Open versus arthroscopic release for lateral patellar compression syndrome: a randomized-controlled trial

Sherwan A Hamawandi, Hazhar I Amin, Ameer Kadhim Al-Humairi, Sherwan A Hamawandi, Hazhar I Amin, Ameer Kadhim Al-Humairi

Abstract

Introduction: Lateral patellar compression syndrome is one of the causes of anterior knee pain in young adults and resulted from tight lateral patellar retinaculum. The aim of our study is to compare between open and arthroscopic release of lateral patellar compression syndrome in relation of functional outcome, time of surgical procedure, length of hospital stays, intraoperative and postoperative complications as bleeding, infection, recurrence, and patellar instability with 2 years of follow-up.

Materials and methods: 80 patients, age (21-49 years), were divided randomly into 2 groups (A and B). Group A (40 patients) were treated with open release. Group B (40 patients) were treated by arthroscopic release. All these patients are diagnosed as lateral patellar compression syndrome depending on clinical features and MRI. All patients were assessed by Lysholm knee scoring scale before surgery and at periods of 2, 6 weeks, 6, 12, and 24 months after surgery.

Results: There is significant difference in functional outcome, measured by Lysholm knee scoring scale, between preoperative and postoperative assessment periods in both groups (P < 0.001). There is significantly better functional outcome at 2 years of follow-up with arthroscopic release (P = 0.018). There is no recurrence in both groups, but there were 4 patients develop medial patellar instability in the group of open release.

Conclusion: Both open and arthroscopic lateral release for patients with isolated lateral patellar compression syndrome can be effective surgical procedures, but arthroscopic release can achieve better functional outcome.

Trial registration: NCT, NCT04130412. Retrospectively registered on 3rd of June, 2020 at ClinicalTrials.gov.

Keywords: Arthroscopic release; Lateral patellar compression syndrome; Lateral patellar retinaculum; Lysholm knee scoring scale; Open release.

Conflict of interest statement

All authors declared that they have no conflict of interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
The association between LKSS in 2 years postoperatively and study groups

