Historically, a lateral retinacular release was a popular mode of treatment for a variety of knee conditions, including lateral patellar instability, anterior knee pain, and patellar chondromalacia. This procedure was often preferred because of the reported low complication rates. In 1988, Hughston and Deese described medial patellar instability as a complication of a lateral retinacular release procedure. The static and dynamic lateral stabilizers of the patella, including the lateral patellotibial ligament and the lateral epicondylopatellar ligament, can be compromised during a lateral retinacular release. Most cases of medial patellar instability reported in the literature are iatrogenic, but traumatic and spontaneous cases have also been reported.
Medial patellar instability can be a disabling condition. Some patients with prior lateral retinacular release report pain and other symptoms that are worse than prior to their surgery. Sanchis-Alfonso reported that patients with iatrogenic medial patellar instability had higher rates of disabling psychologic symptoms such as anxiety and depression compared with patients with more typical anterior knee pain. The optimal treatment of this condition is debatable. Several techniques have been described, including direct lateral ligament repair, arthroscopic medial retinacular release, lateral retinacular reconstruction with soft tissue augmentation, lateral patellofemoral ligament reconstruction, and lateral patellotibial ligament reconstruction. The purpose of this study was to review the outcomes in patients after treatment for medial patellar instability with a lateral patellotibial ligament reconstruction at a minimum of 2 years’ follow-up. We hypothesized that patients who had a prior lateral release would have good outcomes after lateral patellotibial ligament reconstruction at a minimum of 2 years after surgery.
Full Article: Medial Patellar Instability: Treatment and Outcomes