Outcome and experience of arthroscopic lateral retinacular release combined with lateral patelloplasty in the management of excessive lateral pressure syndrome

Background Only a few studies have described the effect of full arthroscopic surgery in treatment of excessive lateral pressure syndrome (ELPS). Therefore, the purpose of this study was to assess the clinical efficacy and experience of total arthroscopic lateral retinacular (LR) release and lateral patelloplasty for the treatment of ELPS. Methods A total of 73 patients (88 knees) with ELPS underwent arthroscopic LR release and lateral patelloplasty. The visual analogue scale (VAS), Kujala score, Lysholm scores, patella medial pushing distance, patellar tilt angle (PTA), and lateral patellofemoral angle (LPFA) were measured and evaluated before and after surgery. Results Follow-up ranged from 12 to 36 months with an average of 24 ± 5.8 months. The VAS was significantly lower at the last follow-up than before surgery (P < 0.01). The patella medial pushing distance, Kujala score, Lysholm score, PTA, and LPFA were significantly higher at the last follow-up than before surgery (P < 0.01, respectively). Years and lateral patella Outerbridge classification at the last follow-up have negative correlation with Kujala score, Lysholm score, Patella medial pushing distance, PTA, and LPFA (P < 0.01, respectively) and have positive correlation with VAS (P < 0.01, respectively). Related complications were not reported. Conclusions Full arthroscopic LR release combined with lateral patelloplasty in the treatment of ELPS is an effective minimally invasive method, which can effectively correct anomalies of force line and skeleton of patella, relieve pain, and restore knee joint motor function with less complications.

Normalisation of Patella Alta with MPFL Reconstruction Reduces the Prevalence of Risk Factors Associated With Recurrent Patella Dislocations - A Prospective Cross Sectional Study

Background: Patella alta is a well-established risk factor for recurrent lateral patella dislocations. Medial patellofemoral ligament (MPFL) reconstruction has been shown to consistently reduce patella height. Our hypothesis is that MPFL reconstruction reduces the number of risk factors for recurrent dislocations through the correction of patella alta, resulting in a decreased risk of recurrence.Methods: A prospective cross-sectional case series of 33 knees which underwent MPFL reconstruction for lateral patella dislocations. Information on patellar height utilising the Insall-Salvati (IS) and Caton-Deschamps (CD) ratios, Tibial Tuberosity–Trochlear Groove (TT-TG) distance, trochlear dysplasia, and outcome scores were recorded pre-operatively and post-operatively. The mean change in patella height and the number of knees which achieved normalisation of patella alta were determined. Student’s paired samples T-tests were used to compare the differences in the means scores of the groups pre-operatively and post-operatively. The McNemar test for paired categorical data was used to compare the number of the patella alta corrected after MPFL reconstruction. A pre-determined significance of alpha level of 0.05 was used.Results: The mean age of 33 patients included in the study was 21.5 years (range, 16 – 34 years). There was statistically significant reduction in patella height between pre-operative and post-operative measurements using the various patella height indices for all patients (p<0.001), and normalisation of patella alta (CD ≥1.3) for 90% of patients post-operatively (p<0.004). One third of patients 33.3% had at least 3 risk factors pre-operatively. This was reduced to 18.2% after MPFL reconstruction, representing a 45.5% decrease. A statistically significant improvement in the outcome scores was found – Kujala score 57.1 ± 14.1 pre-operatively to 94.8 ± 5.1 post-operatively (p<0.0001). The recurrent dislocation rate was 3.0%.Conclusion: MPFL reconstruction for lateral patella dislocation results in a statistically significant improvement in clinical outcomes and decrease in patellar height ratios. Normalisation of abnormal patella height culminated in the reduction of anatomical risk factors associated with recurrent dislocations.

Modified Partial Lateral Facetectomy of the Patella for Stage III Patellofemoral Osteoarthritis with 5-Year Follow-Up

The main aim of this article was to examine the therapeutic evaluation of our modified partial lateral facetectomy of the patella for stage III lateral patellofemoral osteoarthritis (PFOA), which includes (1) partial lateral patella articular facet that was resected; (2) coronal Z-shaped incision to lengthen lateral retinaculum; (3) patellar perimeter electrocoagulation to denervate. Between December 2008 and January 2013, 36 knees of 32 patients with severe patellofemoral (PF) osteoarthritis (OA) were treated with our modified partial patellar lateral facetectomy. All patients were stage III according to the Iwano scale, and their patellas were all Wiberg type III or Baumgartl type IV in shape. The study group included 6 males and 26 females with an average age of 54.03 years and an average disease course of 8.67 years. The modified Kujala scores were used to evaluate PF function, and the congruence angle was used to evaluate the patellar position. Knee Society Scores (KSS) were used to evaluate overall knee function. Six knees of five cases were lost to follow-up. Thirty knees of 27 cases were followed up for 5 years, with an average follow-up time of 60 ± 3.2 months. The average preoperative modified Kujala score was 15.93, and the average score at last follow-up was 32.03; The satisfactory PF function was achieved in 28 knees (93.33%). The congruence angle improved from preoperative +23. 07 degrees to 11. 91 degrees at the last follow-up. The average preoperative KSS were 110.40 points, which increased to 156.77 points at the last postoperative follow-up. Pain was significantly relieved, and the ability to climb stairs was significantly improved. All scores showed statistically significant improvements after surgery (p < 0.05). No complications were reported. Our modified partial lateral facetectomy of the patella for stage III lateral PFOA can relieve pain and partially improve function. This modified procedure is relatively simple, safe, and an effective treatment method for middle-aged and elderly patients with PFOA. Furthermore, this surgery can be used as an alternative or prephase to total knee arthroplasty. This is a Level IV, therapeutic study.

Efficacy and experience of arthroscopic lateral patella retinaculum releasing through/outside synovial membrane for the treatment of lateral patellar compression syndrome

Objective: To investigate the method and effect of arthroscopic lateral patella retinaculum releasing (LPRR) either through or outside synovial membrane for the treatment of lateral patellar compression syndrome (LPCS).Methods: From September 2014 to December 2017, 125 patients with LPCS underwent arthroscopic LPRR either through or outside synovial membrane combined with joint debridement. In the outside synovial membrane (OSM) group, synovial membrane was retained. In the through synovial membrane (TSM) group,The synovial membrane was cut open. Active rehabilitation training was conducted after surgery. Before and after surgery, Lysholm score, patella medial shift, Kujala score, VAS score and surgical complications were evaluated and compared.Results: All patients in this study were followed up for 1.5-5 years. All patients had significant reduction in knee pain and improved function after 1 month and 1 year. The Lysholm score, the distance of patella medial shift, the Kujala score, and the VAS score in the OSM group and the TSM group were significantly improved in the final follow-up compared with before surgery ( P <0.001), but these observed targets before surgery and at the last follow-up between the two groups were compared with no statistical differences. However, the number of occurrences of joint hematoma and adhesion was significantly higher in the TSM group than the OSM group ( P =0.024).Conclusion: Arthroscopic closing LPRR for the treatment of LPCS can effectively improve the function and symptoms of the patellofemoral joint with the advantages of small trauma, rapid recovery and less complications. But, the number of occurrences of hemarthrosis and joint adhesion in the TSM group were significantly higher than those in the OSM group.