Lateral patellar retinacular release

Abstract

Forty-one lateral knee retinacular releases were per formed in 33 patients over a 27-month period. This group represented 6.9% of patients seen during that time with symptomatic patellalgia. A retrospective analysis was done on 24 patients from that group who returned for follow-up examination 8 to 16 months after surgery. Thirty-three knees in these patients were operated upon by one of the authors and as sessed independently by the other author. Eighteen females and six males had surgery at an average age of 18 years (range 13 to 32). All patients had at least three months of supervised, nonoperative management that emphasized flexibility and static strengthening of the quadriceps and hamstrings. The preoperative history of injury, pain pattern, and pseudolocking were evaluated. Roentgenograms were checked for patella alta. Follow-up examination included assessment of pain factors, Q angle, patellar tracking, ligamentous laxity, and range of motion of hip, knee, ankle, and foot joints. Hamstring and quad riceps power was measured with a Universal testing machine. Intensive postoperative physical therapy emphasized obtaining and maintaining a painless range of motion prior to strengthening. Results assessed functional and anatomic criteria. Overall, 76.7% of patients had excellent or good results and improved following surgery. Males had a higher proportion of excellent results. The benefits of the procedure tended to remain at the level noted three months postoperatively. Although increased ligamentous laxity, increased Q angle, or patella alta did not preclude a good or excellent result, all patients in this series with fair or poor ratings had increases in Q angle, ligamentous laxity, knee valgus, genu recurvatum, and body weight. Lateral knee retinacular release, a noncomplex pro cedure, does not interfere with the permanent align ment of the extensor mechanism in the skeletally immature individual. It is recommended for patients who do not have evidence of significant patellar mal alignment but fail a supervised, conscientious, non operative therapeutic program.