Arthroscopic Medial Retinacular Plication With a Needle-Hole Technique Niti Prasathaporn, M.D., Somsak Kuptniratsaikul, M.D., Kitiphong Kongrukgreatiyos, M.D.  Arthroscopy Techniques  Volume 3, Issue 4, Pages e483-e486 (August 2014) DOI: 10.1016/j.eats.2014.05.004 Copyright © 2014 Arthroscopy Association of North America Terms and Conditions

Fig 1 The left knee are fully extended in the supine position. The standard anteromedial (AM), anterolateral (AL), and superolateral (SL) portals are defined. The stab incisions are located on the superomedial quadrant of the patellar rim (S). Arthroscopy Techniques 2014 3, e483-e486DOI: (10.1016/j.eats.2014.05.004) Copyright © 2014 Arthroscopy Association of North America Terms and Conditions

Fig 2 A superolateral portal is used as a viewing portal. An 18-gauge needle, which is loaded with No. 1 PDS thread, is passed through the stab skin incision and medial retinaculum at the medial rim of the patella. Arthroscopy Techniques 2014 3, e483-e486DOI: (10.1016/j.eats.2014.05.004) Copyright © 2014 Arthroscopy Association of North America Terms and Conditions

Fig 3 A hook or suture retriever, which passes through the anteromedial portal, is holding the first loop of suture. The needle is passed through the same skin incision; then slide the needle on the medial retinaculum medially before the needle is passed through the medial retinaculum. Arthroscopy Techniques 2014 3, e483-e486DOI: (10.1016/j.eats.2014.05.004) Copyright © 2014 Arthroscopy Association of North America Terms and Conditions

Fig 4 The suture end of the second loop is drawn through the first loop and out the anteromedial portal. Arthroscopy Techniques 2014 3, e483-e486DOI: (10.1016/j.eats.2014.05.004) Copyright © 2014 Arthroscopy Association of North America Terms and Conditions

Fig 5 The first suture loop is pulled out the skin incision; then the suture end from the anteromedial portal is drawn to the skin incision. Arthroscopy Techniques 2014 3, e483-e486DOI: (10.1016/j.eats.2014.05.004) Copyright © 2014 Arthroscopy Association of North America Terms and Conditions

Fig 6 The No. 1 PDS thread is changed to the soft, malleable No. 2 Ethibond thread, which is then relayed through the retinaculum. Arthroscopy Techniques 2014 3, e483-e486DOI: (10.1016/j.eats.2014.05.004) Copyright © 2014 Arthroscopy Association of North America Terms and Conditions

Fig 7 The viewing portal changes to the anterolateral portal. The No. 2 Ethibond suture stitch is tied to plicate the medial retinaculum through the superolateral portal. Arthroscopy Techniques 2014 3, e483-e486DOI: (10.1016/j.eats.2014.05.004) Copyright © 2014 Arthroscopy Association of North America Terms and Conditions

Fig 8 Three to five suture stitches are required for medial retinacular plication. Arthroscopy Techniques 2014 3, e483-e486DOI: (10.1016/j.eats.2014.05.004) Copyright © 2014 Arthroscopy Association of North America Terms and Conditions