Arthroscopic treatment for patellar dislocation with lateral retinacular release combined with medial patellofemoral ligament reconstruction_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 LI Xiaojian , FU Zhanli , Lü Changwei

Department of Orthopedics, No.3 Hospital of Xi’an, P.R.China;

Corresponding?author：

LI Xiaojian, Email: leexiaojian@163.com

Keywords：

Patellar dislocation; arthroscopy; lateral retinacular release; medial patellofemoral ligament; reconstruction

DOI：

10.7507/1002-1892.201711050

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

ObjectiveTo investigate the effectiveness of the arthroscopic lateral retinacular release combined with medial patellofemoral ligament (MPFL) reconstruction for patellar dislocation.MethodsBetween January 2016 and March 2017, 28 cases (32 knees) with patellar dislocation were treated by arthroscopic lateral retinacular release and MPFL reconstruction. There were 6 males (6 knees) and 22 females (26 knees) with an average age of 21 years (range, 17-29 years). The disease duration ranged from 2 days to 2 years (mean, 8 months). Apprehension test of all patients were positive. The preoperative Lysholm score was 68.34±12.26. Anteroposterior X-ray film showed the patellar subluxation or dislocation. The Q angle was (17.67±4.21)° and the distance of tibia tuberosity-trochlear groove was less than 20 mm. The femoral attachment of retinacular were fixed by the interference screws (16 knee) or the anchors (16 knee), respectively.ResultsAll incisions healed by first intention. All patients were followed up 6 months. The function of knee joint was significantly improved at 6 months after operation. The Lysholm score was 92.88±6.42 and the Q angle was (12.15±3.68)° at 6 months. There were significant differences in the Lysholm score and the Q angle between pre- and post-operation (t=–3.408, P=0.006; t=–2.317, P=0.004). Apprehension test of all patients were negative. No knee pain, knee weakness, and patellar dislocation occurred during follow-up. There was no significant difference in the Lysholm score and the Q Angle between the anchor group and interference screw group (t=–3.254, P=0.820; t=–3.576, P=0.940). ConclusionLateral retinacular release combined with MPFL reconstruction under arthroscopy can effectively improve the function of the knee joint for patients with Q angle less than 20° and TT-TG less than 20 mm, and the early effectiveness is good. There is no significant difference in knee function between the anchor and interference screw internal fixation.

Citation： LI Xiaojian, FU Zhanli, Lü Changwei. Arthroscopic treatment for patellar dislocation with lateral retinacular release combined with medial patellofemoral ligament reconstruction. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(2): 169-173. doi: 10.7507/1002-1892.201711050 Copy

1.	Roth S, Madarevic T, Vukelic L, et al. Influence of arthroscopic lateral release on functional recovery in adolescents with recurrent patellar dislocation. Arch Orthop Trauma Surg, 2013, 133 (10): 1441-1445.
2.	Suganuma J, Mochizuki R, Sugiki T, et al. Reconstruction of the medial patellofemoral ligament using a synthetic graft with arthroscopic control of patellofemoral congruence. Arthroscopy, 2016, 32 (11): 2259-2268.
3.	Schorn D, Yang-Strathoff S, Gosheger G, et al. Long-term outcomes after combined arthroscopic medial reefing and lateral release in patients with recurrent patellar instability—a retrospective analysis. BMC Musculoskel Disord, 2017, 18 (1): 277.
4.	戴祝, 尤迪, 廖瑛, 等. 髕骨復發性脫位伴陳舊性骨軟骨骨折的治療. 中國修復重建外科雜志, 2016, 30(1): 10-14.
5.	Chen S, Zhou Y, Qian Q, et al. Arthroscopic lateral retinacular release, medial retinacular plication and partial medial tibial tubercle transfer for recurrent patellar dislocation. Int J Surg, 2017, 44: 43-48.
6.	Nelitz M, Williams RS, Lippacher S, et al.Analysis of failure and clinical outcome after unsuccessful medial patellofemoral ligament reconstruction in young patients. Int Orthop, 2014, 38 (11): 2265-2272.
7.	Howells NR, Barnett AJ, Ahearn N, et al. Medial patellofemoral ligament reconstruction: a prospective outcome assessment of a large single centre series. J Bone Joint Surg (Br), 2012, 94 (9): 1202-1208.
8.	Blackman AJ, Smith JC, Luhmann SJ. Arthroscopic lateral retinacular release in adolescents with medial patellofemoral ligament-centered knee pain. J Pediatr Orthop, 2016, 36 (3): 268-273.
9.	陳輝, 王群, 燕雙喜, 等. 外側支持帶松解聯合髕骨韌帶重建修復復發性髕骨脫位. 中國組織工程研究, 2015, 19(29): 4747-4751.
10.	Liu C, Duan G, Niu Y, et al. Lateral retinaculum plasty instead of lateral retinacular release with concomitant medial patellofemoral ligament reconstruction can achieve better results for patellar dislocation. Knee Surg Sports Traumatol Arthrosc, 2017. [Epub head of print].
11.	Balcarek P, Rehn S, Howells NR, et al. Results of medial patellofemoral ligament reconstruction compared with trochleoplasty plus individual extensor apparatus balancing in patellar instability caused by severe trochlear dysplasia: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc, 2017, 25 (12): 3869-3877.
12.	Sanders TL, Pareek A, Hewett TE, et al. High rate of recurrent patellar dislocation in skeletally immature patients: a long-term population-based study. Knee Surg Sports Traumatol Arthrosc, 2017. [Epub head of print].
13.	Testa EA, Camathias C, Amsler F, et al. Surgical treatment of patellofemoral instability using trochleoplasty or MPFL reconstruction: a systematic review. Knee Surg Sports Traumatol Arthrosc, 2017, 25 (8): 2309-2320.
14.	Placella G, Tei M, Sebastiani E, et al. Anatomy of the medial patello-femoral ligament: a systematic review of the last 20 years literature. Musculoskelet Surg, 2015, 99 (2): 93-103.
15.	Meyers AB, Laor T, Sharafinski M, et al. Imaging assessment of patellar instability and its treatment in children and adolescents. Pediatr Radiol, 2016, 46 (5): 618-636.
16.	Marchionatti E, Desrochers A, Sheen, AD, et al. Surgical correction of traumatic lateral patellar luxation. Vet Surg, 2016, 45 (1): 121-124.
17.	王乾, 齊尚鋒. 關節鏡下外側支持帶松解、內側緊縮與髕股韌帶重建治療復發性髕骨脫位. 中國骨與關節損傷雜志, 2016, 31(6): 602-605.
18.	李良軍, 丑克, 何志勇, 等. 關節鏡輔助下解剖重建內側髕股韌帶治療復發性髕骨脫位. 中南大學學報(醫學版), 2015, 40 (11): 1239-1245.

