Evaluation of long-term clinical results of patientstreated with arthroscopic medial reefing for patellar instability

Evaluation of Long-Term Clinical Results of Patients Treated with Arthroscopic Medial Reefing for Patellar Instability A lot of methods have been described for the treatment of patellar instability in the historical development. The treatment is still controversial nowadays. MPFL reconstruction, which has become popular in recent years, continues to be questioned due to the need for graft harvesting and the morbidity of graft fixation sites due to its proximity to the distal femur during treatment of patellar instability, especially in young patients. In our study, we evaluated long term clinical results of a mean of 118.3 months (85-143 months) of the 15 patients' 16 knees that were operated because of patellar instability between 2005 and 2010 using the ''arthroscopic medial reefing'' technique, described by Halbrecht JL in 2001. 12 of 15 patients were female and 3 patients were male. The mean age of operation was 18.6 years (11-36 years). 8 of 15 patients were operated from right knee, 6 patients were operated from left knee and 1 patient was operated from bilateral knees. All patients had at least one patellar dislocation history. Preoperative Anteroposterior (AP) knee radiographies, lateral knee radiographies in 30° knee flexion and axial graphies of the patients were evaluated. There were no trochlear dysplasia, no patella alta, no accelerated TT-TG distance. Average preoperative Lysholm score of the patients was 66.5 and preoperative average Tegner Score was 4.0. Arthroscopic medial reefing procedure were performed to patients whom preoperative examination informations and functional scale scores were recorded. Operation started with opening standard anterolateral portal. After than we examined knee joint by using anteromedial portal. Then, the superolateral portal was opened and arthroscopic medial reefing procedure was applied. According to the examination during the operation, knots ranging from 2 to 4 were applied. We applied 2 knots for 1 patient, 3 knots for 11 patients and 4 knots for 4 patients. Post-operatively all patients were allowed to bear weight on the operated leg immediately. Full knee flexion was allowed at the end of 3 weeks. At the last follow-up, 6 of 16 knees had a re-dislocation history (%37.5). All knees were observed to have complete range of motion. 1 cm Q atrophy in 2 patients and 0.5 cm atrophy in 1 patient were recorded. At the last follow-up, the average Lysholm score was 89.312, which was 66.5 preoperatively, (p:0.001) and the Tegner Score was 4.66, which was 4.0 preoperatively. We evaluated the Kujala and KOOS Scores of the patients at last follow-up. Average Kujala Score was 89.312 (good) and KOOS score was 91.475. We found out that fewer than 4 knots were used in all of the patients who had recurrence, and none of the patients who were treated with 4 knots had recurrences. There are a few studies that report the long term results of arthroscopic medial reefing for patellar instability. The higher recurrence rate seen in our study may be due to the fact that our study reported long-term clinical outcomes. The use of less than 4 knots in 12 knees may also be the reason for the high rates of dislocations. Before planning arthroscopic medial reefing for patellar instability, possible anatomical reasons should be excluded in preoperative evaluation. Appropriate patient selection and the use of at least 4 knots during surgery are important for a successful outcome. The most significant advantages of this technique are that the epiphseal plates are protected in young patients, no autografts are harvested and has low morbidity. Key Words: Arthroscopy, Arthroscopic Medial Reefing, Patellar Instability