Modified Insall Procedure for Recurrent Patellar Dislocation: A Case Report of Four Cases

It has been suggested that recurrent dislocation, subluxation, and functional instability due to patellofemoral pain are experienced by 30% to 60% of patients with post-traumatic patella instability who are managed with non-surgical methods [1-3]. Recently, the medial patellofemoral ligament (MPFL) has been recognized as the most important ligamentous stabilizer for preventing lateral dislocation of the patella [4-7]. Thus, the use of the MPFL during reconstructive treatment for recurrent patellar dislocation has been increasing [8,9]. However, hamstring grafts, which are often used during such procedures, have the potential to cause patellofemoral overload. Elongated MPFL can be advanced to restore patellofemoral stability, as Fulkerson has reported [10]. We report the cases of four patients with recurrent patellar dislocation who underwent arthroscopic lateral release and MPFL advancement using a new fixation technique.