Lateral Retinacular Release During MPFL Reconstruction: A Randomized Clinical Trial

Background: Reconstruction of the medial patellofemoral ligament (MPFL) has become the gold standard treatment for patellofemoral instability. A lateral retinacular release (LRR) may be performed in conjunction with MPFL reconstruction (MPFLR); however, its effect on outcomes is unclear. Purpose/Hypothesis: This study aimed to evaluate the effect of LRR on the outcomes of MPFLR. It was hypothesized that isolated MPFLR would not be inferior to MPFLR with LRR in terms of the subjective International Knee Documentation Committee (IKDC) score and patellar tilt (PT). Study Design: Randomized controlled trial; Level of evidence, 2. Methods: Patients aged 18 to 45 years undergoing MPFLR without associated osseous procedures were randomized to isolated MPFLR or MPFLR with arthroscopic LRR. Outcome measures were subjective IKDC score and PT assessed by computed tomography with the quadriceps relaxed (PTQR) and contracted (PTQC). Results: Out of 140 patients randomized and included, 3 were excluded from analysis because of the performance of unexpected osseous procedures or the use of a graft other than a gracilis autograft; 9 patients were lost to follow-up; and 3 patients could not complete the study due to medical reasons. A total of 125 patients (89%) were evaluated at a median follow-up of 36 months (range, 24-144 months) postoperatively. The mean subjective IKDC score was 78.1 ± 16 (range, 29-98) in the MPFL + LRR group and 80.7 ± 15 (range, 33-100) in the Isolated MPFL group ( P = .309). Postoperatively, the PTQR was 20.9° ± 9.1° in the LRR group and 17.3° ± 7.2° in the isolated MPFL group ( P = .097). The PTQC was 24.4° ± 10° in the MPFL + LRR group and 21.5° ± 8.9° in the isolated MPFL group ( P = .149). Three complications were noted in each group. Conclusion: Routine performance of LRR in association with MPFLR in the absence of bony procedures does not lead to improved patient-reported outcomes or significant alteration of the PT. Study Registration: ClinicalTrials.gov NCT01719666.