Lateral release of the patella: Indications and contraindications

Abstract

Charts were reviewed on patients at the Salt Lake Knee and Sports Medicine Clinic who had had a lateral release of the patella. Patients were divided into two groups. Group I contained patients who were entirely satisfied with the procedure, and Group II included patients who were complete failures (defined as a need for further surgical procedures). In Group I, 74 patients were included in the subjective followup. Forty of the 74 patients also had an objective followup, including roentgenograms and a physical examination. Group II contained 43 patients. Results indicated that the most predictable criterion for success was a negative passive patellar tilt. Secondary criteria included a medial and lateral patellar glide of two quadrants or less and a normal tubercle-sulcus angle at 90 degrees of flexion. Patients had less predictable results after an isolated lateral release with a positive (greater than 5 degrees) passive patellar tilt and a three quadrant or greater medial and lateral patellar glide or an abnormal tubercle-sulcus angle at 90 degrees of flexion.

Development of a Clinical Prediction Rule for Classifying Patients With Patellofemoral Pain Syndrome Who Respond to Patellar Taping

“…35 Our findings indicate that it was subjects with a positive patellar tilt test that responded favorably to medial glide taping. Presumably, individuals with a positive patellar tilt have a flexible lateral retinaculum.…”

“…The patellar tilt test was originally described as a convenient clinical measure to determine if a patient has a tight lateral retinaculum. 35,65 Kolowich et al 35 proposed that an excessively tight lateral retinaculum is identified by the inability of the examiner to lift the lateral border of the patella above the true horizontal plane (with the patient supine and relaxed and knee in full extension). If the lateral border of the patella can be Nomogram showing the pretest probability of intervention success using patellar taping (52%), and the improved posttest probability (83%) for intervention success after applying the clinical prediction rule.…”

“…The patellar tilt test was a key predictor of intervention success. Kolowich and colleagues 35 proposed that patients with a negative patellar tilt test have an excessively tight lateral retinaculum, and presumably a laterally tracking patella. According to McConnell, 43 these patients will respond well to taping with a medial glide component, by stretching the tight lateral restraints and shifting the patella medially, centering it within the femoral trochlea.…”

Patellofemoral kinematics during knee flexion-extension: An in vitro study

“…The frequency and complexity of clinical problems has led to a wide range of surgical procedures 1 that address joint geometry, 2,3 skeletal alignment, [4][5][6][7] or the soft tissues. 8,9 Little data are available providing objective information about the effects of these factors on patellar tracking or relationships to symptoms. 10 Patellar ''maltracking'' implies that the patella is not following a normal stable path of movement, within the femoral trochlear groove, when the knee is flexing-extending.…”

Quantitative analysis of dynamic patellar tracking in patients with lateral patellar instability using a simple video system

“…Both the knee with patellar dislocation (dislocated group) and the contralateral knee without patellar dislocation (non-dislocated group) were investigated. No patient in this series had a hypermobile patella that was defined abnormal medial and lateral laxity in the patellar glide test [22].…”