Arthroscopic Treatment for Acute or Subacute Patellar Dislocation

Song, In Soo; Kim, Seung Ki; Song, Chol

Abstract

PURPOSE: The acute or subacute patellar dislocation is frequently neglected. Arthoscopy has provided a new method of both diagnosis and treatment of the patellofemoral instability. In our series, we performed proximal realignment including lateral retinacular release and medial capsular imbrication under arthroscopic alone on the patients who had normal skeletal alignment with Q angle less than 20 degree. The clinical and radiographic results of the procedure was assessed. MATERIAL AND METHODS: 21 knees in 20 patients were evaluated at an average 36 months following arthroscopic procedures alone. The average patient's age was 25 years old and the mean follow-up period was 18 months. The patients had been treated surgically after conservative management for mean three weeks from initial trauma. Medial patellar osteochondral fractures and loose bodies in 7 knees of 6 patients and osteochondral defect of lateral femoral condyle in 1 knee of 1 patient were confirmed radialologically and intraoperatively. We performed additional treatments for the associated disease. The radiologic results of Insall-Salvati index, congruence angle for subluxation and lateral patellofemoral angle (LPFA) for tilt on preoperative, postoperative and last follow-up and clinical outcome were assessed, according to Crosby and Insall's criteria.
RESULTS
Congruence angle(+10.8 to -0.5), LPFA(+7.2 to -7.3) and Insall-Salvati index(0.82 to 1.05) were radiologically normalized. Clinically, results were excellent to good results in 19 knees(90.5%).
CONCLUSION
The arthroscopic proximal realignment was done by minimal surgical exposure and was effective on relief of the patellofemoral pain after acute or subacute dislocation, it also proved the less pain, rapid rehabilitation and ability to diagnose the other intraarticular disorders.