Chapter 5: Arthroscopy of the patellofemoral joint

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Figure 5.1. From the superomedial portal, the skin incision is made just medial to the midline. It is two fingerbreadths proximal to the superior pole of the patella, angled 45 to 60 degrees off the horizontal. Illustration by Susan Brust.

Figure 5.2. The arthroscope enters the joint approximately 2 cm proximal to the patella for the superomedial portal. Illustration by Susan Brust.

Figure 5.3. Lateral patellar tilt looking from the anterolateral view. Note how far lateral the central ridge appears at 45 degrees of flexion.

Figure 5.4, A and B, Lateral patellar subluxation at 30 and 45 degrees of flexion.

Figure 5.5. Grade 4 medial facet lesion of patella due to chronic lateral subluxation of the patella.

Figure 5.6. Proximal patellar pole crush injury from the superomedial portal view.

Figure 5.7. A, Traumatic medial trochlear osteophyte from dashboard injury in a 26‑year‑old. Initially seen on Merchant view, this lesion was resected with a burr, and subsequently, symptoms abated (B).

Figure 5.8. A, Pristine patellofemoral joint. B, Minimal dimpling of articular cartilage of patella.

Figure 5.9. A, Abrasion arthroplasty of Grade 4 patellar lesion. B, Second look arthroscopy 1 year later; fibrocartilage has been laid down (Photo courtesy JY DuPont, Quimper, France).

Figure 5.10. Grade 1 lesion on patella: note softening of cartilage without frank breakdown.

Figure 5.11. Grade 2 lesion on lateral facet of patella secondary to chronic lateral tilt.

Figure 5.12. Grade 2 lesion on central ridge of patella, note fissuring and depth of probe.

Figure 5.13. Grade 3 lesion on central ridge of patella—"crab‑meat" appearance.

Figure 5.14. Grade 3 deep central ridge patellar le­sion.

Figure 5.15. Grade 4 trochlear lesion from crush injury in central portion (patella had reciprocal Grade 2 lesion).

Figure 5.16. Grade 5 degenerative patellar lesion, eroded down to bone, with surrounding arthritic changes.

 

Figure 5.17. A, When looking at the patella through the arthroscope, the surgeon is so close to the patel­lar surface that his view is somewhat distorted, and he may not appreciate other important areas. B, During an open procedure or viewing from a second portal, the surgeon may gain a better perspective of the patel­lar surface. Illustration by Phoebe Fulkerson.

Figure 5.18. A, spinal needle marks the superior aspect of the proposed release. Care is taken to stay out of the vastus lateralis tendon. B, The initial cautery is through the synovium, a few millimeters lateral to the patella. C, The cautery starts through the lateral retinaculum. Note the insulated tip on the cautery. D, Completed arthroscopic lateral release.

Figure 5.19. Inferomedial plica looking from superomedial portal view. The plica is thicker and more inflamed at point of contact on the medial femoral condyle.

Figure 5.20. Inferomedial plica from superomedial portal view.

        

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