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Complications in Brief: Arthroscopic Lateral Release

Elkousy, Hussein, MD1, a

Clinical Orthopaedics and Related Research: October 2012 - Volume 470 - Issue 10 - p 2949–2953
doi: 10.1007/s11999-012-2383-7
In Brief
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SDC

Arthroscopic lateral release refers to an arthroscopic procedure that incises the lateral stabilizing structures of the patella, in particular, the lateral retinaculum. The lateral retinaculum attaches the lateral patella to the lateral femoral epicondyle, the iliotibial band, and the anterolateral tibia. Arthroscopic lateral release rarely is performed as an isolated procedure and rather is generally performed in combination with medially based stabilization procedures to more effectively allow for medial realignment. The procedure is relatively simple and straightforward, but, if not done for the appropriate indications or if done technically poorly, either it will not achieve the desired result or it may result in additional pain, instability, and weakness. This In Brief article provides an overview of potential complications of lateral release.

1 Fondren Orthopedic Group, 7401 South Main St, 77030, Houston, TX, USA

a e-mail; he700@fondren.com

Each author certifies that he or she, or a member of their immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

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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.

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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.

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Summary

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.

Table 1

Table 1

Fig. 1A-B

Fig. 1A-B

Table 2

Table 2

Fig. 2A-B

Fig. 2A-B

Fig. 3

Fig. 3

Fig. 4A-B

Fig. 4A-B

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