Open Lateral Patellar Retinacular Lengthening Versus Open Retinacular Release in Lateral Patellar Hypercompression Syndrome: A Prospective Double-Blinded Comparative Study on Complications and Outcome

Department of Orthopaedic Surgery, University Hospital of Basel, Spitalstrasse 21, Basel, Switzerland.
Arthroscopy The Journal of Arthroscopic and Related Surgery (Impact Factor: 3.21). 01/2012; 28(6):788-97. DOI: 10.1016/j.arthro.2011.11.004
Source: PubMed

ABSTRACT To compare complication rates and outcome of open lateral retinacular (LR) lengthening and open LR release in the treatment of lateral patellar hypercompression syndrome (LPHS).
In a prospective double-blinded study, 28 patients (mean age, 48 years; 21 women and 7 men) received either LR release (14 patients) or LR lengthening (14 patients) in alternating fashion over the same lateral parapatellar skin incision for LPHS (blinding of patients to surgical procedure [i.e., single blinding]). Strict inclusion criteria (retinacular pain, tight retinaculum, decreased patellar mobility) were used to exclude other reasons for anterior knee pain (patellar instability, leg malalignment or maltorsion, trochlear dysplasia, patella alta). The surgeon and postsurgical rehabilitation were the same. Preoperatively and at 3, 6, 12, and 24 months postoperatively, complications, muscle atrophy, and Kujala patellofemoral outcome score were documented by examiners blinded to the surgical procedure (double blinding). All patients completed 2 years of follow-up.
The results of 2 years of follow-up showed that recurrence of LPHS, as indicated by the patellar tilt test and decreased medial patellar glide test, developed in 2 cases after LR release and 1 case after LR lengthening (P > .999). Medial patellar subluxation, as indicated by the gravitation-subluxation test and increased medial patellar glide test, developed in 5 cases after LR release and no case after LR lengthening (P = .041). Quadriceps atrophy, as indicated by the mean circumference difference compared with the healthy contralateral side, was significantly higher (P = .001) in the LR release group (1.8 cm) than in the LR lengthening group (0.2 cm). The mean Kujala score was significantly lower (P = .035) in the LR release group (77.2 points) than in the LR lengthening group (88.4 points).
In this prospective double-blinded study, retinacular lengthening showed less medial instability, less quadriceps atrophy, and a better clinical outcome at 2 years compared with retinacular release. We believe that this may be explained by the controlled preservation of the lateral patellar muscle-capsuloligamentous continuity after retinacular lengthening.
Level II, prospective double-blinded comparative study.

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    • "The lateral retinaculum merges from the distal iliotibial tract to the superior, lateral border of the patella and contains many nerve fibres,40 especially in patients with symptomatic patellofemoral malalignment.41 However, it has been reported that lateral release can lead to secondary medial and lateral patellar instability in knee flexion,42 therefore making secondary repair necessary.43 Lateral retinaculum lengthening shows better results in a prospective and double-blinded study in terms of function and lesser patellofemoral instability than lateral release.42 "
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    • "The procedure should be reserved for the few patients with a clearly identified lateral patella compression syndrome in presence of a tight lateral retinaculum (decreased lateral patellar tilt) following failure of six months of physical therapy [39,46-49]. Pagenstert et al. [50] conducted a level II prospective double blinded comparative study demonstrating better clinical outcomes when retinacular lengthening procedures were employed instead of LRR in the treatment of lateral patellar hypercompression syndrome. "
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