title: Medial reefing without lateral release for recurrent patellar instability: midterm and long-term outcomes.
abstract: BACKGROUND
  There is no consensus on the optimal surgical technique for recurrent patellofemoral instability. Despite many different surgical procedures discussed in the literature, there are few studies with long-term outcomes.
  
  
  OBJECTIVE
  The purpose of this study was to compare subjective and objective preoperative data from patients with recurrent patellar instability and normal alignment to midterm and long-term outcomes after an arthroscopically assisted medial reefing technique. The hypothesis was that the previously reported successful outcomes at 60 months would be well maintained over time.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  A total of 19 patients (20 knees) with recurrent patellar instability and normal bony anatomy underwent arthroscopically assisted medial reefing without lateral release. They were evaluated preoperatively and then at midterm (average, 63 months) and long-term (average, 142 months) follow-ups. Patients underwent a history assessment, physical examination, and radiographic evaluation. Outcomes evaluated included Lysholm and Tegner scores, subjective data, and examination and radiographic findings. Operative reports were reviewed for the presence of chondral lesions. Comparative statistics were utilized (P < .05).
  
  
  RESULTS
  All patients were satisfied with their surgery results and would undergo the procedure again. There was 1 recurrent subluxation and no recurrent dislocations. Subjective symptom scores demonstrated significant improvement from preoperative to midterm and long-term follow-ups for pain, instability, and swelling. Both Lysholm and Tegner scores improved significantly from preoperative to midterm and long-term follow-ups. At long-term follow-up, 70% of the patients reported excellent or good results, 5 patients reported fair results, and 1 patient reported a poor result. However, Tegner activity scores decreased significantly from midterm to long-term follow-ups. Significant improvement from preoperative to midterm and long-term follow-ups was demonstrated in physical examination findings including decreases in patellar apprehension and patellar quadrant glide; however, there was no significant difference in retropatellar pain or range of motion. For radiographic measurements, the lateral patellofemoral angle was significantly improved from preoperative to midterm and long-term follow-ups. At long-term radiographic analysis, 5 knees (25%) had narrowing of the patellofemoral joint space, 10 knees (50%) revealed patellofemoral osteophytes, and 7 knees (35%) demonstrated a medial ossicle. The presence of preoperative chondral lesions resulted in significantly lower Lysholm and Tegner scores and increased findings of osteoarthritis at long-term follow-up.
  
  
  CONCLUSIONS
  Arthroscopically assisted medial reefing, without lateral release, is an effective long-term treatment for patients with recurrent patellar instability and normal bony anatomy.
authors.affiliation: Gregory J. Adamson, Congress Medical Associates, 800 South Raymond Avenue, 2nd Floor, Pasadena, CA 91105. cagjamd@aol.com.
authors.forename: Madhav R
authors.initials: MR
authors.lastname: Boddula
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Adamson
authors.forename: Marilyn M
authors.initials: MM
authors.lastname: Pink
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001182:Arthroscopy; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D031222:Patellar Dislocation / Q000601:surgery*; D057071:Patellofemoral Joint / Q000601:surgery; D016059:Range of Motion, Articular; D012008:Recurrence; D016896:Treatment Outcome
keywords: lateral release; long-term outcomes; medial reefing; patellar instability