The Hip: Preservation, Replacement and Revision

Arthroscopic Lateral Retinacular Release

- Discussion:
    - lateral release detaches patella from lateral soft tissue structures, including lateral retinaculum, fibers from tensa fascia lata muscle, &
           joint capsule;
    - a tourniquet should not be used during this procedure since it has been shown to increase the occurance of postoperative hemarthrosis;
    - prior to performing the release, a complete arthroscopic exam is performed, which includes the knee flexion angle at patellar
           engagement and the knee flexion angle at patellar centralization;
          - normally, patellar centralization should take place between 30-45 deg;
    - part of the surgical statedgy is to avoid the superior geniculate artery;
    - a needle can be placed adjacent to the superior pole of the patella (1 cm proximal and lateral to the superior edge of the patella) which 
          serves as a intra-articular marker;
    - the arthroscope is switched from the anterolateral portal to the anteromedial portal;
    - scissor release:
          - metzenbaum scissors are inserted into the anterolateral portal and are used to bluntly spread over the retinaculum;
          - the tips of the scissors are then placed across the retinaculum and are pushed superiorly in order to effect the release;
          - care is taken to keep the curved tips of siccors directed posteriorly and 1 cm from the patellar edge;
          - the release should be visualized thru the anteromedial portal;
    - cautery release:
          - turn the cautery on the lowest setting that allows tissue cutting (avoids iatrogenic damage);
          - perform the retinacular release in layers starting from the superolaterally placed needle, and moving distally to the anterolateral portal;
                  - removing the fascia in layers allows a better opportunity to control bleeding;
          - the release procedes until the subcutaneous tissue is visualized;
          - care should be taken to avoid cutting the muscular fibers of the vastus lateralis;
    - judge the adequacy of release:
          - the patella should allow 45 deg of eversion following the release and/or should allow medial translation of 25% of the patellar width;
          - document the change in knee flexion angles for patellar engagement and centrallization;
    - following the release, hemstasis is achieved w/ cautery (note that bleeding often does not become manifest until several minutes following 
          the release, esp if a tourniquet is used)
    - references:
          - Arthroscopic determination of patellofemoral malalignment.
          - The percutaneous lateral retinacular release.
          - Arthroscopic lateral retinacular release and the lateral patellar compression syndrome.

Anatomy of the junction of the vastus lateralis tendon and the patellae.

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Wednesday, May 9, 2012 4:04 pm