A technique for lateral retinacular release

The following article does not intend to present indications or contraindications for lateral retinacular release as a therapeutic measure; it presents a simple, effective method of doing a complete lateral retinacular release with a minimal degree of effort for the surgeon, if he or she decides on release as a therapeutic measure. A carefully designed scissors that allows a complete release of the lateral retinaculum in a matter of moments is described, as well as a basic technique for a complete release. This method has given the author satisfactory release in all cases, with a minimal degree of complications. The instrumentation is basic, effective, and readily available.     

Factors associated with poor results following arthroscopic subcutaneous lateral retinacular release

Forty-eight patients who underwent 55 arthroscopic subcutaneous lateral retinacular releases with an average follow-up period of 15 months were examined. Advancing age, postoperative hemarthrosis, incomplete release, incomplete quadriceps rehabilitation, and severe ligamentous laxity are factors that may contribute to a poor result following this procedure. In patient selection the increased risk of poor results in patients older than 30 years of age and in those with generalized ligamentous laxity must be considered. During surgery, release of the tight lateral tether is essential to produce a positive "tilt" sign, signifying complete release. Although postoperative hemarthrosis is usually associated with immediate morbidity, it can ultimately lead to poor results. Incomplete or incorrect quadriceps rehabilitation is almost always associated with a compromised result.     

Lateral retinacular release for intractable lateral retinacular pain

Lateral retinacular release was performed in a series of patients with intractable lateral retinacular pain characterized by tenderness localized in some portion of the lateral retinaculum. Patients with other patellofemoral problems were excluded. Of 14 knees, 79% responded favorably. Lateral retinacular release may be best indicated in patients with less severe malalignment of the patella and intractable pain in the lateral retinaculum.     

关节镜下髌骨外侧支持带松解术治疗髌骨外侧高压综合征

目的 探讨关节镜下髌骨外侧支持带松解术治疗髌骨外侧高压综合征(ELPS)的临床疗效.方法 对42例经非手术治疗无效的ELPS患者行关节镜辅助下经皮髌骨外侧支持带松解手术,术后积极康复训练.结果 42例均获得随访,时间12～19(15±2.3)个月.Lysholm评分:优26例,良9例,可5例,差2例,优良率83.3%,患者主观满意率为95.2%.Lysholm评分从术前52～74(65.08±4.26)分提高到术后62～100(92.38±2.76)分,差异有统计学意义(t=5.98,P＜0.05).结论 关节镜下髌骨外侧支持带松解术治疗ELPS具有操作简单、创伤小的优点.能否获得满意的疗效取决于四个方面:术前正确评估、严格手术适应证、正确手术操作及术后康复训练.     

Patellar retinacular peel: an alternative to lateral retinacular release in total knee arthroplasty

The need to perform a lateral retinacular release (LRR) during total knee arthroplasty (TKA) may be lessened or eliminated by performing a patellar retinacular peel (PRP). PRP involves peeling the extensor retinaculum off the dorsolateral border of the patella to the extent necessary to facilitate patellar eversion. Generally, a portion of the lateral patellar facet is removed to allow conformity with a round patellar prosthesis. The combination of retinacular peel and partial facetectomy decreases lateral retinacular tension, which reduces the tendency toward lateral subluxation. In the study reported here, a series of 50 TKAs that included a PRP in all cases was compared with an earlier series of 50 TKAs that included LRR for control of patellar tracking, as needed. The incidence of anterior knee pain was lower in the PRP group than in the LRR group, though this difference was not significant from a statistical perspective. The 2 groups were virtually identical on other comparison criteria. PRP seems to be a viable alternative to LRR.     

The effect of lateral retinacular release in idiopathic chondromalacia patellae

The results of lateral retinacular release were evaluated in 28 patients with idiopathic chondromalacia patellae. Follow-up was performed 3-5 years after the operation. At follow-up 13 patients were improved, while the symptoms were equal or intensified in 15 patients. However, compared with the situation before the operation, the levels of activity were increased in only two patients, while the levels of activity were unchanged or reduced in the remaining 26 patients. From this study it is concluded that the results of lateral retinacular release for idiopathic chondromalacia patellae are poor with regard to relief of symptoms, and especially with regard to improvement in ability to perform physical activities.     

The effect of lateral retinacular release in idiopathic chondromalacia patellae

Summary The results of lateral retinacular release were evaluated in 28 patients with idiopathic chondromalacia patellae. Follow-up was performed 3–5 years after the operation. At follow-up 13 patients were improved, while the symptoms were equal or intensified in 15 patients. However, compared with the situation before the operation, the levels of activity were increased in only two patients, while the levels of activity were unchanged or reduced in the remaining 26 patients. From this study it is concluded that the results of lateral retinacular release for idiopathic chondromalacia patellae are poor with regard to relief of symptoms, and especially with regard to improvement in ability to perform physical activities.     

