The Outcomes of Isolated Lateral Release in Patellofemoral Instability: A Systematic Review and Meta-Analysis.

Abstract

There have been conflicting reports regarding the outcomes of lateral release when used in the management of patellofemoral instability. This systematic review and meta-analysis therefore aims to evaluate the outcomes of isolated lateral release in the management of patellofemoral instability. The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All studies that reported the outcomes of isolated lateral release for recurrent patellofemoral dislocations were included. A total of 10 publications were included, with 204 knees. All studies consistently reported a decrease in the rates of patellofemoral dislocation (odds ratio [OR] < 0.01; 95% confidence interval [CI]: <0.01-0.01) and an increase in the odds of having a good outcome (OR 0.01; 95% CI: <0.01-0.02) after lateral release. All studies also consistently reported a similar number of patients participating in sports postoperatively as compared with preinjury (OR 2.78; 95% CI: 0.53-14.68). A total of 28 (14.1%) out of 198 patients had postoperative dislocation. Of these patients, 15 required a secondary procedure for patellofemoral realignment; however, all patients who had their eventual outcomes reported still had a good outcome postoperatively. Isolated lateral release can lead to good short- to middle-term outcomes when used in the management of recurrent patellofemoral dislocations. The procedure can lead to a significantly decreased rate of recurrence of patellofemoral dislocations, a significantly increased rate of good outcomes, and a similar number of patients being able to participate in sports as compared with the number of patients participating in sports prior to having patellofemoral dislocations. An isolated lateral release could therefore potentially serve as a simple and relatively low-risk procedure that could be performed as a first-line surgical management in selected patients with patellofemoral instability, allowing them to possibly avoid a more complex and major operation. This is a Level IV study.