Arthroscopic treatment for patellar dislocation with lateral retinacular release combined with medial patellofemoral ligament reconstruction / 中国修复重建外科杂志

Objective: To investigate the effectiveness of the arthroscopic lateral retinacular release combined with medial patellofemoral ligament (MPFL) reconstruction for patellar dislocation.

The Effect of Concomitant Arthroscopic Lateral Retinacular Release on Postoperative Patellar Position and Orientation in Open Wedge High Tibial Osteotomy

PURPOSE: The purpose of this study was to evaluate the effect of concomitant arthroscopic lateral release (LR) in open wedge high tibial osteotomy (OWHTO) by comparing the pre- and postoperative radiological parameters of patellar position and orientation. MATERIALS AND METHODS: The study was comprised of 19 knees undergoing OWHTO and concomitant LR and 18 knees undergoing OWHTO alone. Radiological parameters for patellar position and orientation included the Caton-Deschamps index (CDI), Blackburne-Peel index (BPI), patellar tilting angle (PTA), patellar lateral shift (PLS), and patellofemoral distance (PFD), which were evaluated in the preoperative period and at one year after surgery. RESULTS: Patellar height was significantly reduced after surgery as indicated by the decrease in BPI (p=0.03) in the OWHTO/LR group, and decrease in CDI (p=0.03) and BPI (p=0.04) in the OWHTO alone group. PTA and PLS were significantly reduced after the combined OWHTO/LR procedure (p=0.04 and p=0.04, respectively). By contrast, no significant changes were detected when isolated OWHTO was performed. CONCLUSIONS: OWHTO induced a postoperative decrease in patellar height in both groups. Regarding the change in patellofemoral alignment, concomitant LR in OWHTO significantly decreased lateral patellar tilt and shift, while no significant difference in those parameters were noted in the OWHTO alone knees.

Double bundle medial patellofemoral ligament reconstruction with anterior half tendon of peroneus longus and lateral retinacular release in treatment of recurrent patellar dislocation:A report of 12 cases and literature review / 吉林大学学报(医学版)

Objective:To observe the process and curative effect of 12 cases of recurrent patellar dislocation treated by double bundle medial patellofemoral ligament (MPFL)reconstruction with anterior half peroneus longus and lateral retinacular release,and to investigate the etiology and treatment method of recurrent patellar dislocation. Methods:A total of 12 patients with recurrent patellar dislocation were enrolled in this study,the MPFL was reconstructed with the anterior half peroneus longus,patellar fixation with suture anchors was completed with 2 parallel 5.0 mm anchors which were spaced 1.0 cm apart at the anatomic insertion site of the native MPFL,the femoral side was secured with a interference screw,and the lateral retinaculum was released at the same time.The Lysholm score,IKDC score,congruence angle,J sign,grind test,and apprehension test of the patients before and after operation were detected.Results:The mean follow-up period was 16.4 months,and the Lysholm score of the patients before operation was lower than the last follow-up (t = 9.03,P < 0.001);the IKDC score of the patients before operation was lower than the last follow-up (t = 9.75,P < 0.001);the congruence angle of the patients before operation was larger than after operation (t = 7.22,P <0.001).All of the patients demonstrated the positive results before operation in J sign,grind test,and apprehension test,and the negative results in J sign, grind test,and apprehension test after operation.No patient appeared pateela fracture and recurrence of patellar dislocation during the follow-up period.Conclusion:The curative effect of reconstruction of the MPFL with anterior half peroneus longus combined with lateral retinacular release is well in the treatment of recurrent patellar dislocation,which is suitable for clinical promotion.

A Study on the Criteria for Lateral Retinacular Release in Total Knee Arthroplasty: The No Thumb Technique with One Stitch Method

PURPOSE: This study was performed to determine new criteria for performing lateral retinacular release (LRR) without having a detrimental effect on patellar tracking. MATERIALS AND METHODS: For 17 patients who underwent bilateral TKAs, LRR was not performed at one side (A) due to improvement of patellar tracking after deflation of tourniquet although maltracking existed with the inflation of tourniquet. At the other side (B), LRR was not performed either because patellar tracking improved with one stich method although maltracking existed regardless of tourniquet status. We measured the lateral patellar tilt angle (LPTA) of each side inthose 17 patients after 1 year after TKAs and compared them. We also surveyed the incidence of LRR in 225 primary TKAs with the staged method of patellar tracking evaluation during the same period. RESULTS: The average LPTA was 3.4degrees at side (A) and 4.6degrees at side (B) respectively. There was no significant difference in LPTA between side (A) and side (B) (p=0.337). From the survey for incidence of LRR in 225 primary TKAs during the same period, LRR was not required in 19% of patients showing good patellar tracking with inflation of tourniquet, 58% of patients showing improved patellar tracking after deflation of tourniquet and 21% of patients showing improved patellar tracking by one stitch method regardless of tourniquet status. Consequently, only 2% of patients required LRR in primary TKA. CONCLUSION: One stitch method under the deflation of tourniquet in evaluating process of patellar tracking during primary TKAs is supposed to be very effective and to reduce the incidence of LRR to only 2% without influencing the LPTA.

