chapter 8: Patellar Tilt‑Compression and the Excessive Lateral Pressure Syndrome (ELPS)
LATERAL RELEASE FOR THE PATIENT WITH TILT‑COMPRESSION SYNDROME
Lateral retinacular release has been proved effective for relief of many patients who have patellofemoral pain (22‑30). Although initial studies did not differentiate the tracking patterns of such patients, it has become more apparent that lateral retinacular release may reduce lateral deforming force on the patella, thereby permitting more appropriate tracking of the patella.
The patient with patellar tilt, but little arthrosis (31), should benefit from lateral retinacular release in most cases (Fig. 8.16). Our group has shown, using CT, that lateral retinacular release will reduce abnormal tilting of the patella (increasing the lateral patellofemoral angle as described in Chapter 4) provided the lateral facet has not collapsed. Huberti and Hayes (32), however, noted that there was little or no change of patellar contact pressure in a cadaver laboratory model when there was no specific prerelease tilt of the patella. Vuorinen et al (33) noted specifically that operations that modify patellar mechanics are most successful in treating patients with patellar articular cartilage lesions. It is important, therefore, that lateral release be done only when it will have a mechanically beneficial effect (such as relieving documented tilt).
Once the lateral facet has collapsed as a result of ELPS, lateral release will be less effective in reducing tilt (20). If pain in the patient who has lateral facet arthrosis is predominantly noted in the retinaculum (presumably caused by retinacular neurofibrosis ), lateral retinacular release may still be very helpful. If pain is more related to arthrosis (Outerbridge Grades 3 to 4), the surgeon may consider anteromedial tibial tubercle transfer (34, 35) to unload the lateral patella at the same time that lateral retinacular release is accomplished. This decision is best made on clinical grounds. Certainly, when lateral retinacular release has failed to benefit a patient with lateral patellar tilt and lateral facet arthrosis, anteromedial tibial tubercle transfer becomes a desirable alternative (see Chapter 13).
Inside Chapter 8: