Summary

Systematic performance of LRR in association with MPFL reconstruction in the absence of bony procedures does lead result in improved patient-reported outcomes or significant alteration of patellar tilt. The routine addition of LRR to MPFL reconstruction in this setting is not recommended.

Abstract

Objective

Reconstruction of the medial patellofemoral ligament (MPFL) has become the gold standard treatment for recurrent patellar dislocation (RPD). A lateral retinacular release (LRR) may be performed in conjunction with MPFL reconstruction, but its effect on outcomes is unclear. The aim of this study is to evaluate the effect of LRR on the outcomes of MPFL reconstruction. The hypothesis is that isolated MPFL reconstruction is not inferior to MPFL reconstruction with LRR in terms of subjective IKDC score and patellar tilt (PT).

Methods

Patients aged 18 to 45 years undergoing MPFL reconstruction without associated osseous procedures were randomized to either isolated MPFL reconstruction or MPFL reconstruction with arthroscopic LRR. Outcome measures were subjective IKDC score and PT assessed by computed tomography with the quadriceps relaxed (PTQR) and contracted (PTQC).

Results

Out of 140 patients randomized and included, 3 were excluded from analysis due to the performance of unexpected osseous procedures (2) or the use of a graft other than gracilis autograft (1); 8 were lost to follow-up; and 4 could not complete the study due to medical reasons. A total of 125 patients (89%) were evaluated at a median follow-up of 36 (Range: 24-144) months post-op. The mean subjective IKDC score was 78 ± 15 (29-98) in the LRR group and 81 ± 15 (33-100) in the Isolated MPFL group. PTQR was 21° ± 9° (4-39) in the LRR group and 17° ± 7° (2-35) in the Isolated MPFL group. PTQC was 24° ± 10° (5-45) in the LRR group and 21° ± 9 (7-43) in the Isolated MPFL group. Three complications were noted in each group: 3 stiffness cases in the LRR group and 1 stiffness, 1 neuroma, and 1 scar dehiscence in the Isolated MPFL group.

Conclusion

Systematic performance of LRR in association with MPFL reconstruction in the absence of bony procedures does lead result in improved patient-reported outcomes or significant alteration of patellar tilt. The routine addition of LRR to MPFL reconstruction in this setting is not recommended.