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A Closed Case for Kneecap Surgery

Have you ever bent your finger back too far? Ouch! What about dislocating your kneecap? Double ouch! For some people, a dislocating kneecap, or patella, can be a problem. Sometimes the kneecap isn't positioned over the knee joint where it should be. When this happens, the patella can get pulled too far to the outside of the knee, causing it to dislocate.

What can be done about this problem? Most people with this condition do well with a program of specific exercises to strengthen the muscles around the knee. This helps hold the patella in its proper place when bending and straightening the leg. Sometimes a soft brace or similar support helps keep the patella in the right place. When the patella dislocates over and over, surgery may be needed to correct the problem.

Realigning the patella can be done as an outpatient procedure. The patient has the surgery and goes home on the same day. The surgeon uses an arthroscope to see inside the knee joint. This instrument has a TV camera on the end that allows the doctor to repair the problem without cutting the knee open. In fact, the entire repair can be made without large incisions. It merely requires a tiny opening, about the size of a pencil eraser, to insert the arthroscope.

When an arthroscope was used for this problem in the past, it was still necessary to cut a large opening in the leg on the inside edge of the knee. That way, the surgeon could stitch the patella in place. A new technique has been devised to eliminate this step. One doctor has described how to use the arthroscope to make the repairs and realign the patella without any big incisions.

Making all the repairs on the inside without big incisions into the knee means fewer complications. The thigh muscle is not cut, reducing scar tissue and joint stiffness. In a study of 26 patients (29 knees), there were no complications and no more patellar dislocations using this method. This kind of "closed" arthroscopic patella surgery may offer doctors an improved way to repair patellar dislocations.

References: Jeffrey Halbrecht, MD. Arthroscopic Patella Realignment: An All-Inside Technique. In Arthroscopy. November/December 2001. Vol. 17. No. 9. Pp. 940-945.

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