Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 16, 2016; 4(8): 202-206
Published online Aug 16, 2016. doi: 10.12998/wjcc.v4.i8.202
Lateral patellofemoral ligament reconstruction to restore functional capacity in patients previously undergoing lateral retinacular release
Mitch Beckert, Dylan Crebs, Michael Nieto, Yubo Gao, John Albright
Mitch Beckert, Dylan Crebs, Michael Nieto, Yubo Gao, John Albright, Department of Orthopedics, University of Iowa, Iowa City, IA 52240, United States
Author contributions: Beckert M helped design and perform the research and helped write the paper; Crebs D helped with research and manuscript editing; Nieto M helped with research and manuscript editing; Gao Y did statistical analysis and manuscript editing; and Albright J helped with study design and helped write the paper.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Fukushima Medical University Hospital.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: We have no financial relationships or conflicts of interest to disclose.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at Consent was not obtained from patients for data sharing but the presented data are anonymized and risk of identification is extremely low.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Mitch Beckert, BS, Department of Orthopedics, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52240, United States.
Telephone: +1-563-3407212
Received: February 18, 2016
Peer-review started: February 18, 2016
First decision: March 24, 2016
Revised: April 7, 2016
Accepted: June 14, 2016
Article in press: June 16, 2016
Published online: August 16, 2016

AIM: To study patient outcomes after surgical correction for iatrogenic patellar instability.

METHODS: This retrospective study looked at 17 patients (19 knees) suffering from disabling medial patellar instability following lateral release surgery. All patients underwent lateral patellofemoral ligament (LPFL) reconstruction by a single surgeon. Assessments in all 19 cases included functional outcome scores, range of motion, and assessment for the presence of apprehension sign of the patella to determine if LPFL reconstruction surgery was successful at restoring patellofemoral stability.

RESULTS: No patients reported any residual postoperative symptoms of patellar instability. Also no patients demonstrated medial patellar apprehension or examiner induced subluxation with the medial instability test described earlier following LPFL reconstruction. Furthermore, all patients recovered normal range of motion compared to the contralateral limb. For patients with pre and postoperative outcome scores, the mean overall knee injury and osteoarthritis outcome score increased significantly, from 34.39 preoperatively (range: 7.7-70.12) to 69.54 postoperatively (range: 26.82-91.46) at final follow-up (P < 0.0001).

CONCLUSION: This novel technique for LPFL reconstruction is effective at restoring lateral restraint of the patellofemoral joint and improving joint functionality.

Keywords: Lateral patellofemoral ligament, Knee, Sports medicine, Patellar instability, Orthopedics

Core tip: This is a case series of patients presenting with an initial history of anterior knee pain who underwent lateral capsular surgical release procedure at an outside institution. They were referred to us after a dramatic increase in their knee problems following this procedure, including recurrent medial patellar instability and pain. There are two techniques in the current literature that describe lateral patellofemoral ligament reconstruction. Here we present a third technique, as well as the specific physical examination that indicated each patient for surgery. This is an important topic because of the debilitating nature of these iatrogenic symptoms, and the 100% relief of medial patellar subluxation we were able to accomplish in the postoperative period.