The purpose of this study was to investigate the influence of lateral retinacular release and medial and lateral retinacular deficiency on patellofemoral position and retropatellar contact pressure. Human knee specimens (n = 8, mean age = 65 SD 7 years, all male) were tested in a kinematic knee-simulating machine. During simulation of an isokinetic knee extension cycle from 120 degrees to full extension, a hydraulic cylinder applied sufficient force to the quadriceps tendon to produce an extension moment of 31 Nm. The position of the patella was measured using an ultrasound based motion analysis system (CMS 100, Zebris). The amount of patellofemoral contact pressure and its pressure distribution was measured using a pressure sensitive film (Tekscan, Boston). Patellar position and contact pressure were first investigated in intact knee conditions, after a lateral retinacular release and a release of the medial and lateral retinaculum. After lateral retinacular release the patella continuously moved from a significant medialised position at flexion (P = 0.01) to a lateralised position (P = 0.02) at full knee extension compared to intact conditions, the centre of patellofemoral contact pressure was significantly medialised (0.04) between 120 degrees and 60 degrees knee flexion. Patellofemoral contact pressure did not change significantly. In the deficient knee conditions the patella moved on a significant lateralised track (P = 0.04) through the entire extension cycle with a lateralised centre of patellofemoral pressure (P = 0.04) with a trend (P = 0.08) towards increased patellofemoral pressure. The results suggest that lateral retinacular release did not inevitably stabilise or medialise patellar tracking through the entire knee extension cycle, but could decrease pressure on the lateral patellar facet in knee flexion. Therefore lateral retinacular release should be considered carefully in cases of patellar instability.

This study compares the effects of two different techniques of medial patellofemoral ligament (MPFL) reconstruction, and proximal soft tissue realignment on patellar stabilization against lateral dislocation. Eight human cadaver knee specimens with no radiological pathomorpholgy on a straight lateral view, contributing to patellofemoral instability, were mounted in a kinematic knee simulator and isokinetic extension was simulated. Patellar kinematics were measured with an ultrasound positioning system (zebris) while a 100 N laterally directed force was applied to the patella. The kinematics were compared with intact knee conditions under MPFL deficient conditions, as well as following dynamic reconstruction of the MPFL using a distal transfer of the semitendinosus tendon, following static reconstruction by a semitendinosus autograft, and following proximal soft tissue realignment of the patella (Insall procedure). Dynamic reconstruction of the MPFL resulted in no significant alteration (P = 0.16) of patellar kinematics. Static reconstruction of the MPFL significantly medialized (P < 0.01) the patellar movement without, but restored intact knee kinematics under the laterally directed force. In contrast, following proximal soft tissue realignment, the patellar movement was constantly medialized and internally tilted (P = 0.04). Dynamic and static reconstruction of the MPFL create sufficient stabilization of the patella. Following proximal soft tissue realignment, the patellar position was over-medialized relative to intact knee conditions, which could lead to an overuse of the medial retropatellar cartilage.

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