Open lateral retinacular lengthening compared with arthroscopic release. A prospective, randomized outcome study

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Biomechanical Engineering

Background:

• Patellofemoral pain and lateral patellar tilting are common in athletes.
• Conservative management including structured rehabilitation is often insufficient.
• Surgical intervention may be necessary for persistent symptoms.

Purpose of the Study:

• To compare arthroscopic lateral retinacular release (Group I) with open lateral retinacular lengthening (Group II).
• To evaluate patient outcomes, including return to athletic activity and knee function.
• To assess complications and need for further surgery.

Main Methods:

• Prospective, randomized study of 86 patients with refractory patellofemoral pain and lateral patellar tilting.
• Group I underwent arthroscopic lateral retinacular release; Group II underwent open lateral retinacular lengthening.
• Follow-up averaged 46 months, assessing athletic activity, range of motion, thigh atrophy, complications, and knee function scores (Lysholm and Gillquist, modified by Tegner and Lysholm).

Main Results:

• Both groups demonstrated high rates of return to pre-symptom athletic activity (93% Group I vs. 100% Group II).
• No significant differences were found in range of motion, thigh atrophy, complications, or need for reoperation.
• Open lengthening resulted in significantly better knee function scores (88% vs. 77% scoring ≥80 points) and fewer low scores (0% vs. 14% scoring <70 points) compared to arthroscopic release (p=0.028).

Conclusions:

• Open lateral retinacular lengthening may offer superior functional outcomes for patients with patellofemoral pain and malalignment compared to arthroscopic release.
• Both surgical techniques facilitate a return to athletic activity with comparable safety profiles.
• Further research may explore long-term functional differences and patient-reported outcomes.