Lateral Retinacular Release in Total Knee Arthroplasty; Patella Resurfacing versus Retaining

PURPOSE: To investigate the rate of lateral retinacular release and the contributing factors between the patellar resur- faced total knee arthroplasty(TKA) and patellar retained TKA. MATERIAL AND METHODS: From Jan. 2003 to Jan. 2006, 179 cases(90 patella retained, PR; 89 patellar resurfaced, PS) were enrolled in this study. To investigate the contributing factors on the lateral retinacular release along the patellar replacement, the preoperative and postoperative radiographic evaluation was done. Patellar height, congruence angle and medial displacement was measured with the Merchant view. Anterior-posterior knee distance was measured at a lateral film. The statistical significance between two groups was analyzed using the student's t-test. RESULTS: Lateral retinacular release was done in 59 of 179 cases. Thirty-six cases of PR group and 23 cases of PS group were undertaken. The rate of lateral retinacular release was higher in PR group(p<0.05). The difference between preoperative and postoperative patellar height at a Merchant was 2.5, 0.5mm reduction in PS and PR group respectively. PS group showed more medial displacement(mean 2.5mm) than PR group(mean 1.2mm)(p<0.05). CONCLUSION: In PR group, higher rate of a lateral retinacular release was shown than PS group. Less reduction of patellar height and less medial displacement of patella might be related with the high rate of a lateral retinacular release in PR group.

A Study of the Decision Status for the Lateral Retinacular Release based on Lateral Patellar Tilt Angle in Total Knee Arthroplasty: Related with Tourniquet Effect

PURPOSE: The pattern of patellar tracking is changed depending upon whether a tourniquet is operating or not. This study was performed to suggest the criteria of lateral retinacular release(LRR) in total knee arthroplasty(TKA) based on the lateral patellar tilt angle(LPTA). MATERIALS AND METHODS: In study 1, the LPTA was compared in 24 bilateral TKAs, one side was required LRR and performed LRR, but not required and not done LRR on the other side according to the patellar tracking status in deflating tourniquet. In the second prospective study, we performed LRR one side and not the other side intentionally in all 11 patients' knees(22 knees) those who were same situations that the patellar tracking was not good under the condition of operating tourniquet but tracking was improved after deflation of tourniquet. We compared LPTA in both studies with paired t-test of SPSS 11.0. RESULTS: The LPTA was average 4.86 degrees on the side of performed LRR and 4.83 degrees on the other side in 24 patients. There was no significant difference of LPTA between them(p=0.952) in study 1. And the LPTA was average 5.18 degrees on the side of underwent LRR based on the condition of operating tourniquet, 5.45 degree on other not LRR side knee. There were also no significant difference between them(p=0.829) in study 2. CONCLUSION: The incidence of LRR will be reduced with no detrimental effect on lateral patellar tilt angle when making decision of LRR based on the patellar tracking status in deflating tourniquet.

Incidence of Lateral Retinacular Release in Total Knee Arthroplasty

PURPOSE: To assess the incidence of lateral retinacular release (LRR), performed to improve patellar tracking in total knee arthroplasty according to tourniquet effect and design of femoral components. MATERIALS AND METHODS: From March 1999 to March 2004, we have evaluated the patellar tracking status based on "no thumb technique" with or without tourniquet inflation and calculated the frequency of LRR respectively in order to assess the tourniquet effect. In addition, we have examined the difference in the frequency of LRR according to the femoral component designs. RESULTS: Among 286 total knee arthroplasties, LRR was need in 241 cases (84.3%) under the inflated tourniquet, but only in 81 cases (28.3%) under deflated tourniquet. In Genesis II prosthesis, LRR was needed in 3 cases (9.7%) among the 31 cases after deflating tourniquet, but in 25 cases (80.6%) with inflating tourniquet. In Scorpio prosthesis, LRR was needed in 52cases (33.8%) among 154 cases after deflating tourniquet, but in 124 cases (80.5%) with inflating tourniquet. In the other prostheses, LRR was needed in 92 cases (91.1%) among 101 cases with inflating tourniquet inflation, but only in 26 cases (25.7%) after deflating tourniquet. CONCLUSION: The tourniquet application altered intraoperative patellofemoral tracking during total knee arthroplasty. The need for LRR should be evaluated after tourniquet deflation and the incidence of LRR is expected to reduce by 56% with this criteria. The frequency of LRR also could be influenced by femoral component designs.