References

    1. Johnson RP. Lateral facet syndrome of the patella. Lateral restraint analysis and use of lateral resection. Clin Orthop Relat Res. 1989;238:148–158. doi: 10.1097/00003086-198901000-00022.
    1. Krompinger WJ, Fulkerson JP. Lateral retinacular release for intractable lateral retinacular pain. Clin Orthop Relat Res. 1983;179:191–193. doi: 10.1097/00003086-198310000-00029.
    1. Metcalf RW. An arthroscopic method for lateral release of subluxating or dislocating patella. Clin Orthop Relat Res. 1982;167:9–18. doi: 10.1097/00003086-198207000-00004.
    1. Miltner O, Siebert CH, Schneider U, Niethard FU, Graf J. Patellar hypertension syndrome in adolescence: a three-year follow up. Arch Orthop Trauma Surg. 2003;123(9):455–459. doi: 10.1007/s00402-003-0564-2.
    1. Steinbrück A, Schröder C, Woiczinski M, Glogaza A, Müller PE, Jansson V, Fottner A. A lateral retinacular release during total knee arthroplasty changes femorotibial kinematics: an in vitro study. Arch Orthop Trauma Surg. 2018;138(3):401–407. doi: 10.1007/s00402-017-2843-3.
    1. Migliorini F, Maffulli N, Eschweiler J, Quack V, Tingart M, Driessen A. Lateral retinacular release combined with MPFL reconstruction for patellofemoral instability: a systematic review. Arch Orthop Trauma Surg. 2020 doi: 10.1007/s00402-020-03689-9.
    1. Saper MG, Shneider DA. Diagnosis and treatment of lateral patellar compression syndrome. Arthrosc Tech. 2014;3(5):e633–e638. doi: 10.1016/j.eats.2014.07.004.
    1. Maniar RN, Singhi T, Rathi SS, Baviskar JV, Nayak RM. Surgical technique: lateral retinaculum release in knee arthroplasty using a stepwise, outside-in technique. Clin Orthop Relat Res. 2012;470(10):2854–2863. doi: 10.1007/s11999-012-2420-6.
    1. Fulkerson JP. Patellofemoral pain disorders: evaluation and management. J Am Acad Orthop Surg. 1994;2(2):124–132. doi: 10.5435/00124635-199403000-00006.
    1. Ford DH, Post WR. Open or arthroscopic lateral release. Indications, techniques, and rehabilitation. Clin Sports Med. 1997;16(1):29–49. doi: 10.1016/s0278-5919(05)70006-5.
    1. Aglietti P. Surgery of the patellofemoral joint. Indications, effects, results, and recommendations. In: Scott WN, editor. Insall & Scott surgery of the knee. 4. Philadelphia: Elsevier Churchill Livingstone; 2006.
    1. Fulkerson JP. Diagnosis and treatment of patients with patellofemoral pain. Am J Sports Med. 2002;30(3):447–456. doi: 10.1177/03635465020300032501.
    1. Henry JH, Goletz TH, Williamson B. Lateral retinacular re- lease in patellofemoral subluxation. Indications, results, and comparison to open patellofemoral reconstruction. Am J Sports Med. 1986;14:121–129. doi: 10.1177/036354658601400205.
    1. Hughston JC, Deese M. Medial subluxation of the patella as a complication of lateral retinacular release. Am J Sports Med. 1988;16:383–388. doi: 10.1177/036354658801600413.
    1. Laurin CA, Dussault R, Levesque HP. The tangential x-ray investigation of the patellofemoral joint: x-ray technique, diagnostic criteria and their interpretation. Clin Orthop Relat Res. 1979;144:16–26.
    1. Nonweiler DE, DeLee JC. The diagnosis and treatment of medial subluxation of the patella after lateral retinacular release. Am J Sports Med. 1994;22(5):680–686. doi: 10.1177/03635465940220051712.
    1. O'Neill DB. Open lateral retinacular lengthening compared with arthroscopic release. A prospective, randomized outcome study. J Bone Joint Surg. 1997;79(12):1759–1769. doi: 10.2106/00004623-199712000-00001.
    1. Aglietti P, Pisaneschi A, Buzzi R, Gaudenzi A, Allegra M. Arthroscopic lateral release for patellar pain or instability. Arthroscopy. 1989;5(3):176–183. doi: 10.1016/0749-8063(89)90167-9.
    1. Christensen F, Søballe K, Snerum L. Treatment of chondromalacia patellae by lateral retinacular release of the patella. Clin Orthop Relat Res. 1988;234:145–147. doi: 10.1097/00003086-198809000-00027.
    1. Larson RL, Cabaud HE, Slocum DB, James SL, Keenan T, Hutchinson T. The patellar compression syndrome: surgical treatment by lateral retinacular release. Clin Orthop Relat Res. 1978;134:158–167.
    1. Panni AS, Tartarone M, Patricola A, Paxton EW, Fithian DC. Long-term results of lateral retinacular release. Arthroscopy. 2005;21(5):526–531. doi: 10.1016/j.arthro.2005.01.007.
    1. Ostermeier S, Holst M, Hurschler C, Windhagen H, Stukenborg-Colsman C. Dynamic measurement of patellofemoral kinematics and contact pressure after lateral retinacular release: an in vitro study. Knee Surg Sports Traumatol Arthrosc. 2007;15(5):547–554. doi: 10.1007/s00167-006-0261-0.
    1. Elkousy H. Complications in brief: Arthroscopic lateral release. Clin Orthop Relat Res. 2012;470(10):2949–2953. doi: 10.1007/s11999-012-2383-7.
    1. Pagenstert G, Wolf N, Bachmann M, et al. Open lateral patellar retinacular lengthening versus open retinacular release in lateral patellar hypercompression syndrome: a prospective double-blinded comparative study on complications and outcome. Arthroscopy. 2012;28(6):788–797. doi: 10.1016/j.arthro.2011.11.004.
    1. Lattermann C, Drake GN, Spellman J, Bach BR., Jr Lateral retinacular release for anterior knee pain: a systematic review of the literature. J Knee Surg. 2006;19(4):278–284. doi: 10.1055/s-0030-1248120.
    1. Fonseca L, Kawatake EH, Pochini AC. Lateral patellar retinacular release: changes over the last ten years. Rev Bras Ortop. 2017;52(4):442–449. doi: 10.1016/j.rboe.2017.06.003.
    1. Christoforakis J, Bull AM, Strachan RK, Shymkiw R, Senavongse W, Amis AA. Effects of lateral retinacular release on the lateral stability of the patella. Knee Surg Sports Traumatol Arthrosc. 2006;14(3):273–277. doi: 10.1007/s00167-005-0699-5.
    1. Chhabra A, Subhawong TK, Carrino JA. A systematised MRI approach to evaluating the patellofemoral joint. Skeletal Radiol. 2011;40(4):375–387. doi: 10.1007/s00256-010-0909-1.
    1. Beighton P, Solomon L, Soskolne CL. Articular mobility in an African population. Ann Rheum Dis. 1973;32(5):413–418. doi: 10.1136/ard.32.5.413.
    1. Staheli LT, Corbett M, Wyss C, King H. Lower-extremity rotational problems in children. Normal values to guide management. J Bone Joint Surg Am. 1985;67(1):39–47. doi: 10.2106/00004623-198567010-00006.
    1. Aglietti P, Insall JN, Cerulli G. Patellar pain and incongruence. I: Measurements of incongruence. Clin Orthop Relat Res. 1983;176:217–224.
    1. Collins NJ, Misra D, Felson DT, Crossley KM, Roos EM. Measures of knee function: International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS), Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL), Lysholm Knee Scoring Scale, Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Activity Rating Scale (ARS), and Tegner Activity Score (TAS) Arthritis Care Res (Hoboken) 2011;63:S208–S228. doi: 10.1002/acr.20632.
    1. Kolowich PA, Paulos LE, Rosenberg TD, Farnsworth S. Lateral release of the patella: indications and contraindications. Am J Sports Med. 1990;18(4):359–365. doi: 10.1177/036354659001800405.
    1. Sahu R, Iunawat S, Taneja D (2008) The patellar compression syndrome: Treatment by miniopen lateral retinacular release results and review of literature. Internet J Orthop Surg 14(2)

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi