- See:
Retinacular Release for TKR:
- Discussion:
- see
lateral anatomy of the knee and
blood supply to the knee;
- lateral release detaches patella from lateral soft tissue structures, including lateral retinaculum, fibers from tensa fascia lata muscle, & joint capsule;
- a successful release should release the lateral patellofemoral ligament and the lateral patellotibial ligament;
- in some cases, a
distal realignment procedure or repair of the
medial patellofemoral ligament will be required along w/ the lateral release;
-
anatomy:
- lateral retinaculum consists of two layers;
- superficial oblique layer;
- extends from the IT band to the lateral border of the patella and patellar tendon;
- transverse retinaculum:
- extends from the undersurface of the IT band to the lateral patellar border;
-
indications for release: retinacular tightness and pain
- lateral release is indicated only in individuals demonstrating tightness of lateral retinaculum.
- patella tilt test indicates tightness of lateral retinaculum;
- inability to rotate the lateral border of the patella more than 5 mm;
-
patella alta,
chondromalacia, an elevated
Q angle, and an atrophic trochlear groove may be associated w/ a tight retinaculum but these alone are not
indications for lateral release;
- failure of 6 months of formal physical therapy which is designed to strengthen quads and hamstrings;
- references:
-
Clinical prognosticators for the efficacy of retinacular release surgery to treat patellofemoral pain.
- Evaluation of patients with persistent symptoms after lateral retinacular release by kinematic MRI of the patellofemoral joint.
FG Shellock et al. Arthroscopy Vol 6: 1990. p 226-234.
- Arthroscopic lateral retinacular release: functional results in a series of 67 knees. M Malek. Orthop Rev. Vol 14. 1985. p 55.
- Lateral retinacular release of the patella: indications and contra-indications. P Kolowich et al. American J. Sports Med Vol 18. 1990. p 359.
-
Lateral retinacular release for anterior knee pain: a systematic review of the literature.
-
Long-term results of lateral retinacular release.
-
Lateral retinacular release: a survey of the International Patellofemoral Study Group.
-
Lateral release for patellofemoral arthritis.
-
indications for release: patellofemoral instability: (see
subluxation)
- Lateral retinacular release in patellofemoral subluxation: Indications, results and comparison to open patellofemoral reconstruction.
JH Henry. Am J. Sports Med. Vol 14. 1986. p 121-129.
-
The role of lateral retinacular release in the treatment of patellar instability.
-
Comparison of lateral release versus lateral release with medial soft-tissue realignment for the treatment of recurrent patellar instability.
-
Thermal medial retinaculum shrinkage and lateral release for the treatment of recurrent patellar instability.
-
Long-term results of lateral retinacular release.
-
Lateral retinacular release: a survey of the International Patellofemoral Study Group.
- Examination of the Patellofemoral Joint:
-
Radiographic evaluation;
- Computerized tomography of the patellofemoral joint before and after lateral release or realignment.
- Arthroscopic Release:
- note: arthroscopic lateral retinacular release should always be delayed until the end of the arthroscopy procedure, since bleeding and fluid
extravasation will force termination of the case;
- Open Lateral Lengthening:
- advantages:
- avoids division of the vastus lateralis obliqus;
- allows retinacular lengthening which allows adequate hemostasis and avoids hemarthrosis;
- technique:
- 6 cm longitudinal incision is made 1 cm off the lateral border of the patella;
- incision extends from the superior pole of the patella to a point just above Gerdy's tubercle;
- incision extends down to the lateral retinaculum, and then a lateral subcutaneous flap is created;
- lateral retinaculum is incised in line with the skin incision from a point just distal to vastus lateralis muscle fibers to a point just proximal to Gerdy's tubercle;
- it is important to preserve the deep fibers of the retinaculum and synovium;
- check the mobility of the patella at this point, and determine whether further release is necessary;
- some authors accept 45 deg of lateral patellar mobility where as other insist on 90 deg of mobility;
- if patellar mobility is inadequate at this point, then further dissection is needed;
- a lateral retinacular flap is dissected off of the deep fibers of the retinaculum (and synovium) for a distance of 2 cm;
- deep retinacular layer is then incised 2 cm lateral to and parallel to the superficial retinacular layer incision;
- medial edge of the deep layer is sutured to the lateral edge of the superficial retinaculum;
- this closure should be water tight, which helps to prevent hemarthrosis;
- reference:
-
Open lateral retinacular lengthening compared with arthroscopic release.
- Z-plasty lateral retinacular release for the treatment of patellar compression syndrome. LC Ceder et al. CORR Vol 144. 1979. p 110-113.
- Post Operative Care:
- initially knee is kept in a well fitted compression dressing inorder to prevent hemarthrosis;
- after the release, rapid mobilization of the joint is very important to prevent scarring and tightening along released lateral structures;
- intense rehabilitation of the vastus medialis is required;
- Complications:
-
Medial subluxation of the patella as a complication of lateral retinacular release. JC Hughston. Am J. Sports Medicine. Vol 16: 1988. p 383-388.
-
An analysis of complications in lateral retinacular release procedures. N Small. Arthroscopy. Vol 5. 1989. p 282.
- Factors associated w/ poor results following arthroscopic subcutaneous lateral retinacular release. L Simpson et al. CORR. Vol 186. 1984 p 165.
-
An analysis of complications in lateral retinacular release procedures.
- Pitfalls of the lateral retinacular release. DeHaven KE: Clin Sports Med 1989;8:279-290.
Anatomy of the junction of the vastus lateralis tendon and the patellae. MJ Hallisey et al. JBJS Vol 69-A. Apr 1987. p 545-549.
Lateral release and proximal realignment for patellar subluxation and dislocation. A long-term follow-up.
