chapter 8: Patellar Tilt‑Compression and the Excessive Lateral Pressure Syndrome (ELPS)
Disruption of Medial Stabilizers
Anything that diminishes the factors that naturally stabilize valgus forces normally operating on the patellofemoral joint will cause a disequilibrium in favor of the lateral forces. Rupture of the medial retinaculum is the most common of these factors. Diminution of the retentive power of the medial retinacular structures may follow medial arthrotomy, patellar subluxation, or dislocation. Chronic effusion may bulge out the medial capsular structures, rendering them less effective. Atrophy of the vastus medialis certainly reduces this medial stabilizer. We believe that physical therapy to develop this muscle is of primary importance in the treatment of ELPS and that the efficacy of this treatment is a testimony to its importance.
After lateral retinacular release, a small number of patients continue to have pain despite release for appropriate indications and minimal arthrosis. On clinical examination of such patients, the author has noted bands of tender retinaculum, usually either proximal or distal to the release, in some patients. A very localized injection of 1% lidocaine into the tender portion of the band may give complete relief of the patient's pain.
If a band of tender retinaculum is left after lateral release, pain may not only persist, it may intensify because other retinacular supports have been removed, and therefore, the residual tender band may experience increased loads! Transection of the painful residual band usually brings prompt relief.
Inside Chapter 8: