Electrosurgical arthroscopic patellar denervation.
Patellofemoral pain depends on many pathophysiologic factors and may be difficult to manage. It often occurs with no apparent cause in young persons. A new arthroscopic technique based on anatomic and pathophysiologic studies is described here for the treatment of patients with patellofemoral pain and no or minimal malalignment. Nociceptive receptors are richly distributed in the peripatellar soft tissue. We surmised that a thermal lesion to this region would lead to desensitization of the anterior knee area, referred to as patellar denervation. With the leg in maximum extension, the electrocoagulator is inserted through a combined anterointernal and suprapatellar approach to access the entire perimeter of the patella. A simple thermal lesion to the peripatellar soft tissue in the region closest to the patella is enough to obliterate a considerable number of nociceptive receptors. This thermal lesion should not include the region of the patellar tendon because this is an important site of entry for vessels reaching the patella, and injury to these vessels may cause patellar necrosis. Patellar denervation achieved through this simple technique may offer a solution for patients with intractable patellofemoral pain with no evident alterations.