Comparison of Surgical Approach in Total Knee Arthroplasty: Midvastus and Medial Parapatellar Approaches

PURPOSE: In the incidence of lateral retinacular release, patellar tracking and clinical results were analyzed according to the surgical approach of total knee arthroplasty. MATERIALS AND METHODS: 286 osteoarthritic knees (228 patients) who had undergone patellar non-resurfaced total knee arthroplasty were analyzed and divided into two groups. Group I was 171 cases with midvastus approach, and group II was 115 cases with medial parapatellar approach. On the basis of patellar subluxation degree with no thumb test, we were deciding on whether the lateral retinacular release was needed or not. We radiologically evaluated patellar tracking, and clinically evaluated the range of knee motion, flexion contracture, and anterior knee pain. RESULTS: The lateral retinacular release was performed in 6 cases(3.5%) from group I, and 18 cases(15.7%) from group II (p=0.001). Patellar maltracking was observed in 26 cases, which were 14 cases(8.2%) from group I and 12 cases(10.4%) from group II (p=0.517). On the other hand, patellar maltracking was found in only 2 cases(8.3%) from retinaculum released group, and in 24 cases(9.2%) from retinaculum non-released group (p=0.623). Surgical approach and lateral retinacular release had no influence on clinical results. CONCLUSION: Midvastus approach could reduce the need for lateral retinacular release, but it had no influence on patellar maltracking and clinical results.

Comparative Study between the Group with Lateral Retinacular Release and the Group without Lateral Retinacular Release Following Total Knee Arthroplasty

PURPOSE: We compared the results of total knee arthroplasties combined with lateral retinacular release with those without lateral retinacular release. MATERIALS AND METHODS: Results of 277 total knee arthroplasties from 1996 to 2002, follow up for at least one year ( average follow-up periods : 32 months). Lateral retinacular release was performed in 190 knees (70.1%) and not performed in 87 knees (29.9%). The clinical results of total knee arthroplasties were evaluated by the Knee Scoring System of hospital for Special Surgery (HSS) and range of motion. The patello-femoral complications were evaluated by tilt and displacement of patella at the last follow-up Hughston 's view. Osteonecrosis and fracture of patella were evaluated by simple x-ray. RESULTS: HSS score and range of motion improved postoperatively in both groups, but there was no sig-nificant difference between the two groups. There were 3 cases (3.4%) with patellar subluxations and 1 case (1.1%) with patellar dislocation in the group without lateral retinacular release. There was no avascu-lar necrosis or fracture of patella in either group. CONCLUSION: We suggest that lateral retinacular release can be performed without great risk of potential patellar complications in total knee arthroplasties requiring lateral retinacular release for proper patellar tracking.

Lateral Retinacular Release in Primary Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: To determine the effect of lateral retinacular release on patellofemoral alignment in primary total knee arthroplasty (TKA). MATERIALS AND METHODS: From June 1990 to December 1998, 351 cases of TKA, which were followed up more than 3 years, were divided into two groups, 147 cases (group I) with lateral retinacular release and 204 cases (group II) were without release. We compared the two groups in terms of the range of motion, patellofemoral alignment and clinical results using a Hospital for Special Surgery score. RESULTS: Average range of motion in group I (112 degrees preoperatively and 113 degrees on final follow-up) and group II (114 degrees preoperatively and 113 degrees on final follow-up) showed no statistical difference. The average functional knee score in group I (58 preoperatively and 88 on final follow-up) and group II (59 and 85 respectively) also showed no statistical difference. Patellar maltracking occurred in 4 cases (2.7%) in group I and 31 cases (15.2%) in group II. Patellar tilting (4.5 degrees in group I and 7.7 degrees in group II) and patellar translation (3.7 mm in group I and 7.8 mm in group II) showed significant statistical difference between the two groups at the final follow-up. CONCLUSION: Patellar tracking was better in the lateral retinacular release group, although there was no clinically significant difference at the short term follow-up period.

Patellofemoral Complications Following Total Knee Arthroplasty: Comparative Study between the Group with Lateral Retinacular Release and the Group without Lateral Retinacular Release / 대한정형외과학회잡지

Results of 170 total knee arthroplasties(TKAs) performed from 1986 to 1995, followed up for at least one year, were reviewed. Lateral retinacular release was performed in 76 knees(45%) and not performed in 94 knees(55%). We compared the results of TKAs combined with lateral retinacular release with those without lateral retinacular release. The clinical results of TKAs were evaluated by the Knee Scoring System of Hospital for Special Surgery(HSS). The average follow-up period was 34 months. The clinical results assessed by HSS score, pain score and range of motion improved postoperatively in both groups, but there was no significant difference between the two groups. There were 8(4.7%) with patellar subluxations in 170 TKAs, one(1.3%) in the group with lateral retinacular release and 7(7.5%) in the group without lateral retinacular release(t-test; p<0.05). Analysis of lateral tilt of patella on roentgenographs also showed a significant difference between the two groups. 7 knees(9.2%) with lateral tilt were observed in the group with lateral retinacular release and 22 knees(23.4%) with lateral tilt in the group without lateral retinacular release(t-test; p<0.05). There was no osteonecrosis or fracture of patella in either group. In summary, lateral retinacular release might improve the patellar tracking and lower the incidence of patellar subluxation and lateral tilt of patella. Lateral retinacular release alone did not seem to cause patellar osteonecrosis and subsequent patellar fracture which were detectable in plain roentgenographs. So, we suggest that lateral retinacular release can be performed without great risk of potential patellar complications in TKAs requiring lateral retinacular release for proper patellar tracking.