Isolated lateral release shows positive outcomes for recurrent patellofemoral instability
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Isolated lateral release is a low-risk procedure that shows good short- to middle-term outcomes as a first-line surgical management of patients with patellofemoral instability, according to published results.
Si Heng Sharon Tan, MBBS, MRCS, and colleagues from the department of orthopedics at the Hand and Reconstructive Microsurgery Cluster in Singapore conducted a systematic review of 10 publications (179 patients, 204 knees) that reported outcomes of isolated lateral release for recurrent patellofemoral dislocations.
Tan and colleagues used four databases from inception through Feb. 15, 2018 to identify research: PubMed, Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Cochrane Library.
According to the study, all research was consistent in the reporting of decreased rates of patellofemoral dislocations after lateral release, with 79.4% of patients reporting good outcomes. Tan and colleagues found a statistically signicant difference between the odds of experiencing a patellofemoral dislocation postoperatively compared with preoperatively, at less than 0.01. They also noted that no publication bias was identified.
“The procedure can lead to a signicantly decreased rate of recurrence of patellofemoral dislocations, a signicantly increased rate of good outcomes and a similar number of patients being able to participate in sports as compared with the number of patients participating in sports prior to having patellofemoral dislocations,” Tan and colleagues wrote in the study. “This is in contrast to the current opinion that lateral release should be reserved as an adjunct procedure to other realignment procedures and should not be used in isolation.”
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Jason Koh, MD, MBA
In their review of 10 case series, Tan and colleagues found that 14.1% (28 patients) had recurrent instability requiring additional procedures, which is eight to 20 times higher than the reported instability rates of medial patellofemoral ligament reconstruction in several recent meta-analyses (Previti and colleagues, Arthroscopy 2020; Kang and colleagues, KSSTA 2019; Schneider and colleagues, AJSM 2016). Notably, there does not appear to be a biomechanical rationale for lateral release for patella instability, with multiple studies showing that that lateral release increases lateral patella laxity (Amis, KSSTA 2006 and J Biomech 2009) and clinical data showing significantly increased lateral translation and laxity (Niimoto, KSSTA 2014). Lateral release can lead to disabling pain and medial instability, as Jack Hughston reported on his series of 54 patients (AJSM 1988).
Although Tan and colleagues report improvement with this procedure in these (mostly decades old) case series, given the lack of biomechanical rationale, high failure rate and risk of serious complications, isolated lateral release has largely been abandoned (Fithian and colleagues, Arthroscopy 2004). If lateral retinacular tightness is a concern, I would instead recommend a lateral lengthening procedure taking advantage of the different layers of the soft tissues, which limits the risk of adverse consequences.
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