Medial Patellar Instability: Treatment and Outcomes

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Knee Biomechanics

Background:

• Lateral retinacular release, a historical treatment for lateral patellar instability, can paradoxically lead to medial instability.
• Iatrogenic medial patellar instability presents a complex clinical challenge requiring effective surgical solutions.

Purpose of the Study:

• To evaluate the midterm efficacy of lateral patellotibial ligament reconstruction for iatrogenic medial patellar instability.
• To assess patient-reported outcomes and satisfaction following this specific surgical intervention.

Main Methods:

• A case series (Level of evidence, 4) involving thirteen patients with symptomatic medial patellar instability post-lateral release.
• Patients underwent lateral patellotibial ligament reconstruction by a single surgeon between May 2011 and December 2013.
• Outcomes were evaluated using patient-reported scores (Lysholm, Tegner, WOMAC) at a minimum of 2 years postoperatively.

Main Results:

• Significant improvement in Lysholm scores (45.6 to 71.9) and Tegner activity scale (3 to 4).
• Marked reduction in Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores (38 to 6).
• High average patient satisfaction rating of 8.2 (out of 10).

Conclusions:

• Lateral patellotibial ligament reconstruction is a viable option for managing iatrogenic medial patellar instability.
• The procedure demonstrates favorable midterm outcomes with significant functional improvement and high patient satisfaction.
• A low complication rate supports the safety and effectiveness of this reconstructive technique.