Role of Combined MPFL Reconstruction and Lateral Retinacular Release in Lateral Patellar Instability

To evaluate the efficacy of the combined medial patellofemoral ligament (MPFL) and reconstruction release in lateral patellar instability in terms of radiological and functional outcomes following the procedure.

A retrospective observational study. Place and Duration of the Study: Department of Orthopaedics, Ghurki Trust Teaching Hospital, Lahore, Pakistan, from January 2019 to January 2024.

Forty-seven patients with lateral patellar instability that underwent MPFL reconstruction and lateral retinacular release were studied, and the average follow-up duration was 17.5 (12-26) months. The patellar tilt, lateral patellar, and congruence angles were determined. Globally accepted scoring systems-such as Kujala, Lyshom, and Nelitz scores-were computed and compared.

Congruence angle improved from 18.7 ± 4.8 to a value of -4.9 ± 1.37 postoperatively. On the last follow-up, the lateral patellar angle had improved from 7.9 ± 3.9 to 6.1 ± 2 which was statistically significant (p <0.05) according to the paired samples t-test evaluation. Additionally, the patellar tilt angle improved, going from 27.6 ± 6.7 to 6.1 ± 0.9. In addition to the radiological improvement, an increase in each of the three measured scores indicated physiological improvement. The postoperative mean Lyshom score increased considerably from 43.82 ± 11.3 to 87.74 ± 8.85 (p <0.001). Likewise, the average Kujala score increased significantly from 45.42 ± 9.29 points to 89.42 ± 6.99 (p <0.001). Eighteen (38%) patients reported as being satisfied, four (9%) patients were partially satisfied, and only one (2%) patient was not satisfied.

Improvements in both radiological and functional outcomes occur with MPFL reconstruction and lateral retinacular release; nonetheless, further higher-level evidence-generating research on the topic is recommended.

Lateral retinacular release, Medial patello-femoral ligament reconstruction, Patellar instability.