KNEE Medial capsule reefing in patellar instability Simone Cerciello • Michele Vasso • Katia Corona • Chiara Del Regno • Alfredo Schiavone Panni Received: 3 December 2013 / Accepted: 19 April 2014 Ó Springer-Verlag Berlin Heidelberg 2014 Abstract Purpose The efficacy of medial capsule reefing in the treatment of patellar instability is well documented. Aim of the present study was to prospectively evaluate the out- comes of an all-arthroscopic medial capsule reefing tech- nique in young patients with painful patella syndrome and potential patellar instability. Methods Thirty patients with painful patellar syndrome and potential patellar instability having undergone a min- imum of 6 months of intensive rehabilitation were enrolled in the present study. All subjects were evaluated with physical examination, clinical and functional outcomes and complete imaging study. Results All patients were reviewed at an intermediate follow-up of 72 months. Average Kujala score improved from 72.9 ± 15.0 to 88.4 ± 7.6 (p \ 0.0001), average Larsen score from 15.0 ± 2.5 to 17.2 ± 2.2 (p \ 0.002), average Lysholm from 63.8 ± 16.7 to 87.9 ± 11.7 (p \ 0.0001) and average Fulkerson score from 69.5 ± 21.5 to 90.8 ± 9.8 (p \ 0.0001). No intraoperative or postoperative complications were recorded. Ninety per cent of patients were very satisfied or satisfied with their functional result. Twenty-eight patients were reviewed at the final follow-up, 120 months after surgery. Average Kujala was 87.7 ± 8.8 (p \ 0.0001), average Larsen was 16.8 ± 2.7 (p \ 0.01), average Lysholm was 87.6 ± 14.3 (p \ 0.0001), and average Fulkerson was 87.2 ± 13.9 (p \ 0.0001). Almost 86 % of patients were very satisfied or satisfied with their result. However, slight deterioration of the outcomes over time was observed. Conclusion At the final follow-up, the outcomes of all- arthroscopic technique were significantly improved from preoperative values; however, they were slightly inferior at the 72 months follow-up. This slight deterioration of the outcomes may be the consequence of the reduction in physical activities. Level of evidence Case series, Level IV. Keywords Medial capsule reefing Á Arthroscopy Á Patellar instability Á Medial retinaculum Á Rehabilitation Introduction The efficacy of medial structures repair in the treatment of patellar instability was demonstrated by Insall in the last century [8]. Anatomic and biomechanics studies have demonstrated the role of medial structures in preventing lateral patellar displacement [1, 13, 15]. The medial pa- tello-femoral ligament (MPFL) contributes to more than 50 % of the restraint, while the medial patello-meniscal ligament (MPML), the medial patello-tibial ligament (MPTL) and the medial retinaculum (MR) contribute to 24, 13 and 13 %, respectively [13]. These passive stabilizers play even more important role in case of patella alta or trochlear dysplasia. For these reasons, it seems reasonable to repair these structures once they are damaged. However, under the term of patellar instability, several spectrums of pathologies are usually included. According to the classification by H. Dejour, three major situations can be identified [4]. The painful patellar syndrome and the potential patellar instability have a common aspect: patients may refer S. Cerciello (&) Á M. Vasso Á K. Corona Á C. Del Regno Á A. S. Panni Department of Health Science, Molise University, Via De Sanctis 1, 86100 Campobasso, Italy e-mail: simo.red@tiscali.it 123 Knee Surg Sports Traumatol Arthrosc DOI 10.1007/s00167-014-3027-0