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Surgical Technique: Lateral Retinaculum Release in Knee Arthroplasty Using a Stepwise, Outside-in Technique

  • Surgical Technique
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Lateral release of a tight lateral retinaculum in a TKA is intended to correct patellar maltracking but the widely used inside-out technique has associated risks. We describe an alternate stepwise outside-in technique, with titrated release intended to maximize the chance of preserving the superior lateral genicular artery (SLGA).

Description of Technique

Patellar maltracking was judged by a no-thumb technique and graded as I and Ia: normal and near normal tracking; II: patella tilted; III: patella subluxed; or IV: patella dislocated. Outside-in release was performed in three progressive steps. Step-1 release was from the midpatella to the upper tibial border, Step-2 release was from the midpatella to the proximal pole of the patella, and Step-3 release was proximal to the superior pole of the patella with sectioning of the SLGA.

Methods

We retrospectively reviewed records of 1884 patients operated on between 2002 to 2008. Two hundred five patients (11%) had lateral release performed, and 177 of those 205 patients (86%) were reviewed. Patellofemoral function was assessed clinically by The Knee Society score. Radiographs were examined for patellar tilt, shift, and avascular necrosis. The minimum followup was 22 months (median 48 months; range, 22–105 months).

Results

The SLGA was preserved in 155 (76%) patients. At last followup, no patient had patellar maltracking, patellar fracture, or avascular necrosis. Six of 177 (3%) patients had anterior knee pain. Female patients and high-flex components had a higher incidence of release and midvastus arthrotomy had a lower incidence of release.

Conclusions

Stepwise release of the lateral retinaculum by an outside-in technique allowed minimum necessary retinacular release, preserving the SLGA in 76% of patients. No complications were seen at followup with functional and radiographic examinations.

Level of Evidence

Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Arun Nanivadekar MD MSc, Medical Research Consultant, Lilavati Hospital, Mumbai, India, for assistance with statistical evaluation. We also thank Parul Maniar MS, FRCO, for assistance with editing the manuscript.

Author information

Authors and Affiliations

  1. Department of Orthopaedics, Lilavati Hospital, A-791, Bandra Reclamation, Bandra (W), Mumbai, 400050, Maharashtra, India

    Rajesh N. Maniar MS(Orth), MCh(Orth) & Ravi Mohan Nayak MS

  2. Department of Orthopedics, Breach Candy Hospital, Mumbai, India

    Tushar Singhi MS

  3. Department of Orthopaedics, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha, Maharashtra, India

    Suyog Shashimohan Rathi MS

  4. Department of Orthopaedics, BYL Nair Hospital, Mumbai, India

    Jayesh Vinod Baviskar MS

Authors
  1. Rajesh N. Maniar MS(Orth), MCh(Orth)
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  2. Tushar Singhi MS
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  3. Suyog Shashimohan Rathi MS
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  5. Ravi Mohan Nayak MS
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Corresponding author

Correspondence to Rajesh N. Maniar MS(Orth), MCh(Orth).

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Each author certifies that he or she, or a member of his or her immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

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Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at Lilavati Hospital, Mumbai, Maharashtra, India.

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Maniar, R.N., Singhi, T., Rathi, S.S. et al. Surgical Technique: Lateral Retinaculum Release in Knee Arthroplasty Using a Stepwise, Outside-in Technique. Clin Orthop Relat Res 470, 2854–2863 (2012). https://doi.org/10.1007/s11999-012-2420-6

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  • DOI: https://doi.org/10.1007/s11999-012-2420-6

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