Lateral retinacular release via a prolonged incision versus arthroscopic lateral retinacular release in osteofascial medial patellofemoral ligament reconstruction for recurrent patellofemoral dislocation

Abstract

Objective To compare the short-term outcomes between lateral retinacular release (LRR) via a prolonged incision versus arthroscopic LRR in osteofascial medial patellofemoral ligament reconstruction (MPFL-R) for recurrent patellofemoral dislocation. Methods From May 2012 to March 2015, 51 patients with recurrent patellofemoral dislocation were treated at the Department of Joint Surgery, The Third Affiliated Hospital to Hebei Medical University. They were 16 males and 35 females, aged from 20 to 36 years (mean 27.2 years). Of them, 28 underwent LRR via a prolonged incision in MPFL-R (incision group) and 23 did arthroscopic LRR in MPFL-R (microscopic group). Imaging changes were assessed by comparing preoperative and postoperative values of patella extensibility, patellar tilt angle, trochlear groove angle and tibial tuberosity-trochlear groove spacing (TT-TG); the knee joints were scored with Kujala and Lysholm functional rating systems at the last follow-ups. Results The 2 groups were compatible due to insignificant differences in the general data between them preoperatively (P>0.05). The 51 patients were followed up for 10 to 32 months (average, 20 months). The rate of dislocation in the incision and microscopic groups were 0 and 8.7% (2/23), respectively. There were no such complications in either group as patellar fracture, deep venous thrombosis of the lower extremity or limited joint extension or flexion. The last follow-ups revealed that no patients in either group were inflicted with patellofemoral re-dislocation. In the incision group, the patella extensibility, patellar tilt angle, Kujala score and Lysholm score were, respectively, 19.65%±0.75%, 12.39°±0.76°, 56.37±2.94 points and 51.64±6.22 points preoperatively, and 10.34%±0.60%, 8.83°±0.89°, 92.68±2.75, and 90.71±1.91 points postoperatively; in the microscopic group, the patella extensibility, patellar tilt angle, Kujala score and Lysholm score were, respectively, 19.56%±0.62%, 12.35°±0.66°, 57.46±3.08 points and 52.20±6.94 points preoperatively, and 10.24%±0.66%, 8.78°±0.92°, 92.53±3.32 points and 90.41±2.90 points postoperatively. There were significant differences between the preoperative and postoperative values in both 2 groups (P 0.05). There were no significant differences between the 2 groups in all the above preoperative and postoperative values (P>0.05). Conclusion In MPFL-R for recurrent patellofemoral dislocation, both LRR via a prolonged incision and arthroscopic LRR can improve the patellofemoral joint alignment and stability of the tibia, leading to good short-term outcomes. Key words: Arthroscopy; Patellar ligament; Patellar dislocation; Lysis