Arthroscopic Treatment of Patellar Tendinopathy: Use of 70° Arthroscope and Superolateral Portal

Abstract

Surgical treatment of recalcitrant patellar tendinopathy includes both the open surgical approach and minimally invasive arthroscopic debridement. A variety of arthroscopic techniques have been described that involve the use of a standard 30° arthroscope and standard anterolateral and anteromedial portals. As a result, visualization of the infrapatellar region can be variable, and it may be necessary to create additional portals. A 70° arthroscope provides the advantage of a wider field of view to the surgeon. By placing a 70° arthroscope through a superolaterally created portal around the knee joint, the surgeon acquires a complete view of the infrapatellar region and patellar tendon. Thus, debridement of the pathologic area can be accomplished just by the use of an additional working portal, typically the anterolateral one. This technical note describes a technique that involves the use of a 70° arthroscope for the treatment of patellar tendinopathy.

Fig 1

(A) Left knee arthroscopic view. The patellofemoral joint is viewed through the superolateral portal with a 70° arthroscope. The proximal patellar tendon pathology is visible (black arrow). (B) The T1 weighted image reveals marked thickening and increased signal intensity in the patellar tendon (red arrow).

Fig 2

The surgeon is demarcating the coronal width of the left patellar tendon under direct visualization, with the 70° arthroscope placed in the superolateral portal. This is achieved by means of direct palpation of the tendon by the surgeon and inserting a needle at the most lateral and medial border of the tendon. Thus, the working area is recognized (left-right arrow) and the surgeon can proceed to debridement. This step is often advantageous because the inflamed tissue blocks the direct view to healthy patellar tendon.

Fig 3

Debridement of left proximal patellar tendon with straight arthroscopic shaver. This is achieved through the working anterolateral portal. (A) The procedure is performed under visualization with a 70° arthroscope placed in the superolateral viewing portal. The targeted, pathologic infrapatellar region is visible. The arthroscopic shaver is introduced through the working portal. (B) Debriding with swiping movements of the arthroscopic shaver from proximal to distal causes the healthy proximal patellar tendon to become visible. Viewing and working portals remain unchanged throughout the procedure.

Fig 4

Superolateral view of left patellar tendon through a 70° arthroscope. After decompression and removal of degenerative tissue, the healthy patellar tendon is visible (arrow).