Arthroscopic Lateral Retinacular Release and Modified Goldthwait Technique for Patellar Instability

Abstract

Surgical options for patellofemoral (PF) disorders include proximal or distal realignment, cartilage restoration techniques, open or arthroscopic lateral retinacular release, and medial soft-tissue reefing. Skeletal immaturity and donorsite morbidity can be of concern in most reconstructive procedures. The Goldthwait procedure with hemi-patellar transfer and medialization combined with arthroscopic lateral retinacular release results in medialization of the PF contact point in flexion and corrects maltracking to prevent recurrent patellar dislocation. This functional procedure is indicated for PF instability and has historically been used in children to accommodate the immaturity of the tibial tubercle and physis. The purpose of surgical correction is to improve PF tracking, reducing the lateralizing forces on the patella with the correction of the Q angle (angle between the quadriceps tendon and patellar tendon). The purpose of this Technical Note was to describe, in detail, arthroscopic lateral retinacular release combined with the modified Goldthwait procedure for recurrent patellar instability.

Lateral Retinacular Release for Treatment of Excessive Lateral Pressure Syndrome: The Capsule-Uncut Immaculate (CUI) Technique

“… 12 , 13 , 14 , 15 In other operations, a layer-by-layer incision was made inward with surgical instruments from outside the joint capsule, which often required the creation of a subcutaneous space. 16 , 17 , 18 , 19 , 20 , 21 All of these procedures cut open the knee joint capsule and destroyed the integrity of the joint capsule. Despite the achievement of significant improvements in the incidence of postoperative complications compared with open surgery, as well as functional scores such as the International Knee Documentation Committee (IKDC) score, Lysholm score, and Kujala score, postoperative patellofemoral joint instability, weakened extensor mechanism muscle strength, and intra-articular hematoma still occurred.…”

Derotational Hybrid Closed-Wedge High Tibial Osteotomy for Knee Osteoarthritis With Patellar Subluxation Caused by Tibial Torsional Deformity

“…Gentle knee hyperextension achieved by placing a small pillow beneath the patient’s heel can help the passage of the instruments through the patellofemoral joint. 22 The lateral retinaculum is released from near the distal end of the patella to just beyond the proximal end of the patella.…”

Management of Fixed Dislocation of the Patella

“…11 Of note, arthroscopic lateral release is a technique which has been implemented in the treatment of patients with recurrent patellar instability, in combination with procedures such as medial reefing, MPFL reconstruction, and distal realignment. 38,39 However, there have not been any documented cases in which arthroscopic lateral release has been implemented for congenital dislocation of the patella specifically. This is due to the extensive nature of the release required to centralize the patella in this condition and the small size of many of these pediatric knees.…”