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

Abstract

Objective: 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.

Study design: 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.

Methodology: 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.

Results: 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.

Conclusion: 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.

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