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Open lateral patellar retinacular lengthening versus open retinacular release in lateral patellar hypercompression syndrome: a prospective double-blinded comparative study on complications and outcome.
[trochlear dysplasia]
To
compare
complication
rates
and
outcome
of
open
lateral
retinacular
(
LR
)
lengthening
and
open
LR
release
in
the
treatment
of
lateral
patellar
hypercompression
syndrome
(
LPHS
)
.
In
a
prospective
double
-blinded
study
,
28
patients
(
mean
age
,
48
years
;
21
women
and
7
men
)
received
either
LR
release
(
14
patients
)
or
LR
lengthening
(
14
patients
)
in
alternating
fashion
over
the
same
lateral
parapatellar
skin
incision
for
LPHS
(
blinding
of
patients
to
surgical
procedure
[
i
.
e
.
,
single
blinding
]
)
.
Strict
inclusion
criteria
(
retinacular
pain
,
tight
retinaculum
,
decreased
patellar
mobility
)
were
used
to
exclude
other
reasons
for
anterior
knee
pain
(
patellar
instability
,
leg
malalignment
or
maltorsion
,
trochlear
dysplasia
,
patella
alta
)
.
The
surgeon
and
postsurgical
rehabilitation
were
the
same
.
Preoperatively
and
at
3
,
6
,
12
,
and
24
months
postoperatively
,
complications
,
muscle
atrophy
,
and
Kujala
patellofemoral
outcome
score
were
documented
by
examiners
blinded
to
the
surgical
procedure
(
double
blinding
)
.
All
patients
completed
2
years
of
follow-up
.
The
results
of
2
years
of
follow-up
showed
that
recurrence
of
LPHS
,
as
indicated
by
the
patellar
tilt
test
and
decreased
medial
patellar
glide
test
,
developed
in
2
cases
after
LR
release
and
1
case
after
LR
lengthening
(
P
>
.
999
)
.
Medial
patellar
subluxation
,
as
indicated
by
the
gravitation-
subluxation
test
and
increased
medial
patellar
glide
test
,
developed
in
5
cases
after
LR
release
and
no
case
after
LR
lengthening
(
P
=
.
041
)
.
Quadriceps
atrophy
,
as
indicated
by
the
mean
circumference
difference
compared
with
the
healthy
contralateral
side
,
was
significantly
higher
(
P
=
.
001
)
in
the
LR
release
group
(
1
.
8
cm
)
than
in
the
LR
lengthening
group
(
0
.
2
cm
)
.
The
mean
Kujala
score
was
significantly
lower
(
P
=
.
035
)
in
the
LR
release
group
(
77
.
2
points
)
than
in
the
LR
lengthening
group
(
88
.
4
points
)
.
In
this
prospective
double
-blinded
study
,
retinacular
lengthening
showed
less
medial
instability
,
less
quadriceps
atrophy
,
and
a
better
clinical
outcome
at
2
years
compared
with
retinacular
release
.
We
believe
that
this
may
be
explained
by
the
controlled
preservation
of
the
lateral
patellar
muscle
-capsuloligamentous
continuity
after
retinacular
lengthening
.
Level
II
,
prospective
double
-blinded
comparative
study
.
Diseases
Validation
Diseases presenting
"controlled preservation of the lateral patellar muscle-capsuloligamentous continuity"
symptom
trochlear dysplasia
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