1. Roth S, Madarevic T, Vukelic L, et al. Influence of arthroscopic lateral release on functional recovery in adolescents with recurrent patellar dislocation. Arch Orthop Trauma Surg, 2013, 133 (10): 1441-1445.
2. Suganuma J, Mochizuki R, Sugiki T, et al. Reconstruction of the medial patellofemoral ligament using a synthetic graft with arthroscopic control of patellofemoral congruence. Arthroscopy, 2016, 32 (11): 2259-2268.
3. Schorn D, Yang-Strathoff S, Gosheger G, et al. Long-term outcomes after combined arthroscopic medial reefing and lateral release in patients with recurrent patellar instability—a retrospective analysis. BMC Musculoskel Disord, 2017, 18 (1): 277.
4. 戴祝, 尤迪, 廖瑛, 等. 髕骨復發性脫位伴陳舊性骨軟骨骨折的治療. 中國修復重建外科雜志, 2016, 30(1): 10-14.
5. Chen S, Zhou Y, Qian Q, et al. Arthroscopic lateral retinacular release, medial retinacular plication and partial medial tibial tubercle transfer for recurrent patellar dislocation. Int J Surg, 2017, 44: 43-48.
6. Nelitz M, Williams RS, Lippacher S, et al.Analysis of failure and clinical outcome after unsuccessful medial patellofemoral ligament reconstruction in young patients. Int Orthop, 2014, 38 (11): 2265-2272.
7. Howells NR, Barnett AJ, Ahearn N, et al. Medial patellofemoral ligament reconstruction: a prospective outcome assessment of a large single centre series. J Bone Joint Surg (Br), 2012, 94 (9): 1202-1208.
8. Blackman AJ, Smith JC, Luhmann SJ. Arthroscopic lateral retinacular release in adolescents with medial patellofemoral ligament-centered knee pain. J Pediatr Orthop, 2016, 36 (3): 268-273.
9. 陳輝, 王群, 燕雙喜, 等. 外側支持帶松解聯合髕骨韌帶重建修復復發性髕骨脫位. 中國組織工程研究, 2015, 19(29): 4747-4751.
10. Liu C, Duan G, Niu Y, et al. Lateral retinaculum plasty instead of lateral retinacular release with concomitant medial patellofemoral ligament reconstruction can achieve better results for patellar dislocation. Knee Surg Sports Traumatol Arthrosc, 2017. [Epub head of print].
11. Balcarek P, Rehn S, Howells NR, et al. Results of medial patellofemoral ligament reconstruction compared with trochleoplasty plus individual extensor apparatus balancing in patellar instability caused by severe trochlear dysplasia: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc, 2017, 25 (12): 3869-3877.
12. Sanders TL, Pareek A, Hewett TE, et al. High rate of recurrent patellar dislocation in skeletally immature patients: a long-term population-based study. Knee Surg Sports Traumatol Arthrosc, 2017. [Epub head of print].
13. Testa EA, Camathias C, Amsler F, et al. Surgical treatment of patellofemoral instability using trochleoplasty or MPFL reconstruction: a systematic review. Knee Surg Sports Traumatol Arthrosc, 2017, 25 (8): 2309-2320.
14. Placella G, Tei M, Sebastiani E, et al. Anatomy of the medial patello-femoral ligament: a systematic review of the last 20 years literature. Musculoskelet Surg, 2015, 99 (2): 93-103.
15. Meyers AB, Laor T, Sharafinski M, et al. Imaging assessment of patellar instability and its treatment in children and adolescents. Pediatr Radiol, 2016, 46 (5): 618-636.
16. Marchionatti E, Desrochers A, Sheen, AD, et al. Surgical correction of traumatic lateral patellar luxation. Vet Surg, 2016, 45 (1): 121-124.
17. 王乾, 齊尚鋒. 關節鏡下外側支持帶松解、內側緊縮與髕股韌帶重建治療復發性髕骨脫位. 中國骨與關節損傷雜志, 2016, 31(6): 602-605.
18. 李良軍, 丑克, 何志勇, 等. 關節鏡輔助下解剖重建內側髕股韌帶治療復發性髕骨脫位. 中南大學學報(醫學版), 2015, 40 (11): 1239-1245.

Chinese Journal of Reparative and Reconstructive Surgery

Arthroscopic treatment for patellar dislocation with lateral retinacular release combined with medial patellofemoral ligament reconstruction

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content