Technical Note Arthroscopic-Assisted Surgical Technique for Treating Patella Fractures Arturo Makino, M.D.,Luis Aponte-Tinao, M.D.,D. Luis Muscolo, M.D., Miguel Puigdevall, M.D.,and Matias Costa-Paz, M.D. Abstract: The purpose of this study was to describe and report preliminary results of an arthroscopic- assisted surgical technique for the treatment of displaced transverse patella fractures with percuta- neous internal fixation. We applied this technique in 5 patients who presented a displaced transverse patella fracture and were followed-up for an average of 18 months. Underan image-intensifier fluoroscope, the fracture was closely reduced with a percutaneously reduction clamp while the congruence of the articular surface was monitored arthroscopically. Two Kirschner wires were inserted perpendicular to the fracture line followed by 2 cannulated lag screws obtaining interfrag- mentary compression. By using a cannulated guide, 2 wires were threaded through both cannulated screws and percutaneously were crossed over the top of the patella creating a figure-8 pattern tension band. At final follow-up, radiographic consolidation was achieved in all patients obtaining full range of motion and returning to the activity level previous to the fracture. Arthroscopic internal fixation is a valid alternative for the treatment of intra-articular displaced and noncomminuted patella fractures. This technique allows healing of the fracture with low patient morbidity, a shorthospi- talization period, and an accelerated rehabilitation of the affected knee. Key Words: Patella— Fracture—Arthroscopy—Percutaneous internal fixation. D isplaced transverse patella fractures affect the joint surface and disrupt the extensor mechanism (Fig 1). The displacement of patella fragments and the articular incongruence are the main indications for surgical treat- ment of these fractures. 1 The goal of operative fixation is to achieve an anatomic reduction of the articular surface and, through a stable fixation, allow the knee early mo- tion. 2 This operation is usually performed with an open technique that requires a substantial dissection of the peripatellar softtissues, with a long skin incision to provide an adequate visualization of the fracture as wel as the joint surface. The traditional technique may caus an important amount of adhesions and prolonged disab ity during the rehabilitation period, 3 as well as a cosmet- ically unpleasant scar. With the use of arthroscopy, it is possible to evaluate the articular surface reduction without performing an arthrotomy, making it possible to perform a closed re- duction and a percutaneous treatment of the fracture. 4,5 This may lead to less morbidity, a short hospitalization period, and an accelerated knee recovery. The purpose this study was to describe and report preliminary result of an arthroscopic-assisted surgical technique for the treatment of displaced transverse patella fractures with percutaneous internal fixation. OPERATIVE TECHNIQUE Surgery is performed with the patient in the supine position and the knee extended. Percutaneous reduc- From the Department of Arthroscopic Surgery (A.M., L.A.T., M.P.,M.C.P.) and the Orthopedic Department “Carlos E.Otto- lenghi” (D.L.M.), Italian Hospital of Buenos Aires, Argentina. Address correspondence and reprint requests to Arturo Makino, M.D.,CINEOT,Potosi4215,1199 BuenosAires,Argentina. E-mail: vgaiteiro@hitalba.edu.ar © 2002 by the Arthroscopy Association of North America 0749-8063/02/1806-3245$35.00/0 doi:10.1053/jars.2002.30745 671 Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 18,No 6 (July-August), 2002: pp 671– 675