Proximal Realignment: Medial Plication

Abstract

Recurrent patellar dislocation and subluxation can be seen mostly in young and physically active individuals. The etiology of the disorder is varied, and numerous factors have been proposed. More commonly, it occurs during normal activities as a result of dysplastic changes in the patellofemoral system. Constitutional connective tissue weakness also predisposes to patellar dislocation. The spectrum of injury may range from elongation of the medial structures to complete rupture of medial para-patellar soft tissue. A combination of injury to the medial retinaculum and the medial patellofemoral ligament may be present in approximately 65 % of the cases. Patients with lateral patellar dislocation have been treated conservatively with a 15–44 % recurrence rate. Historically, lateral retinacular release was performed with the belief that a tight lateral retinaculum is predisposed to lateral patellar subluxation or dislocation. Since the recognition of the importance of the medial patellofemoral ligament (MPFL), there has been increasing interest in different techniques for managing the medial stabilizer.

Numerous surgical options have been evolved, ranging from repair, radio-frequency thermal reefing, imbrication (reefing), or plication of the medial retinacular structures. Proximal realignment generally is addressed by a combination of lateral retinacular release and imbrications of medial retinaculum. With advances in arthroscopy and increased technical expertise, the concept of proximal realignment has yielded promising results. The aim of this chapter is to review the indications of this procedure, describe the surgical technique, and discuss the existing literature till date on its efficacy.