Use of a Superolateral Portal and 70° Arthroscope to Optimize Visualization of Patellofemoral Tracking and Osteochondral Lesions in Patients With Recurrent Patellar Instability

Abstract

Surgical treatment of patellofemoral instability and associated cartilaginous lesions can be technically challenging. Visualization of patellar tracking and underlying osteochondral lesions is paramount to operative success. To treat these conditions effectively, a comprehensive arthroscopic assessment of the patellofemoral joint as well as dynamic visualization of patella tracking must be achieved. Visualization of the patellofemoral joint—in particular, the articular cartilage of the patella and trochlea morphology—can be difficult when using traditional anteromedial or anterolateral portals and a 30° arthroscope lens. The technique described here uses an accessory superolateral portal and a 70° arthroscope to achieve significantly improved visualization of the patellofemoral articulation, in particular the chondral surfaces. This vantage point aids the surgeon in effectively evaluating patellar tracking, trochlea morphology, and importantly, osteochondral lesion location to help guide treatment algorithms in the patellofemoral joint.

Reconstruction of Large Osteochondral Lesions in the Knee: Focus on Fixation Techniques

“…In this context, Niemeyer et al suggested that any osteochondral flake fracture indicates surgical treatment with the objective for internal fixation in both pediatric and adult patients [24]. Hence, due to the improved understanding of patellofemoral pathologies, a variety of arthroscopic and open surgical concepts for the repair of osteochondral lesions and the restoration of joint stability have been developed [25][26][27][28][29]. Furthermore, additional techniques for deformity correction (e.g., HTO) are inconsistently applied within the body of literature [30].…”

“…The reviewed literature predominantly comprises low level and quality evidence and is based on variable treatment protocols (Table 1). Furthermore, various methods of internal fixation are employed, including metallic (headless) and resorbable compression screws [23,24,26], Kirschner wires [26], resorbable polylactid implants (nails, pins and darts) [15,[19][20][21][22]25,27,28,31,33], sutures (e.g., PDS) and suture-anchor constructs [29,34,35,47,48], fibrin sealants [19], and bone pegs [32]. Different main outcome measures and follow-up time periods are reported.…”

“…Major concerns in terms of fragment preservation remain in cases with chondral-only flaps and for those fragments which are only partially salvageable. Various authors reported a successful fixation and good outcomes even after the repair of chondral-only fragments, primarily in children and adolescents [22,25,31,32,35]. While some authors report that the subsequent swelling of the fragment is a concern in shear-off lesions because the anatomic reduction is impaired, a recent innovation takes advantage of the increased fragment dimensions.…”

Effectiveness of an Accelerated Rehabilitation Protocol After Tibial Tubercle Osteotomy

“… 30 In all cases, diagnostic arthroscopy was carried out to examine for cartilage lesions and qualify trochlear morphology and patellar tracking from a superolateral portal with a 70° arthroscope. 2 In some cases, this guided the treatment decision to include or exclude the TTO. The arthroscope was withdrawn once the patient was deemed an adequate candidate for osteotomy.…”

Treatment of Proximal Trochlear Dysplasia in the Setting of Patellar Instability: An Arthroscopic Technique

“…In some cases, a 70° arthroscope may be used to improve visualization of the patellar articular surface. 24 It is important to note the extent and location of patellar cartilage wear. In cases of trochlear entrance dysplasia, patellar lesions are most commonly seen along the distal patella.…”