Summary

This study has revealed a significant quadriceps muscle deficit observed during fluid arthroscopy compared to dry arthroscopy, particularly evident in isokinetic tests at both 60°/s and 240°/s concentric speeds. These findings underscore the preference for dry diagnostic arthroscopy in evaluating osteochondral lesions during MPFL reconstruction, given the detrimental impact of fluid arthroscopy on

Abstract

Purpose

Patellar instability is prevalent, particularly among adolescents. The "Menu à la carte" technique, as described by the Lyon school of knee surgery, enables personalized management of each patient's specific anatomical variations. Most cases of recurrent patellar dislocation (RPD) only require MPFL reconstruction due to their anatomical characteristics. However, postoperative quadriceps deficit can significantly impact recovery. Therefore, we aimed to evaluate and compare quadriceps deficiency after MPFL reconstruction using isokinetic testing, following either fluid or dry diagnostic arthroscopy. The hypothesis was that MPFL reconstruction with fluid arthroscopy would result in more significant quadriceps deficiency in isokinetic strength tests compared to the dry arthroscopy group.

Methods

This retrospective, single-center study included 71 patients who underwent MPFL reconstruction for RPD from February 2020 to February 2024. Tibial tubercle osteotomy (TTO) was performed if the Caton-Deschamps index exceeded 1.4. Exclusion criteria were combined trochleoplasty and isokinetic tests missing or conducted more than 6 months postoperatively. Until September 2021, patients had fluid diagnostic arthroscopy; afterward, they had dry diagnostic arthroscopy. All patients were evaluated at 2 months post-surgery by the same senior surgeon and between 4 to 6 months post-surgery by a sports medicine practitioner for isokinetic testing.

Results

The main findings of this study indicate that fluid diagnostic arthroscopy results in a more pronounced quadriceps muscle deficit compared to dry arthroscopy. Isokinetic testing showed significant deficits in the operated quadriceps at both 60°/s and 240°/s concentric speeds, including strength tests, H/Q ratios, and muscle imbalance between the healthy and operated sides. No significant differences were observed in the hamstring muscles across the tests performed.

Conclusion

This study has demonstrated a significant quadriceps muscle deficit in isokinetic tests following fluid arthroscopy compared to dry arthroscopy. These findings highlight the preference for dry arthroscopy in evaluating osteochondral lesions during MPFL reconstruction.