The patellar compression syndrome: Treatment by miniopen lateral retinacular release results and review of literature

摘要

The purpose of this study was to evaluate the result of lateral retinacular release in patellar compression syndrome, which is a painful compression syndrome arthropathy of the lateral facet of the patella.187 knees of 120 patients, were included in this study. The criteria for inclusion were the presence of complaints of anterior knee pain without instability. Clinical signs pointing to lateral retinacular tightness and radiological evidence of lateral patellar tilt with minimal subluxation in 187 knees of 120 patients,130 knees were treated conservatively and 56 knees of 33 patients operatively by lateral retinacular release, those patients were selected after they failed to respond to a minimum of 3 months of conservative treatment that entailed isometric quadriceps strengthening exercises, restrictions of activities that requires prolonged knee flexion and administration of anti-inflammatory agents the lateral retinacular release was performed through a 3 centimeter skin incision. A satisfactory result was achieved in over75% cases. The complication rate was low or negligible. No complications of haemarthroses w as found postoperatively. The data indicated that better results can be achieved in patients who have patellar tightness, lateral Para patellar tenderness, a positive medial patellar glide test and positive medial apprehension test. Poor results are to be expected in patients with severe arthritic changes involving the lateral patellar facet. Introduction Anterior knee pain is a very common complaint among active individual specially adolescents and young adults1in many of these patients ,trauma and substantial anatomical misalignment are important cause of patellar pain, in this age group2,3,4,5,6-7 more ever, in another group of patients with anterior knee pain , no predisposing trauma or subluxation can be identified.4 In this group, Fulkeran et al identified a population of patients who had lateral patellar tilting in their axial radiograph without marked subluxation and with chronic peripatellar pain.8-10 Larson and colleagues attributed the pain in this area of patients to tightness of the lateral retinaculum which leads to increased pressure on the lateral surface of the patella in the femoral sulcus .Hence; they introduced the term patellar compression syndrome (pcs). Biomechanics The lateral retinaculum is a richly innervated fibrous connective tissue structure located on the lateral side of the knee.11; 12 it is composed of two layers, a superficial and deep layer. the superficial layer is composed of oblique fiber from iliotibial band inserting primarily into the lateral border of the patella and interdigitating with longitudinal fiber of the vast us lateralis and patellar tendon,13 The deep layer is mainly composed of dense transverse fiber that connect the deeper portion of the fascia lata directly to the lateral patella. Two distinct ligamentae-epicondylopatellar and patello-tibial ligament are located at the superior and inferior border of the deep layer tethering the patella to the lateral epicondyle and anterolateraltibia respectively, 11 through the contribution of the iliotibial band in the formation of the lateral retinaculum. A posterolateral force is exerted on the lateral aspect of the patella as the knee is flexed.12 this is consistent with the clinical observation that many patients with anterior knee. Pain tolerate prolonged knee flexion poorly 11 furthermore, this posterolateral force is primarily exerted in a posterior direction and therefore release the lateral retinaculum mainly removes a posterior restrain (tilt) on the lateral patella and to a lesser degree, lateral restrain (subluxation) is decreased13 .Accordingly, lateral release corrects patella tilt more than lateral subluxation (Figure 1and 2).12, 14