chapter 8: Patellar Tilt‑Compression and the Excessive Lateral Pressure Syndrome (ELPS)


Patient 2 (A I6‑year‑old woman)

This patient had spontaneous onset of bilateral anterior knee pain 3 years before consultation. Pain had gradually increased in severity and was worse at the end of the day. She was completely unable to participate in sports. Examination: mild ligamentous laxity, no meniscal signs, no significant quadriceps atrophy. The knee showed a full range of movement, but transverse patellar play was reduced, and there was a tender and tight lateral retinaculum bilaterally. Extension against resistance was painful. The patella was noted to have a more definite lateral excursion at the end of extension than normal. AP and lateral radiographs were normal; the axial patellar view showed no subluxation, but the 15‑degree knee flexion midtransverse CT cuts showed 4‑degree patellar tilt angles bilaterally. A 6‑month rehabilitation program failed, so a lateral retinacular release was performed on the right knee. There was softening of the entire lateral facet and of the median ridge, with small fibrillations of the surface. The trochlea appeared to be more prominent than usual. The patient returned with pain in the other knee identical in all respects to the right side. The patient had the same procedure, at which time softening in the area of the median ridge in the critical zone was noted (Fig. 8.18). The patient was seen in follow‑up and had relief of symptoms on both sides.

Patient 3 (30‑year‑old man)

This patient had a lateral release because of persistent patellofemoral pain associated with tilt, but was referred because of persistent, increased anterior knee pain. On examination, he had clinically normal patellar alignment, with no crepitation in the patellofemoral joint. Further examination revealed a single tender band of residual lateral retinaculum running from the distal patella to the tibia. Injection of the tender portion of this band gave complete relief of the patient's pain. The patient was referred back to the operating surgeon, with a recommendation that the residual band of painful retinaculum be released.





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