Full arthroscopic lateral retinacular release with hook knife and quadriceps pressure-pull test: long-term follow-up

Abstract

The most important causes of anterior knee pain include patellofemoral malalignment which causes patella-condyle contact anomalies at the patellofemoral joint, excessive patellar lateral pressure increase, trauma and overuse. In this article, besides presentation of late clinical results of 169 lateral retinacular release cases which were surgically treated between January 1995 and December 2002 with the help of a hook knife from the anterolateral portal due to lateral compression syndrome and patellar maltracking, we also described quadriceps tendon pressure-pull test which strongly indicates patellofemoral pain during physical examination of a patient with anterior knee pain. In addition to radiological patellofemoral imaging methods, we describe dynamic arthroscopic patellofemoral joint examination which is applied perarthroscopically to all of our surgically treated patients. We divided the patients into two groups: group 1 was the younger group with age 16-40 years; group 2 was the older group with age >41 years. Preoperative mean Lysholm scores for group I was 67.6 and 98.6, postoperatively, whereas it was 62.3 preoperatively and 91.4 postoperatively in group 2. This improvement of Lysholm scores postoperatively was statistically significant for each of the two groups (p=0.001). For group 1 preoperative IKDC scores were A in 8 patients, B in 61 patients and C in 11 patients, whereas it was A in 78 patients and B in 2 patients postoperatively. For group 2 preoperative IKDC scores were A in 2 patients, B in 43 patients, C in 36 patients and D in 8 patients, whereas it was A in 78 patients and B in 11 patients. This improvement of IKDC scores postoperatively was also statistically significant for each of the two groups (p=0.001). Preoperative and postoperative congruent angles of all patients were also measured. Preoperative mean congruent angle was +16.4 in group 1 while mean congruent angle was -7.1 postoperatively. For group 2 preoperative mean congruent angle was +18.7 preoperatively and -6.9 postoperatively. This improvement was statistically significant for each of the two groups (p=0.001). The overall number of patellar lateral compression syndrome cases were 51 (24 in group 1, 27 in group 2), patellar lateralization cases were 64 (28 in group 1, 36 in group 2) and patellar subluxation cases were 54 (28 in group 1, 26 in group 2). At the evaluation of arthroscopic lateral patellar facet and lateral femoral condylar chondral pathologies, we statistically showed that patellar chondral pathologies were more severe than the femoral chondral pathologies (p=0.001). In our opinion, the severity of patellar lateral facet chondral lesions, although it has a thicker layer of cartilage, is due to distribution of load to a larger contact area of lateral femoral condyle. Statistically increasing severity of femoral (Kendall's tau-b: 0.248, p=0.001) and patellar chondral lesions (Kendall's tau-b: 0.444, p=0.0001) with age is compatible with our arthroscopic and clinical observations. The most important complication s...

Arthroscopic Lateral Retinacular Release in Adolescents With Medial Patellofemoral Ligament-centered Knee Pain

“…Prior studies have reported results of ALRR for patellar instability in an adolescent population 31 and ALRR for pain in a general population. 8,9,13,15,32 Roth et al 31 reported a mean 31-point improvement in Lysholm score after ALRR for patellar instability in adolescent athletes, similar to the 35-point improvement in IKDC score seen in the current study. Results of ALRR for pain in the general population have been variable, with some studies reporting low levels (14% to 60%) of "satisfactory" results 13,15 and others demonstrating promising clinical outcomes.…”

“…Results of ALRR for pain in the general population have been variable, with some studies reporting low levels (14% to 60%) of "satisfactory" results 13,15 and others demonstrating promising clinical outcomes. 8,9 Calpur et al 8 reported results of ALRR for pain in 80 patients aged 16 to 40 and found a mean 31-point improvement in Lysholm score, and 100% of knees were normal or nearly normal by IKDC objective assessment at long-term follow-up. O'Neill 9 reported results of ALRR for pain in 43 patients aged 13 to 56 and found that 77% of patients had good or excellent Lysholm score at >2 years' follow-up and 93% were able to return to athletic activity.…”

“…Mean postoperative IKDC score was 77.2 in the current study, whereas mean postoperative Lysholm scores have been reported to be 89 to 99 in prior series. 8,9 Both outcomes Values reported as n (%). *Additional procedures included plica excision in 7 patients, medial femoral condyle chondroplasty in 3, partial lateral meniscectomy in 1, and patellar chondroplasty in 1.…”

Knee Health Promotion Option for Osteoarthritic Knee: Cartilage Regeneration is Possible

“…For knees demonstrating medial abrasion phenomenon, medial release (Lyu SR, 2008) was performed to relieve the tension and abrasion between the tight, fibrotic and hypertrophied medial plica and the adjacent medial femoral condyle that have been described in previous studies (Lyu SR and Hsu CC, 2006;Lyu SR, 2007;Lyu et al, 2010). On the other hand, in knees demonstrating lateral compression syndrome over patellofemoral joint, percutaneous lateral capsular release that has the benefits of tension release and denervation (Calpur OU et al, 2005;Paulos LE et al, 2008) was added. The immediate effect of ACRFP is to release the strain caused by chronically inflamed soft tissue and to eradicate the hypertrophied synovium that may cause pain in the degenerative knees over the medial compartment and patellofemoral joint.…”

Imaging of postoperative knee extensor mechanism

“…This procedure is performed arthroscopically, and may be accompanied by tightening of the medial structures (medial reefing) [10]. As with all arthroscopic procedures, scarring may be seen in Hoffa's fat pad (Fig.…”