Deep Transverse Lateral Retinaculum Reconstruction for Medial Patellar Instability

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Biomechanics

Background:

• Medial patellar instability is a potential complication following extensive lateral retinaculum release surgery.
• This complication is often underdiagnosed and requires a high index of suspicion for accurate diagnosis.
• Patients typically present with new, severe pain and instability distinct from preoperative symptoms.

Purpose of the Study:

• To describe a diagnostic approach for medial patellar instability after lateral retinaculum release.
• To present a surgical technique for lateral retinaculum reconstruction to address this specific complication.
• To evaluate the efficacy of non-operative and operative management strategies.

Main Methods:

• Clinical assessment including a high index of suspicion for medial patellar instability.
• Diagnostic use of "reverse" McConnell taping for symptom relief.
• Confirmation with stress radiographs or stress axial computed tomography (CT) scans to identify medial patellar displacement.
• Surgical technique involving reconstruction of the deep transverse layer of the lateral retinaculum using an iliotibial band autograft.

Main Results:

• "Reverse" McConnell taping provided significant pain relief in all affected patients.
• Objective pathological medial patellar displacement was confirmed via stress imaging in cases with symptomatic improvement.
• The described surgical technique successfully reconstructed the lateral retinaculum.

Conclusions:

• Medial patellar instability is a significant complication of lateral retinaculum release that warrants specific diagnostic consideration.
• Non-operative management with "reverse" McConnell taping can be effective for symptom management.
• Surgical reconstruction of the lateral retinaculum using an iliotibial band graft is a viable option for persistent instability.