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Lateral Retinacular Release During MPFL Reconstruction: A Randomized Clinical Trial.

François Fauré¹, Julien Erard¹, Cécile Batailler²

¹Orthopaedic Department, Lyon North University Hospital, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France.

The American Journal of Sports Medicine

|September 11, 2025

Summary

Adding a lateral retinacular release (LRR) to medial patellofemoral ligament reconstruction (MPFLR) does not improve patient outcomes or patellar tilt. Isolated MPFLR is as effective as MPFLR with LRR for treating patellofemoral instability.

Keywords:

International Knee Documentation Committee score lateral retinacular release medial patellofemoral ligament reconstruction patellofemoral instability

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Area of Science:

Orthopedic Surgery
Sports Medicine
Biomechanics

Background:

Medial patellofemoral ligament reconstruction (MPFLR) is standard for patellofemoral instability.
The role of lateral retinacular release (LRR) in conjunction with MPFLR remains unclear.

Purpose of the Study:

To evaluate the impact of LRR on MPFLR outcomes.
To test the hypothesis that isolated MPFLR is non-inferior to MPFLR with LRR regarding subjective International Knee Documentation Committee (IKDC) scores and patellar tilt (PT).

Main Methods:

A randomized controlled trial (Level of evidence, 2) involving 125 patients (aged 18-45) undergoing MPFLR.
Patients were randomized to either isolated MPFLR or MPFLR with arthroscopic LRR.
Outcomes included subjective IKDC scores and patellar tilt (PTQR and PTQC) assessed via CT scan at a median 36-month follow-up.

Main Results:

No significant difference in mean subjective IKDC scores between the MPFL + LRR group (78.1) and the isolated MPFL group (80.7) (P = .309).
No significant difference in postoperative patellar tilt, neither relaxed (PTQR: 20.9° vs 17.3°, P = .097) nor contracted (PTQC: 24.4° vs 21.5°, P = .149).
Complication rates were similar, with three events in each group.

Conclusions:

Routine LRR with MPFLR, without bony procedures, does not enhance patient-reported outcomes.
LRR does not significantly alter patellar tilt when performed with MPFLR.
Isolated MPFLR demonstrates comparable efficacy to MPFLR with LRR.