Trends in Lateral Retinacular Release from 2010 to 2017

Abstract

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.

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

“…Medial patellar retinaculum (MPR)sewing, LRR and MPFL reconstruction are considered to be the three most common treatments for patellar instability [1,3,6,11].Of all of these, LPR release has been used to treat patellofemoral instability for a longer period of time, with Merchant [12] using this technique to treat patellofemoral instability as early as 1974. Although the surgical approach to LRR has changed over the years from skin incision to arthroscopic release of the Lateral retinacular, there is a more consensus that LRR has become the routine surgical procedure for patellofemoral instability and has yielded relatively good postoperative knee function scores [13][14][15][16].…”

Editorial Commentary: Handling the (Contact) Pressure in Patellofemoral Surgery: The Role of Lateral Retinacular Release

“…T he role of lateral retinacular release for the treatment of patellofemoral pathology has evolved over the years. 1,2 This procedure was once popularized in the treatment of patellofemoral pain, instability, and maltracking, due to its ability to reduce contact pressures in the lateral patellofemoral compartment. However, reports of resultant iatrogenic medial patellar instability and decreases in lateral patellar stability through clinical and biomechanical studies have limited the role of lateral release as an isolated procedure in the treatment of patellar instability.…”