Medial reefing

 

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 its underlying groove, and also to counter any excessive patellar instability that may have resulted from a prior lateral release.

But this surgical procedure has not proven very effective and is being replaced with medial patellofemoral ligament reconstruction (MPFL-R ).

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Relationship of medial reefing to lateral release

Medial reefing has often been 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 that commonly performed.

 

• Quote from peer-reviewed paper:

  "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 [of medial reefing and lateral release] 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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Why MPFL reconstruction is nowadays preferred to medial reefing

MPFL reconstruction may be done after a patellar dislocation event 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, in contrast, tightens up the soft tissues in the same area without using bone tunnels.

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Forum discussions

• Kirsten's TTT, LR, and medial reefing Post-Op Diary 11/19/08

  A patient's diary after a medial reefinf procedure.

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