The LIBRARY > NOTES - Surgical Procedures

Medial reefing


The KNEEguru:
'Medial reefing' is a procedure to tighten up the structures on the inner (medial) aspect of the kneecap. It is generally, but not always, performed in association with the procedure of 'lateral release', which loosens the structures on the outer (lateral) aspect of the kneecap.

When I had it done I thought they tightened some medial tendon or ligament but actually what happens is the knee joint is encased in whats called a joint capsule. It keeps the synovial fluid in the joint to keep it lubricated, I'll compare it to a small balloon. I don't know how come it doesn't leak with stuff running through it but PTL it doesn't. So the Surgeon gathers(pinches) it together and sews it to make it smaller. Kind of like a face lift for your knee. The patella is sort of attached to it so it is done to change the tracking of the patella along with a lateral release, Theresa

Is the Medial Reefing the same thing as a Proximal Patellar Realignment?  I will have the PPR, Lateral Release and Synovectomy done on 5/27/04.  Not finding much on the Proximal Realignment which I'm told should have been done when I had the distal TTT in 2000.  This Medial Reefing procedure sounds like what I am suppose to have.

Can anyone tell me post op what to expect from this procedure if indeed this is what I am having done?

Thanks a million!

My impression is that medial reefing is repair of the medical retinaculum and medial patellofemoral ligament. You could view it as a spectrum with the minimum being a thermal plication of the retinaculum to the far extreme of MPFL reconstruction, with VMO advancement and MPFL repair being somewhere in between.  I think That the PPR you refer to might be the VMO advancement or Insall procedure. Ask your OS for a copy of your operative report.

Heather M.:
I believe PPR does include medial reefing under the umbrella.  Proximal just means closer to the midline of the body, as opposed to distal, which means further away (toward the feet?).  The words usually refer back to each other, so a proximal patellar realignment involves soft tissue work at or close to the kneecap, whereas distal involves work further away from the kneecap than proximal--don't you love latin?

Anyway, here's a quote from about the procedures:

--- Quote --- Surgical procedures have been arbitrarily divided into proximal and distal procedures. All seek to somehow transform a tilted and/or lateral-tracking patella into a less tilted, centrally tracking patella. Proximal re-alignments involve surgical manipulation of the lateral retinaculum, the medial retinaculum, the vastus lateralis, the vastus medialis obliquus and any combination thereof. Like balancing a marionette, it is a question of tightening certain "strings" and giving others more slack. The term distal re-alignment denotes (by convention) a transfer of the tibial tuberosity. Certain procedures fall into neither category: prosthetic re-surfacing of the patella or trochlea for example.

--- End quote ---

So it sounds like your OS is going to do medial reefing and/or VMO advancement--either of these could be proximal patellar realignment procedures.  Sometimes they are done together.

FWIW, here's the blurb on MPFL reconstruction, which doesn't seem to fall into any category, though it sounds like it could also be considered a PPR in a way:

--- Quote ---Reconstruction of the medial patello-femoral ligament (MPFL). This procedure has been designed for the patient whose kneecap dislocates (completely slips out of the trochlear groove). Operations go in and out of favor, and this one is currently in vogue. Since the MPFL helps keep the kneecap in its groove, it is logical to repair or reconstruct this ligament when the kneecap has dislocated. But repair only makes sense if the ligament was normal to begin with. In many patients it is stretched out even before it tears, so simple repair doesn't create a normal MPFL. Reconstruction implies that the surgeon is creating a ligament from scratch, and this means taking a ligament from some other part of the knee or using a synthetic material. This is a bigger procedure than some of the others listed above.
--- End quote ---


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