All-Arthroscopic Management of Lateral Patellar Instability

Abstract

Patellar dislocations are common injuries that can lead to recurrent dislocations and instability. Patellar instability is a complex problem and requires a multifactorial approach. Over the years, many different repair and reconstruction techniques has been developed. The variety of techniques proves that there is no best procedure, and different options must be taken into consideration in every case. Many of these techniques are complicated and require graft harvesting or drilling through the patella. We present a technique of arthroscopic patellar stabilization with a single suture anchor and lateral release that is easy to perform, cost-effective, and does not require drilling tunnels through patella or graft harvesting.

Fig 1

With visualization through the anterolateral portal, the medial parapatellar portal is created (left knee, outside view).

Fig 2

Arthroscopic view from the anterolateral viewing portal into the medial side of the left patella. Through the medial parapatellar portal, the middle third, superomedial aspect of the patella is debrided using a shaver until the bone is exposed.

Fig 3

Outside view of the left knee. The Y-Knot flex suture anchor is placed into the middle third superomedial aspect of the patella.

Fig 4

(A-B) Arthroscopic view from the anterolateral viewing portal into the medial side of the left patella. Reattaching the MPFL. Using suture passer, the thread is passed to the proximal part of the MPFL (A) in the direction of suprapatellar recess and is retrieved behind the ligament in its proximal bottom part (B). (MPFL, medial patellofemoral ligament.)

Fig 5

Arthroscopic view from the anterolateral viewing portal into the medial side of the left patella. Reattaching of the MPFL is performed with 4 threads of Y-Knot flex suture anchor, each time passing the thread in a point more distal to the previous one, which results in passing threads through almost entire width of MPFL. (MPFL, medial patellofemoral ligament.)

Fig 6

Arthroscopic view from the anteromedial viewing portal into the lateral side of the left knee patella. Release of the lateral retinaculum is shown.

Fig 7

(A) After the MPFL is reattached, the knots are tied on both implant threads. (B) Arthroscopic view from the anterolateral viewing portal into the medial side of the left knee patella. (MPFL, medial patellofemoral ligament.)

Fig 8

Arthroscopic view from the anterolateral viewing portal into the patellofemoral joint. After the MPFL is reattached, the control of patellar tracking should be performed. (LFC, lateral femoral condyle; MPFL, medial femoral condyle.)