Evaluation of patellar retinacular tension during total knee arthroplasty: Special emphasis on lateral retinacular release

Tension of a suture placed to the patella to close the medial capsule during 35 primary total knee arthroplasties was measured. The increase in tension with flexion after arthrotomy was significantly smaller in 10 knees with a subvastus incision (subvastus group) than in 25 knees with a standard medial parapatellar incision (standard group). With the prosthesis in place, the patella showed maltracking with the no-thumb technique in 1 knee (10%) of the subvastus group and in 9 knees (36%) of the standard group. A lateral retinacular release was performed in 5 of these 10 knees but not in the remaining 5 knees because the increase in tension was a minimum. There was no case of patellar maltracking at an average follow-up period of 2.1 years after surgery, suggesting that a lateral release is not always needed if retinacular tension shows no significant increase, even cases where the patella dislocates with the no-thumb technique.     

关节镜下外侧支持带松解治疗髌骨外侧高压综合征

目的探讨关节镜下外侧支持带松解治疗髌骨外侧高压综合征的效果和临床意义.方法采用关节镜下外侧支持带松解术治疗39例(51膝)髌骨外侧高压综合征.男1例(1膝),女38例(50膝);单膝27例,双膝12例;平均年龄49.6岁(28～71岁).临床症状以髌股关节钝痛为特点,疼痛位置不易确定,髌股关节负荷过度的活动会使疼痛加重.物理检查见Q角增大(＞20°)45膝,髌软骨外侧小面抠触痛50膝,外侧支持带压痛39膝,被动髌骨倾斜试验阳性51膝,内外侧滑动试验阳性49膝,压髌试验阳性51膝.X线检查轴位片见髌股对合角异常32膝.术中在关节镜监视下,用射频汽化钩刀松解外侧支持带,必要时可向近端扩大松解范围,切断部分股外侧肌,达到完全松解.结果术后所有病例均得到随访,平均随访14.5个月(3～26个月).疗效评定参照改良Lysholm评分标准,优37膝,良12膝,可2膝.Lysholm评分从术前平均(62.04±5.98)分(49～75分)提高到术后平均(93.71±3.55)分(86～100分),有显著性差异(t=6.63,P＜0.001).髌股对合角异常的32膝中术后有30膝髌股对合角恢复正常(94%).术后5膝有血肿形成(10%).结论关节镜下外侧支持带松解是一种微创的软组织平衡手术,能够有效地缓解髌骨外侧高压综合征引起的髌股关节疼痛,且并发症较少.     

Indications for lateral retinacular release in total knee replacement

The rule of no thumb test was compared with the towel clip test in determining the need for lateral retinacular release in 200 consecutive primary total knee replacements. The towel clip test was positive in 13 knees (6.5%) and the rule of no thumb test was positive in 78 knees (39%). Using a positive towel clip test as the indication for lateral retinacular release, there was no radiographic evidence of patellar tilt, subluxation, or dislocation in any knee at 6 months postoperatively. Therefore, the rule of no thumb test falsely predicted the need for lateral release in 65 knees (32.5%). The authors advocate the towel clip test to determine the need for lateral retinacular release.     

An analysis of complications in lateral retinacular release procedures

Complications were reviewed for 446 lateral retinacular release procedures performed by 21 arthroscopic surgeons in various centers. There were 32 complications among the 446 procedures. The overall complication rate for lateral retinacular release was 7.2%. Information obtained from each individual surgeon in the study allowed scrutiny of various surgical techniques as they related to complications in lateral retinacular release procedures. Higher complication rates were noted with tourniquet use (p = 0.037), in arthroscopically controlled subcutaneous technique (p = 0.057), and most significantly, in the use of a postoperative suction drain for 24 h or longer (p less than 0.001). Electrocautery use did not affect the complication rate (p = 0.50). Outpatient procedures had no higher complication rate than inpatient procedures (p = 0.95).     

外侧支持带松解术后髌骨轨迹的分析

[目的]探讨膝关节外侧支持带松解前后髌骨轨迹的变化,寻找外侧支持带松解术后部分病例效果不佳的原因。[方法]临床采集符合纳入标准的92例(138膝)样本,松解前后分别行10°、20°、30°和40°屈膝位髌股关节CT扫描,测量髌股适合角,髌骨外移角和股骨远端内侧扭转角,比较松解前后髌骨轨迹的变化。[结果]通过测量髌股适合角,髌骨外移角发现髌骨轨迹29膝松解后无改善,109膝明显改善。109膝的股骨远端内侧扭转角均9°,29膝的股骨远端内侧扭转角均9°。说明股骨远端内侧扭转角可能是影响外侧支持带松解后髌骨轨迹的一个重要因素。[结论]外侧支持带松解术是治疗髌股关节紊乱症非常有效的手术,但是术后部分病例效果并不理想,尤其是长期随访效果,其中原因并不明了,通过实验发现术后髌骨轨迹未发生改变可能是主要的原因,而股骨远端扭转可能是影响髌骨轨迹恢复的重要因素。     

