Clinical Outcome of Arthroscopic Lateral Retinacular Release for Symptomatic Bipartite Patella in Athletes

Felli, Lamberto; Formica, Matteo; Lovisolo, Stefano; Capello, Andrea Giorgio; Alessio-Mazzola, Mattia

doi:10.1016/j.arthro.2017.11.038

Cited by 25 publications

(20 citation statements)

References 29 publications

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“…Mori et al suggested that patients with symptomatic BPP may have had pain from not only the bipartite synchondrosis but also concurrent lateral pressure syndrome or patellofemoral syndrome, with lateral retinacular release providing value in improving all knee symptoms from any of the 3 conditions. Felli et al 10 subsequently reported that arthroscopic lateral retinacular release facilitated return to sports and symptom improvement in a series of 11 patients. Among the current study cohort, none of the 5 patients who received isolated lateral retinacular release required reoperation.…”

Section: Discussionmentioning

confidence: 99%

Operative Treatment of Bipartite Patella in Pediatric and Adolescent Athletes: A Retrospective Comparison With a Nonoperatively Treated Cohort

Kallini

Micheli

Miller

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Bipartite patella (BPP) is a developmental anomaly that forms when incomplete patellar ossification leaves a residual fibrocartilaginous synchondrosis between ossification centers. Repetitive traction forces across the synchondrosis can cause knee pain, most commonly presenting in adolescence. Symptoms frequently resolve with nonoperative management. Few surgical case series exist to guide treatment approaches for refractory pain. Purpose: To investigate the clinical features, surgical techniques, and outcomes associated with operative treatment of symptomatic BPP in pediatric and adolescent athletes and to compare features of the series with a large control group managed nonoperatively. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective medical record review was conducted of all patients aged ≤20 years who were diagnosed with symptomatic, radiologically confirmed BPP between 2003 and 2018 at a single tertiary-care pediatric hospital (N = 266). Demographic and clinical variables were analyzed, and additional radiologic and perioperative variables were collected for the surgical subcohort. Results: Of the 266 patients included, 27 were treated operatively (10.2%). When compared with those treated nonoperatively (with rest, physical therapy, cryotherapy, and anti-inflammatory medications), the operatively managed group experienced a longer duration of symptoms before first presentation (21.5 vs 7.6 months; P < .001) and were more likely to be older (mean age, 15.4 vs 12.4 years; P < .001), female (59.3% vs 35.6%; P = .03), and competitive athletes (100% vs 84.5%; P = .02). In the 27 patients treated operatively, procedures were categorized as isolated fragment excision (n = 9), fragment excision with lateral release (n = 8), isolated lateral release (n = 5), fragment screw fixation (n = 4), and synchondrosis drilling (n = 1). The mean time between surgery and return to sports was 2.2 months. Four patients (14.8%) reported residual symptoms requiring secondary surgery, including lateral release (n = 1), excision of residual fragment (n = 1), and fixation screw removal (n = 2). Conclusion: BPP can cause knee pain in adolescent athletes and is generally responsive to nonoperative treatment. Patients undergoing surgical treatment—most commonly female competitive athletes with prolonged symptoms—represented 10% of cases. A variety of surgical techniques may be effective, with a 15% risk of persistent or recurrent symptoms warranting reoperation. Prospective multicenter investigations are needed to identify optimal candidates for earlier interventions and the optimal operative treatment technique.

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Section: Discussionmentioning

confidence: 99%

Operative Treatment of Bipartite Patella in Pediatric and Adolescent Athletes: A Retrospective Comparison With a Nonoperatively Treated Cohort

Kallini

Micheli

Miller

et al. 2021

Orthopaedic Journal of Sports Medicine

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“…1,26 However, IMPI and other complications became increasingly reported, especially in the setting of RPI, with subsequent high rates of disabling patient outcomes. 8,14,15,[27][28][29][30][31][32][33] In addition, evidence on the role of the lateral retinaculum as a secondary lateral patellar stabilizer has become increasingly recognized. 14 Christoforakis et al demonstrated in a biomechanical study that lower forces were required to translate the patella laterally following LRR, marking the importance of lateral soft-tissue restraints, especially when medial restraints are absent.…”

Section: Discussionmentioning

confidence: 99%

Trends in Lateral Retinacular Release from 2010 to 2017

et al. 2021

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Historically, lateral retinacular release (LRR) procedures have been utilized in the treatment of a variety of patellofemoral disorders, including lateral patellar instability. However, in the past decade, there has been an increasing awareness of the importance of the lateral stabilizers in patellar stability, as well as the complications of LRR, such as recurrent medial patellar instability. The purpose of this study was to investigate current trends in LRR procedures from 2010 through 2017 using a large national database. The American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for arthroscopic LRR procedures (the Current Procedural Terminology [CPT] code, 29873) from 2010 to 2017. The number and incidence of lateral release procedures, both isolated and nonisolated, were analyzed and separated into cohorts for analysis. Age and gender of the LRR cohort was investigated and compared with all other orthopaedic procedures during the same time period in the NSQIP database. In addition, concomitant procedures and associated International Classification of Disease-9th Revision (ICD-9) and ICD-10th Revision (ICD-10) codes were analyzed over time and between LRR groups. From 2010 to 2017, 3,117 arthroscopic LRRs were performed. The incidence for LRR was 481.9 per 100,000 orthopaedic surgeries in 2010 and significantly decreased to 186.9 per 100,000 orthopaedic surgeries in 2017 (p < 0.01). LRR was more commonly performed in females (66%) and 58% of patients were under 44 years of age. In addition, LRR was most commonly performed with a concomitant meniscectomy (36%), synovectomy (19%), or microfracture (13%), and for a diagnosis of pain (22%). The overall incidence of LRR procedures significantly decreased from 2010 to 2017. LRRs were more commonly performed in younger, female patients for a diagnosis of pain with the most common concomitant procedure being meniscectomy, synovectomy, or microfracture.

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“…Shortening of the patellar tendon and long-term PF osteoarthritis are possible consequences of the Goldthwait procedure for recurrent patellar dislocation, but the association with lateral retinacular release seems to provide better long-term outcomes 1, 2, 3, 5. Aärimaa et al 10 .…”

Section: Discussionmentioning

confidence: 99%

“…Any associated meniscal tear is treated, if necessary. With the knee in full extension, the accessory superolateral portal is created about 2.5 cm proximal to the superolateral corner of the patella 5 . Patellar tracking is evaluated through the accessory superolateral portal to identify excessive patellar lateralization with the patella riding over the lateral femoral trochlear facet with increased lateral tilt (Fig 1).…”

Section: Surgical Techniquementioning

confidence: 99%

Arthroscopic Lateral Retinacular Release and Modified Goldthwait Technique for Patellar Instability

Felli

Lovisolo

Capello

et al. 2019

Arthroscopy Techniques

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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.

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Clinical Outcome of Arthroscopic Lateral Retinacular Release for Symptomatic Bipartite Patella in Athletes

Cited by 25 publications

References 29 publications

Operative Treatment of Bipartite Patella in Pediatric and Adolescent Athletes: A Retrospective Comparison With a Nonoperatively Treated Cohort

Operative Treatment of Bipartite Patella in Pediatric and Adolescent Athletes: A Retrospective Comparison With a Nonoperatively Treated Cohort

Trends in Lateral Retinacular Release from 2010 to 2017

Arthroscopic Lateral Retinacular Release and Modified Goldthwait Technique for Patellar Instability

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