Arthroscopy‐controlled medial reefing and lateral release for recurrent patellar dislocation: clinical, radiologic outcomes and complications

Abstract

Background Few studies have reported the clinical outcomes of the medial reefing procedure and lateral release with arthroscopic control of medial retinacular tension in patients with recurrent patellar dislocation. The purpose of this study was to investigate the clinical, radiologic outcomes and complications of arthroscopy-controlled medial reefing and lateral release. Methods Patients who underwent arthroscopy-controlled medial reefing and lateral release for recurrent patellar dislocation between November 2007 and June 2017 were retrospectively evaluated. The clinical outcome (Kujala score), radiologic outcome (congruence and patellar tilt angles), and complications were evaluated at final follow-up. The results were also compared with literature-reported outcomes of other surgical procedures for patellar dislocation. Results Twenty-five patients (mean age, 18.3 ± 4.8 years) were included in the study. The mean clinical follow-up period was 7.0 ± 2.5 (range, 3.8–12.2) years. The mean Kujala score was significantly improved from 54.7 ± 14.0 (range, 37–86) preoperatively to 91.0 ± 7.6 (range, 63–99) at a mean follow-up period of 7 years (P < 0.001). The radiologic results also significantly improved from 17.8° ± 5.9° to 6.8° ± 2.4° (P < 0.001) in the congruence angle and from 17.5° ± 8.2° to 5.6° ± 3.1° (P < 0.001) in the patella tilt angle at a mean follow-up period of 3.6 years. One patient developed a redislocation after a traumatic event, and two patients showed patellofemoral osteoarthritis progression. Conclusions Arthroscopy-controlled medial reefing and lateral release significantly improved the clinical and radiologic outcomes of the patients with recurrent patellar dislocation at a mean follow-up period of 7 years. The results of this study are comparable with the literature-reported outcomes of other surgical procedures for patellar dislocation. Level of evidence Level IV, retrospective therapeutic case series.

Lateral retinacular release combined with MPFL reconstruction makes a meaningful role in the treatment of Recurrent Patellar Dislocation: by a digital tensiometer test

“…Beck [19] in 2007 used a digital tensiometer to observe patellofemoral ligament tension on frozen cadavers and concluded that a force of 2 N would restore a good patellofemoral track and Philippot [20] that a force of 10 N would restore a good patellofemoral track, but both authors used frozen cadavers and knees that had not previously been subluxated, and therefore may not have maximised the simulate the mechanics and graft tension in patients with patellar dislocation, our inclusion criteria in the study were all patients with recurrent patellar dislocation and yielded a pre-LRR, graft tension of approximately 35 N and post-LRR, a force of approximately 24 N was required to restore a good patellofemoral track, we used observation of graft tension to observe a statistically signi cant difference in the change in pre-LRR surgery and no previous studies in the literature have preoperative graft tension, the comparison in this study could provide new data to support the study of LRR [21,22].…”

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

“…In some operations, under arthroscopic observation, the joint capsule was cut through the joint and released layer by layer until the subcutaneous tissue was reached. 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. 15 , 22 …”

Efficacy of Osteopathic Manipulative Treatment for Pain Reduction in Patients With Patellofemoral Pain Syndrome: A Meta-Analysis of Randomized Controlled Trials

“…Non-operative approaches include medially directed tape application, nonsteroidal anti-inflammatory drugs, and exercise regimens targeting the trunk, hip, and decreased extremity muscle mass [11]. Surgical options involve arthroscopy, lateral release, and medial tissue tightening, though these have been deemed ineffective [12,13]. Current literature suggests that a majority of patients may see improvement through the use of conservative treatments [9].…”