Medial retinacular flap advancement and arthroscopic lateral release for symptomatic chronic patellar lateral subluxation with tilting.

ABSTRACT

PURPOSE: The purpose of this study was to investigate outcomes of surgical treatment in patients with symptomatic chronic patellar lateral subluxation with tilting. METHODS: Thirty-two patients (38 knees) underwent arthroscopic lateral release and mini-open advancement of medial retinacular flap for the treatment of symptomatic chronic patellar lateral subluxation with tilting with a mean follow-up of 52.0±11.4 months. The mean age at surgery was 24.7±8.8 years, and the duration of symptoms was 4.8±4.1 years. The patellofemoral function of the knee was evaluated before surgery and at the clinical follow-up using the Kujala functional score. RESULTS: Thirty-six knees (95%) showed excellent or good results after surgery. Two knees with grade IV chondromalacia of the patella had fair results with persistent apprehension signs and persistent pain. The Kujala patellofemoral functional scores improved by an average of 20.9 points from a mean value of 71.8±12.1 preoperatively to 92.7±10.7 postoperatively (P<0.01). Radiographically, there were significant improvements in congruence angle from 23.4°±7.9° preoperatively to -7.2°±6.4° postoperatively (P<0.01) and in the lateral patellofemoral angle from -8.6°±6.8° preoperatively to 6.3°±4.2° postoperatively (P<0.01). CONCLUSIONS: Medial retinacular flap advancement and arthroscopic lateral release offer a promising treatment for symptomatic chronic patellar lateral subluxation and tilt without frank traumatic episode. LEVEL OF EVIDENCE Retrospective study, Level IV.