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. 2024 Mar 18;13(6):102967.
doi: 10.1016/j.eats.2024.102967. eCollection 2024 Jun.

Arthroscopic Lateral Retinacular-Lengthening Procedure

Jason L Dragoo  1 , Ankit Hirpara  1 , Stephen Sylvia  1 , Timothy McCarthy  1 , Evangelia Constantine  1 , George Pappas  2
Affiliations

Arthroscopic Lateral Retinacular-Lengthening Procedure

Jason L Dragoo et al. Arthrosc Tech. .

Abstract

Anterior knee pain is a common musculoskeletal complaint that is often due to an excessively tight lateral retinaculum, which normally plays a role in patellar tracking and stabilization. Several etiologies underlie lateral soft-tissue tightness in the knee, including lateral patellar compression syndrome, patellofemoral arthritis, patellofemoral instability, and patellofemoral pain syndrome. Stretching the lateral retinaculum through conservative treatment may be helpful, but lateral retinacular lengthening may be indicated. Since this surgical procedure has classically been performed in an open fashion, the purpose of this Technical Note is to describe an arthroscopic technique designed to limit complications, improve patient outcomes, and reduce operative and recovery times.

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Conflict of interest statement

The authors report the following potential conflicts of interest or sources of funding: S.S. reports educational funding from Kairos Surgical. J.D. reports a relationship with 10.13039/100007307Arthrex that includes: consulting or advisory, a relationship with CONMED Corp that includes: consulting or advisory, a relationship with 10.13039/100012630Zimmer Biomet that includes: consulting or advisory, a relationship with 10.13039/501100008645Terumo Corp that includes: consulting or advisory, and educational funding from Linvatec, Smith & Nephew, Breg, and Ossur. Full ICMJE author disclosure forms are available for this article online, as supplementary material.

Figures

Fig 1
Fig 1
The figure demonstrates a negative patellar tilt test of the left knee since the lateral patellar border was able to be pulled up to neutral compared to the medial border. A positive test, indicating that the lateral retinaculum may be overtightened, would be a lateral border of the patella that could not be pulled up to the neutral postion.
Fig 2
Fig 2
The arthroscopic image through the anteromedial portal of the left knee in full extension shows the proximal border of the lateral retinaculum with fiber contributions from the ITB as well as the lateral retinacular fibers that will be lengthened with the described procedure. Care should be taken not to disrupt the proximal border fibers through the lengthening procedure. (ITB, iliotibial band.).
Fig 3
Fig 3
The arthroscopic image through the anteromedial portal of the left knee in full extension shows a single linear lengthening of the inner layer of the retinaculum with the ITB fibers left intact. Incised area expands with saline pump pressure. (ITB, iliotibial band.).
Fig 4
Fig 4
Arthroscopic lateral retinacular-lengthening procedure. (A) Pre-lengthened state showing patellar tilt of the right knee due to tightened inner capsular layer of retinaculum. (B) Small incision is made in inner capsular layer using a radiofrequency probe but outer layer is kept intact. (C) Arthroscopic fluid pressure distends the incised inner layer effectively lengthening the retinaculum and neutralizing the patellar tilt. (D) Lengthened inner layer heals to outer layer in lengthened position.
See this image and copyright information in PMC

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