Medial reefing is a surgical procedure to tighten the tissues on the medial aspect of the patella. It is being used less and less as studies show it is not very effective.
Page updated October 2023 by Dr Sheila Strover (Clinical Editor)
Why has medial reefing traditionally been performed?
Medial reefing tightens up the superficial layers on the medial side of the patella to try and better align the patella in the groove and also to counter any excessive patellar instability that may have resulted from a prior lateral release. But it ha not proven very effective and is being replaced with MPFL-R (medial patellofemoral ligament reconstruction).
Relationship of medial reefing to lateral release
Medial reefing is often performed in association with lateral release or lateral retinacular lengthening in patients who have problems with instability of the patella. Because lateral release surgery has in the last two decades fallen out of favour, medial reefing is no longer as commonly performed.
Why MPFL reconstruction is nowadays preferred to medial reefing
MPFL reconstruction may be done after patellar dislocation has torn the medial patellofemoral ligament. The procedure uses a harvested ligament and bone tunnels in both patella and femur. It gives a strong reconstruction but is quite invasive. Medial reefing, on the other hand, tightens up the same area but does not use bone tunnels but only soft tissues.
- Kirsten's TTT, LR, and medial reefing Post-Op Diary 11/19/08
A patient's diary after a medial reefinf procedure.
"Taking into consideration the negative impact on patella stability and the poor clinical results of isolated lateral release, we believe that the combined arthroscopic procedure should no longer have a place in the management of patients with chronic patellofemoral instability."
Citation: Schorn D, Yang-Strathoff S, Gosheger G, Vogler T, Klingebiel S, Rickert C, Andreou D, Liem D. Long-term outcomes after combined arthroscopic medial reefing and lateral release in patients with recurrent patellar instability - a retrospective analysis. BMC Musculoskelet Disord. 2017 Jun 24;18(1):277. doi: 10.1186/s12891-017-1636-8. PMID: 28646869; PMCID: PMC5483275.
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