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


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.

Download full-text


Available from: Geert Pagenstert
  • Source
    • "Many of the common conservative treatments have been well reported in the literature, and covered by a number of review papers [1] [2] [3]. The surgical treatment of AKP is not discussed in the literature with the same quality of studies as has been demonstrated for the conservative treatments [4] [5] [6]. Generally there are few randomised controlled trials (RCTs), and those that have been conducted have failed to prove that surgical therapy is more effective than nonsurgical treatments [7]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Anterior knee pain (AKP) encompasses a range of pathologies. As a result, there are a number of therapeutic options used to treat AKP. The non-operative treatments have been analysed in a number of randomised controlled trials and systematic reviews. There is however a scarcity of such publications covering the surgical management of AKP. There are no systematic reviews that have investigated surgical interventions for AKP due to pathology of the infrapatellar fat pad (IFP). The aims of this study were to review the literature systematically, to establish which surgical procedures have been used to treat IFP disease and to determine their efficacy. The review was conducted in accordance with the PRISMA reporting guidelines. A search of the literature was performed on 1st January 2014 using multiple databases including CENTRAL, MEDLINE, EMBASE, PubMed, and Google Scholar. The quality of the studies was assessed using Oxford Evidence-Based Medicine Levels of Evidence guidelines and the GRADE approach. Twenty-four eligible studies were found and included. The critical appraisal identified that the current evidence-base has low methodology quality. The clinical findings indicated that there is a positive trend towards the surgical management of IFP disease for AKP symptoms. Excision of IFP tumours and resection of the IFP in Hoffa's disease can lead to improvements in symptoms and function. Truly robust evidence to support the surgical management of IFP pathology requires randomised controlled trials; however the expenses involved to design such trials means that they are unlikely to be undertaken for this uncommon disorder. Consequently well-designed and well-reported case series need to be undertaken to improve our current understanding that includes recording quantitative measures such as range of knee motion, VAS Pain scores and a validated scoring system. Level IV. CRD42013006550. Copyright © 2015 Elsevier Masson SAS. All rights reserved.
    Full-text · Article · Apr 2015 · Orthopaedics & Traumatology Surgery & Research
  • Source
    • "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 "
    [Show abstract] [Hide abstract]
    ABSTRACT: Patellofemoral instability not only involves lateral patellar dislocation, patellar mal-tracking or subluxation but can also cause a limiting disability for sports activities. Its underlying causes are known as morphological anomalies of the patellofemoral joint or the mechanical axis, femorotibial malrotation, variants of the knee extensor apparatus, and ligamentous insufficiencies often accompanied by poor proprioception. Athletes with such predisposing factors are either suffering from unspecific anterior knee pain or from slightly traumatic or recurrent lateral patellar dislocation Treatment options of patellar instability are vast, and need to be tailored individually depending on the athlete's history, age, complaints and physical demands. Different conservative and surgical treatment options are reviewed and discussed, especially limited expectations after surgery.
    Full-text · Article · Jul 2013 · Orthopedic Reviews
  • Source
    • "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. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Management of patellofemoral joint pathology is challenging as a result of the unique and complex organization of static forces and dynamic factors contributing to its functional capacity. Anterior knee pain is a common musculoskeletal complaint seen daily in the practices of primary care physicians, rheumatologists, and orthopedic surgeons. The key to successful treatment lies not only in the correct diagnosis of a chondral defect, but more importantly, in the accurate identification of associated pathomechanical factors. Appreciating the pathoanatomic basis of the disease and addressing imbalances and anatomical abnormalities should guide treatment. Despite the complexity of the interplay of various components it is essential to attempt to describe patellar malalignement as a clinical entity in order to proceed with appropriate surgical management and successful outcomes. The goals of patellofemoral re- alignment surgery should be to create both a stable environment for optimal extensor mechanism performance and an appropriate load transmission for optimal cartilage wear and joint loading. In the context of this article we will review the operative management of patellofemoral malalignment; the indications for surgery, the different techniques available and the evidence regarding their effectiveness. A large number of procedures have been employed and they have all undergone various modifications over the course of the years. The majority of publications are retrospective series in poorly defined population groups. There are significant methodological inconsistencies and as a result there is lack of strong evidence base for the majority of these procedures.
    Full-text · Article · Jul 2012 · The Open Orthopaedics Journal
Show more