The Outcomes of Isolated Lateral Release in Patellofemoral Instability: A Systematic Review and Meta-Analysis

Abstract

There have been conflicting reports regarding the outcomes of lateral release when used in the management of patellofemoral instability. This systematic review and meta-analysis therefore aims to evaluate the outcomes of isolated lateral release in the management of patellofemoral instability. The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All studies that reported the outcomes of isolated lateral release for recurrent patellofemoral dislocations were included. A total of 10 publications were included, with 204 knees. All studies consistently reported a decrease in the rates of patellofemoral dislocation (odds ratio [OR] < 0.01; 95% confidence interval [CI]: <0.01–0.01) and an increase in the odds of having a good outcome (OR 0.01; 95% CI: <0.01–0.02) after lateral release. All studies also consistently reported a similar number of patients participating in sports postoperatively as compared with preinjury (OR 2.78; 95% CI: 0.53–14.68). A total of 28 (14.1%) out of 198 patients had postoperative dislocation. Of these patients, 15 required a secondary procedure for patellofemoral realignment; however, all patients who had their eventual outcomes reported still had a good outcome postoperatively. Isolated lateral release can lead to good short- to middle-term outcomes when used in the management of recurrent patellofemoral dislocations. The procedure can lead to a significantly decreased rate of recurrence of patellofemoral dislocations, a significantly increased rate of good outcomes, and a similar number of patients being able to participate in sports as compared with the number of patients participating in sports prior to having patellofemoral dislocations. An isolated lateral release could therefore potentially serve as a simple and relatively low-risk procedure that could be performed as a first-line surgical management in selected patients with patellofemoral instability, allowing them to possibly avoid a more complex and major operation. This is a Level IV study.

Editorial Commentary: Despite Decades of Research on Patellar Instability, the Isolated Lateral Release Endures

“…meta-analysis study by Tan et al 12 reports good shortterm outcomes of isolated lateral release and recommends its use as a potential cost-saving alternative to MPFLR. It is my own opinion that while lateral retinacular release may have a role in the rare situation in which laterally based capsuloligamentous tightness has led to focal patellar compression, in the setting of patellar instability it should not be used alone as a solution to patellofemoral instability.…”

Does Tibial Tuberosity Osteotomy Improve Outcomes When Combined With Medial Patellofemoral Ligament Reconstruction in the Presence of Increased Tibial Tuberosity–Trochlear Groove Distance? A Systematic Review and Meta-analysis

“…13,46 Patients with recurrent dislocation have up to a 50% chance of further dislocations 9 and often require surgery. 23 There are a variety of surgical treatment options available, including isolated lateral release, 42 tibial tuberosity osteotomy (TTO), 11 and trochleoplasty, 5 but the most common and successful procedure has been medial patellofemoral ligament reconstruction (MPFLR). 32 Radiologic parameters are often relied on to help guide which surgical strategy to take, 45 and the tibial tubercle-trochlear groove distance (TT-TG) is a well-known proxy measure to describe patellofemoral alignment.…”

The Biomechanical Effects of Limited Lateral Retinacular and Capsular Release on Lateral Patellar Translation at Various Flexion Angles in Cadaveric Specimens

“…2,[5][6][7][8][9] Whereas isolated lateral release is not recommended by most patellofemoral experts, it is still performed for lateral patellar instability by some surgeons. 10 This procedure is more commonly used in combination with medial patellofemoral ligament reconstruction. 6,11 Despite studies reporting satisfactory results after isolated lateral release for the treatment of patellofemoral instability, other studies have shown an increase in not only medial instability but also lateral instability after lateral retinacular release.…”