关节镜下髌骨支持带外侧松解内侧紧缩术治疗髌骨半脱位

目的探讨关节镜下行髌骨支持带外侧松解内侧紧缩术治疗髌骨半脱位的临床疗效。方法手术治疗44例髌骨半脱位患者,在关节镜下采用低温等离子电刀松解髌骨外侧支持带,同时采用PDS线沿髌骨内侧缘上极、中点、下极缝合加强内侧支持带,使术中膝关节屈曲过程中髌骨处于正常轨道。根据Lysholm膝关节功能评分及IKDC 2000主观评分进行术前、术后膝关节功能评估。结果 44例均获得随访,时间3~30个月。术后X线片显示髌骨位置良好。末次随访患肢膝关节活动度恢复良好,无关节僵硬、功能障碍等表现,未见复发半脱位。Lysholm评分由术前44~71(52.2±6.3)分提高到术后80~94(88.1±3.9)分(P0.001),IKDC 2000主观评分由术前42~69(52.7±6.1)分提高到术后82~97(89.7±3.1)分(P0.001)。结论关节镜下髌骨支持带外侧松解内侧紧缩术治疗髌骨半脱位,可维持髌骨活动稳定,效果良好。     

Z-plasty lateral retinacular release for the treatment of patellar compression syndrome

Lateral retinacular release by Z-plasty technique in selected patients provides a relatively simple procedure for relief of symptoms in patellar compression syndrome and is a satisfactory initial surgical procedure in cases not responding to conservative therapy. Unfortunately, there is no specific symptom complex, physical finding, radiographic finding, or arthrotomy finding which delineates the patient with patellar compression syndrome who will benefit from an isolated lateral retinacular release. Some patients may require further extensor mechanism realignment procedures (e.g., medial capsular reefing, tibial tubercle transplantation, tibial tubercle elevation, etc.) to relieve the aggravating symptoms of parapatellar and retropatellar pain.     

Treatment of chondromalacia patellae by lateral retinacular release of the patella

A series of 59 knees in 58 patients were surgically treated from 1977 to 1982 for chondromalacia patellae, and were followed for an average of 1.2 to 4.6 years after the operation. The operative procedure was open lateral retinacular release in all knees. In knees with recurrent patellar subluxation, the number of poor results increased from 24% to 70%, and in knees with no subluxation from 21% to 24%. The difference after 4.6 years was statistically significant. No correlation between the severity or location of the cartilage changes and the operative effect was found. Open lateral retinacular release is an acceptable treatment of chondromalacia patellae without subluxation of the patella, whereas in the presence of recurrent subluxation, the release does not correct the basic biomechanical disturbance.     

Plate and screw fixation of arthroscopically assisted tibial tuberosity osteotomy: technique and results

European Journal of Orthopaedic Surgery & Traumatology - We describe a fixation technique for tibial tuberosity osteotomies (TTO) utilising a plate and screw construct which adheres to...     

关节清理术结合外侧支持带松解治疗膝关节骨关节炎

目的 探讨关节镜下关节清理术结合外侧支持带松解治疗膝关节骨关节炎的方法及其效果.方法 对34例伴有髌股关节对线不良的膝关节骨关节炎患者进行关节清理术结合外侧支持带松解.结果 34例获6个月～2年随访,参照Lysholm膝关节评分标准:85分以上26例,70～85分7例,65分1例.结论 关节清理术结合外侧支持带松解治疗伴有髌股关节对线不良的膝关节骨关节炎具有肯定的疗效.     

Balancing severe valgus deformity in total knee arthroplasty using a lateral cruciform retinacular release

We report the technique and results of a cruciform lateral release performed on 35 consecutive knees having > or =15 degrees of valgus with minimum 2-year follow-up. The posterior cruciate ligament (PCL) was preserved in all knees. Preoperative valgus averaged 17 degrees, and range of motion averaged 10 degrees to 107 degrees. Postoperative valgus averaged 4.8 degrees, and average postoperative range of motion was 2 degrees to 110 degrees. The PCL was partially released in 5 knees, and further lateral release of the lateral collateral ligament and popliteus were required in 3 knees. Stable flexion and extension gaps were achieved in all cases, and stability was maintained at follow-up. This lateral cruciform retinacular release provides a simple surgical technique for most valgus deformities of the knee and allows for stable ligamentous balancing.