, R.-Y. Pan, and C.-H. Lee Combined Proximal and Distal Realignment Procedures to Treat the Habitual Dislocation of the Patella in Adults Am. J. Sports Med., December 1, 2007; 35(12): 2101 - 2108. [Abstract] [Full Text] [PDF]