A Technique of Staged Lateral Release to Correct Patellar Tracking in Total Knee Arthroplasty

Surgical Technique: Lateral Retinaculum Release in Knee Arthroplasty Using a Stepwise, Outside-in Technique

“…In 2009 Strachan et al reported a ''staged'' (six stages) outside-in technique in a proximal to distal manner [34]. We began using an outside-in technique in 2000 and have developed it in a manner that is simple to perform.…”

“…Thus, the potential chances of wound discoloration and risk of spread of superficial infection into the joint are increased [15]. However, with the outside-in technique, the synovial cover is left intact under the retinaculum, with no direct exposure of the joint to the subcutaneous plane [34].…”

“…Inside-out and outside-in techniques used for lateral release reportedly improve patellar tracking [12,20,21,34,37]. The inside-out technique is used more frequently because of its ease of performing, ie, in an already opened joint.…”

“…Patellar maltracking can be dealt with in several ways at surgery. Lateral release of the tight lateral retinaculum is one well-described option in the literature [14,34] and has been reported as being performed in 3.8% to 45% of patients [18][19][20][21]37]. Complications include patellar avascularity [24,31,36] and patellar fracture [29,31,35].…”

Does Lateral Release Change Patellofemoral Forces and Pressures?: A Pilot Study

“…Achieving visually acceptable patellar tracking intraoperatively may play an important role in preventing postoperative complications [7,8,16]. Static and dynamic factors influence patellar tracking [18], and any alteration in these factors can result in maltracking. Patellar maltracking can result from excessive or unbalanced tension in the soft tissue constraints surrounding the patella, which may lead to postoperative anterior knee pain [4,5,15].…”