Open Lateral Retinacular Closure Surgery for Treatment of Anterolateral Knee Pain and Disability After Arthroscopic Lateral Retinacular Release

Abstract

Background: Although lateral retinacular release (LR) surgery has historically been one of the most commonly used arthroscopic procedures for the treatment of patellar instability and anterior knee pain, it may be associated with complications and poor functional outcome measures. Purpose: To examine the clinical efficacy of open lateral retinacular closure (LRC), a novel but technically simple procedure in the treatment of disabling anterolateral knee pain, tenderness, and positive medial patellar apprehension testing in patients who have undergone prior arthroscopic LR surgery. Study Design: Case series; Level of evidence, 4. Methods: The records of 22 patients who had previously undergone an arthroscopic LR and underwent a diagnostic arthroscopy and LRC were reviewed. Physical examination findings and symptoms after prior LR surgery, duration between LR and LRC surgeries, and arthroscopic findings immediately before LRC were analyzed. Preoperative and postoperative Lysholm knee scores and activity levels were compared, and subjective satisfaction ratings assessed. Results: Average follow-up after LRC was 3.2 years. Mean preoperative Lysholm knee score was 46.5 (range, 25-90), which improved postoperatively to a mean score of 86 (range, 48-100). Fourteen percent of patients subjectively rated their preoperative function as fair and 86% as poor. Postoperatively, 82% rated themselves as good or excellent and 18% as fair, with all patients improving from the LRC procedure. All patients stated that they would have the procedure again for the same problem. Conclusion: Open LRC provides significant pain relief and improvement in functional knee outcome scores in patients with persistent pain and tenderness at the site of a previous lateral release and a positive medial patellar apprehension test. Lateral release procedures should be considered with caution. For patients with anterolateral knee pain and symptoms of medial patellar instability after lateral release, LRC may provide symptomatic relief and functional improvement.