Avoidance of Major Complications
To reduce pain and improve patellar tracking, before surgery the surgeon must consider if the indications are appropriate, if other concomitant procedures are needed, if the patterns of patellar and trochlear chondral wear are appropriate, and if the patella is hypermobile. In particular, this includes physical examination notation of patellar tracking, glide, tilt, and lower extremity alignment that may require concomitant medially based tightening or stabilizing procedures. Intraoperatively, care must be taken to avoid excessive release or insufficient release of the retinaculum, achieve good hemostasis, and avoid cautery burns. Postoperatively, motion should be initiated immediately.
Detection and Treatment of Major Complications
Postoperative hemarthrosis should be managed with reassurance, compression, ice, pain medication, and sometimes aspiration or surgical evacuation with cauterization if it inhibits postoperative rehabilitation. Dermal or skin burns need to be managed with wound management and possible plastic surgery consultation. Medial instability may be managed with physical therapy or revision with lateral retinacular repair, and continued pain may require medication, injections, or arthroscopic debridement or patellofemoral replacement.
Lateral release involves incising the lateral retinaculum of the patellofemoral joint to reduce the lateral vector of force on the patella or to reduce the lateral compressive forces on the lateral patellofemoral joint [3, 4]. The potential benefits are reduction in pain and improvement in patellar stability if done appropriately based on correct indications and technical application. Potential long-term complications are weakening of the extensor function of the knee, creating medial patellar instability, worsening patellofemoral pain, burning the skin from an aggressive release, and failing to correct the original disorder. The only real short-term complication is hemarthrosis. Some errors in judgment (Table 1) and technical errors (Table 2) may affect the result of surgery.
1. Aderinto, J. and Cobb, AG. Lateral release for patellofemoral arthritis. Arthroscopy.
2002; 18: 399-403. 10.1053/jars.2002.32306
2. Blasier, RB. and Ciullo, JV. Rupture of the quadriceps tendon after arthroscopic lateral release. Arthroscopy.
1986; 2: 262-263. 10.1016/S0749-8063(86)80082-2
3. Ford, DH. and Post, WR. Open or arthroscopic lateral release: indications, techniques, and rehabilitation. Clin Sports Med.
1997; 16: 29-49. 10.1016/S0278-5919(05)70006-5
4. Fulkerson, JP. Diagnosis and treatment of patients with patellofemoral pain. Am J Sports Med.
2002; 30: 447-456.
5. Hallisey, MJ., Doherty, N., Bennett, WF. and Fulkerson, JP. Anatomy of the junction of the vastus lateralis tendon and the patella. J Bone Joint Surg Am.
1987; 69: 545-549.
6. Hautamaa, PV., Fithian, DC., Kaufman, KR., Daniel, DM. and Pohlmeyer, AM. Medial soft tissue restraints in lateral patellar instability and repair. Clin Orthop Relat Res.
1998; 349: 174-182. 10.1097/00003086-199804000-00021
7. Hughston, JC. and Deese, M. Medial subluxation of the patella as a complication of lateral retinacular release. Am J Sports Med.
1988; 16: 383-388. 10.1177/036354658801600413
8. Kolowich, PA., Paulos, LE., Rosenberg, TD. and Farnsworth, S. Lateral release of the patella: indications and contraindications. Am J Sports Med.
1990; 18: 359-365. 10.1177/036354659001800405
9. Krompinger, WJ. and Fulkerson, JP. Lateral retinacular release for intractable lateral retinacular pain. Clin Orthop Relat Res.
1983; 179: 191-193. 10.1097/00003086-198310000-00029
10. Lord, MJ., Maltry, JA. and Shall, LM. Thermal injury resulting from arthroscopic lateral retinacular release by electrocautery: report of three cases and a review of the literature. Arthroscopy.
1991; 7: 33-37. 10.1016/0749-8063(91)90074-8
11. Myers, P., Williams, A., Dodds, R. and Bulow, J. The three-in-one proximal and distal soft tissue patellar realignment procedure: results, and its place in the management of patellofemoral instability. Am J Sports Med.
1999; 27: 575-579.
12. Nietosvaara, Y., Paukku, R., Palmu, S. and Donell, ST. Acute patellar dislocation in children and adolescents: surgical technique. J Bone Joint Surg Am.
2009; 91: (suppl 2 pt 1):139-145. 10.2106/JBJS.H.01289
13. Nonweiler, DE. and DeLee, JC. The diagnosis and treatment of medial subluxation of the patella after lateral retinacular release. Am J Sports Med.
1994; 22: 680-686. 10.1177/036354659402200517
14. Palmu, S., Kallio, PE., Donell, ST., Helenius, I. and Nietosvaara, Y. Acute patellar dislocation in children and adolescents: a randomized clinical trial. J Bone Joint Surg Am.
2008; 90: 463-470. 10.2106/JBJS.G.00072
15. Sallay, PI., Poggi, J., Speer, KP. and Garrett, WE. Acute dislocation of the patella: a correlative pathoanatomic study. Am J Sports Med.
1996; 24: 52-60. 10.1177/036354659602400110
16. Schneider, T., Fink, B., Abel, R., Jerosch, J. and Schulitz, KP. Hemarthrosis as a major complication after arthroscopic subcutaneous lateral retinacular release: a prospective study. Am J Knee Surg.
1998; 11: 95-100.
17. Small, NC. An analysis of complications in lateral retinacular release procedures. Arthroscopy.
1989; 5: 282-286. 10.1016/0749-8063(89)90142-4
18. Vialle, R., Tanguy, JY., Cronier, P., Fournier, HD., Papon, X. and Mercier, P. Anatomic and radioanatomic study of the lateral genicular arteries: application to prevention of postoperative hemarthrosis after arthroscopic lateral retinacular release. Surg Radiol Anat.
1999; 21: 49-53. 10.1007/BF01635052
19. Woods, GW., Elkousy, HA. and O’Connor, DP. Arthroscopic release of the vastus lateralis tendon for recurrent patellar dislocation. Am J Sports Med.
2006; 34: 824-831. 10.1177/0363546505282617