Analysis of patellar maltracking after arthroscopic lateral retinacular release

doi:10.3969/j.issn.2095-4344.2014.51.025

Abstract

Abstract:

BACKGROUND: Lateral retinacular release is the preferred treatment for patellofemoral disorders, but the long-term follow-up results reported in some literatures are not satisfied.

OBJECTIVE: To analyze the improvement in patellar tracking after lateral patellar retinacular release and to determine the reasons for unsatisfactory outcomes during the follow-up.

METHODS: Fifty-seven consecutive knees (34 cases), which had undergone isolated lateral patellar retinacular release, were included in the study. CT scans of each knee were performed before and after surgery with the knee at different degrees of dynamic flexion: 10°, 20°, 30°, and 40°. The following parameters were evaluated: femoral distal medial torsion angle, patellar congruence angle, and patellar lateral translation angle. Preoperative and postoperative measures of patellar tracking were compared.

RESULTS AND CONCLUSION: There were 17 knees in which patellar tracking was not improved after surgery. Patellar tracking was improved in 40 knees after surgery. The improvement in patellar tracking did not reach the preoperative prediction when the femoral distal medial torsion angle was less than 9°. The femoral distal medial torsion angle is found to be an important factor influencing patellar maltracking recovery and may underlie unsatisfactory outcomes in some patients at a long-term follow-up.

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

全文链接：

Key words: biomechanics, ligaments, knee, patella

CLC Number:

R318

Zhang Jian-bing, Hao Jian-qiao, Shen Yun-long, Wang He-wei, Xue Yong-an, Liu Bin. Analysis of patellar maltracking after arthroscopic lateral retinacular release[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(51): 8330-8336.

Figures/Tables 3

Variation of patellar tracking after arthroscopic lateral retinacular release According to previously published research[8] and our experience, abnormal CA and PLTA values should be improved to nearly normal values (CA: -6°-6°, PLTA: 0°-5°) after LRR. Mean preoperative CA and PLTA values were (23.86±11.39)° and (43.59±10.88)° for 10° of knee flexion, (23.97±11.56)° and (43.70±11.67)° for 20° of knee flexion, (24.10±11.49)° and (43.73±11.53)° for 30° of knee flexion, and (23.51±11.91)° and (43.27±12.13)° for 40° of knee flexion, respectively. The overall mean preoperative FMTA was (10.14±6.45)°, which did not change markedly during the four knee flexion phases. Mean postoperative CA and PLTA values were (11.53± 9.12)° and (12.73± 10.63)° for 10° of knee flexion, (11.67±8.93)° and (12.85± 11.19)° for 20° of knee flexion, (11.97±9.31)° and (12.54± 10.19)° for 30° of knee flexion, and (10.97±8.45)° and (11.09±11.10)° for 40° of knee flexion, respectively. The mean postoperative FMTA was (10.14±6.45)°. Mean FMTA remained unchanged after LRR, regardless of the knee flexion phase. There were 17 knees in which patellar tracking (as indicated by CA and PLTA values) did not improve after surgery and 40 knees in which patellar tracking improved after surgery. The quasi constant FMTA was further examined by comparison between the patellar maltracking unchanged group and patellar maltracking improved group using the Wilcoxon rank test (P > 0.05). Lysholm scores were not different between the two groups before and after LRR, nor were CA and PLTA values before LRR. After LRR, CA and PLTA values were significantly lower in the patellar maltracking changed group compared to the patellar maltracking unchanged group (P < 0.01; Table 1). As shown in Figure 2, FMTA influenced patellar-maltracking recovery after LRR. When FMTA was less than 9° or greater than 9°, postoperative CA and PLTA values were significantly different from preoperative values. Patellar tracking improvement did not meet preoperative expectations when the FMTA was less than 9°. Otherwise, we gathered from some patients that bilateral femoral distal ends presented a different extent of torsion, whose side of the larger FMTA had a better patellar tracking recovery than the lesser side (Figure 3). The evidence also substantiated the findings of the research. "

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