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All-Inside Arthroscopic Proximal Patellar Realignment

Mohamad H. Fahmy*

Background: Patello femoral joint injuries are very common in athletes especially the young age and adolescents. Over 100 operations have been described for the management of recurrent lateral patellar instability.
Purpose: The purpose of this study was to determine the clinical results of arthroscopic all-inside proximal patellar realignment.
Patients and methods: 17 patients (19 knees) with chronic lateral patellar instability were managed by arthroscopic all- inside proximal Patellar Realignment. There were 7 male knees and 12 female knees. The right leg was involved in 11 patients, and the left leg in 8. The average patient age was 17 years (range, 14 to 18 years). Medial retinacular sutures were introduced percutaneously using an epidural needle 17–20 gauge. Two accessory superolateral portals were created and a 6mm cannula is introduced in each portal. Each pair of suture was then delivered one by one to the distal accessory superolateral portal and standard arthroscopic knot tying was performed.
Results: The Lysholm score improved from 35 preoperatively to 81 postoperatively. The results were excellent in ten knees (%52.6), good to excellent in four knees (%21.1), fair to good in two knees (%10.5), fair in two knees (%10.5) and poor in one knee (%5.3).
Conclusions: All - inside arthroscopic technique can be used to correct mild lateral patellar instability with 1 to 2+ lateral patellar glide and in teenagers with 3 to 4+ lateral patellar glide with no or mild trochlear dysplasia. It has relatively few complications if proper rules are followed.