The effect on patellofemoral joint stability of selective cutting of lateral retinacular and capsular structures |
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| Authors: | Azhar M Merican Eiji Kondo Andrew A Amis |
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| Institution: | 1. Musculoskeletal Surgery Department, Imperial College London, Charing Cross Hospital, London, UK;2. Department of Orthopaedic Surgery,University Malaya Medical Centre, Kuala Lumpur, Malaysia;3. Biomechanics Section, Mechanical Engineering Department, Imperial College London, London, UK;4. Department of Sports Medicine and Joint Reconstruction Surgery,Hokkaido University School of Medicine, Sapporo, Japan;1. Department of Orthopedics, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, U.S.A.;2. Orthopedic Associates of Hartford, Hartford, Connecticut, U.S.A.;3. Department of Orthopedics, University of Connecticut Health Center, Farmington, Connecticut, U.S.A.;4. Department of Orthopedic Sports Medicine, Technical University of Munich, Munich, Germany;1. Rothman Institute, Thomas Jefferson University, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA;2. Rothman Institute, Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA;1. Institute of Orthopedics and Traumatology of the Clinical Hospital, Medical School, University of Sao Paulo, Sao Paulo, Brazil;2. Medical School, University of Sao Paulo, Sao Paulo, Brazil;1. Orthopaedic Surgery, NorthShore University HealthSystem, 2650 Ridge Avenue, Walgreen''s 2505, Evanston, IL, USA;2. Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago Medicine & Biological Sciences, 5841 S. Maryland Avenue, Rm. P207, MC 3079, Chicago, IL 60637, USA;1. Department of Orthopaedic Surgery, Saitama City Hospital, Saitama-shi, Saitama-ken, Japan;2. Digital Human Research Centre, National Institute of Advanced Industrial Science and Technology, Tokyo, Japan;3. Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan;4. Department of Clinical Biomechanics, Keio University School of Medicine, Tokyo, Japan |
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| Abstract: | Patient selection for lateral retinacular release (LRR) and its efficacy are controversial. Iatrogenic medial subluxation can occur with inappropriate LRR. The aim of this study was to determine the reduction in patellofemoral stability with progressively more extensive LRR. The force required to displace the patella 10 mm medially and laterally in nine cadaveric knees was measured with and without loading of the quadriceps and iliotibial band. The knee was tested intact, then after progressive release beginning proximal to the patella (PR), the mid-level between the proximal and distal limit of the patella (MR) where the fibres are more transverse, then distally till Gerdy's tubercle (DR) and finally the joint capsule (CR). Both medial and lateral stability decreased with progressive releases, larger for the medial. The MR caused a significant reduction of lateral stability between 30° and 90° of knee flexion. There was an 8% reduction in medial stability at 0° flexion with a complete LRR (DR). A comparable reduction in medial stability in the loaded knee at 20° and 30° flexion was obtained with MR alone, with no further reduction after DR. A capsular release caused a further reduction in medial stability at 0° and 20° and this was marked in the unloaded knee. In extension, the main lateral restraint was the joint capsule. At 30° flexion, the transverse fibres were the main contributor to the lateral restraint. |
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