Efficacy and experience of arthroscopic lateral patella retinaculum releasing through/outside synovial membrane for the treatment of lateral patellar compression syndrome

Abstract

Background: Arthroscopic closure release includes arthroscopic lateral patella retinaculum releasing (LPRR) either outside synovial membrane (OSM) or through synovial membrane (TSM). At present, there is no research to compare the clinical efficacy of the above two methods for the treatment of lateral patellar compression syndrome (LPCS). So, the goal of this study was to investigate the method and overcome of arthroscopic LPRR either OSM or TSM for the treatment of LPCS. Methods: From September 2014 to December 2017, 125 patients of LPCS underwent arthroscopic LPRR either OSM or TSM combined with joint debridement. In the OSM group, knee joint was cleaned first. The surface of lateral patella retinaculum (LPR) was created the chamber for arthroscopic operation to release LPR. Synovial membrane was retained. In the TSM group, knee joint was cleaned first. Then synovial membrane, joint capsule and LPR, and superficial fascia were gradually incised from the joint cavity to subcutaneous tissue. The synovial membrane was cut open. Before and after surgery, Lysholm score, patella medial shift, Kujala score, VAS score and surgical complications were collected for evaluating clinical overcomes. Results: All patients were followed up for 1.5-5 years. All patients had significant reduction in knee pain and improved function after 1 month and 1 year. The Lysholm score, the distance of patella medial shift, Kujala score, and VAS score in the OSM group and the TSM group were significantly improved in the final follow-up compared with before surgery (All P < 0.001), but these observed targets before surgery and at the last follow-up were compared between the OSM group and the TSM group with no statistical differences. However, the number of occurrences of joint hematoma and adhesion was significantly higher in the TSM group than the OSM group (P = 0.024). Conclusions: Arthroscopic closing LPRR for the treatment of LPCS can effectively improve the function and symptoms of patellofemoral joint with the advantages of small trauma, rapid recovery and less complications. But, the number of occurrences of hemarthrosis and joint adhesion were significantly higher in the TSM group than in the OSM group. Trial registration: The trial registration number (IRCT): IRCT20200205046378N1 and date of registration: February 10, 2020 (retrospectively registered).

Management of Patellar Chondral Defects with Autologous Matrix Induced Chondrogenesis (AMIC) Compared to Microfractures: A Four Years Follow-Up Clinical Trial

“…Trochlear dysplasia, Install-Salvati ratio ranging from 1.0 and 1.2, and tibial tubercle-trochlear groove (TT-TG) greater than 22 mm also have been evaluated [ 69 , 70 ]. Another cause of persistent pain and possible chondral damage is the lateral patellar compression syndrome (LPCS) [ 71 , 72 ]. LPCS presents shortened and tightened lateral retinacular combined with lateral patellar tilt, with overload of the lateral patellar articular compartment and patellar mal-tracking [ 73 , 74 , 75 ].…”

Outcome and experience of arthroscopic lateral retinacular release combined with lateral patelloplasty in the management of excessive lateral pressure syndrome

“…Verdonk et al [ 25 ] compared the results of knee CT examination before and after LR release surgery and found that the procedure can effectively improve the morphology of the patient’s patellofemoral joint. Arthroscopic closing LR release for the treatment of ELPS can effectively improve the function and relieve symptoms of patellofemoral joint with the advantages of small trauma, rapid recovery and less complications [ 27 ]. In our study, similar results were found that Kujala score and Lysholm score were significantly increased at the last follow-up compared with that before surgery, indicating significant improvement in knee function.…”

“…The synovial membrane, joint capsule, and LR were partially or totally cut off, which easily caused complications of intra-articular hemorrhage and joint adhesion, which affected curative effect [ 10 ]. Therefore, we performed LR release from the surface of LR to preserve synovium and capsule of joint, so as to reduce the risk of joint hematoma and adhesion [ 27 ]. In our study, manipulation under anesthesia for knee contracture due to postoperative adhesion was required in only 3 patients, and joint hematoma has not been reported.…”

Use of hyaluronic acid injection after arthroscopic release in lateral patellar compression syndrome with degenerative cartilage changes: randomized control trial

“…When I compared current study with other studies that exclusively analyzed lateral patellar release or viscosupplementation, I can find the following important points: Chen et al [ 31 ] reported that arthroscopic lateral patellar retinacular release can effectively improve function and symptoms of patellofemoral joint in patients with lateral patellar compression syndrome. In current study, there was improvement after lateral release with better results after intraarticular injection of Hyaluronic acid as those patients, who are involved in current study, had degenerative changes in patellofemoral joint.…”