Factors Associated With the Decision to Perform a Lateral Retinacular Release or Lengthening During Medial Patellofemoral Ligament Reconstruction in the JUPITER Cohort.

Overview

abstract

BACKGROUND: Medial patellofemoral ligament reconstruction (MPFLR) is a standard treatment for patellofemoral instability. Concomitant lateral retinacular release (LR) or lateral retinacular lengthening (LL) is considered for patients with a tight lateral retinaculum (as determined by examination under anesthesia); however, the literature is limited on the frequency of these procedures and the factors associated with their incidence. PURPOSE: To investigate associations between demographic characteristics, physical examination findings, and radiologically measured patellofemoral parameters with LR/LL in patients undergoing primary MPFLR. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: A prospective multicenter cohort study database was queried for patients who underwent primary MPFLR between January 2017 and July 2022. A total of 23 surgeons from academic centers across the United States performed the procedures. Radiologic parameters, concomitant procedures, and pre- and intraoperative physical examination findings were assessed between patients with and without LR/LL using the chi-square test, independent t test, or Mann-Whitney U test, as appropriate. Binary logistic regression was used to perform a multivariable analysis of factors associated with LR/LL. RESULTS: Of 428 patients (mean age, 16.7 ± 4.2 years, 64.5% women), 22.9% underwent LR (13.6%) or LL (9.3%). Those who underwent LR/LL were more frequently men (44% vs 23%; P = .049), had lower Beighton scores (2.6 ± 2.7 vs 3.8 ± 2.9; P < .001), and their surgeons were more likely to have completed a sports fellowship (82.7% vs 64.8%; P < .001) compared with those who did not undergo LR/LL. On preoperative examination, patients with LR/LL more often exhibited patellar apprehension (92.6% vs 81.2%; P = .008) and pathologic lateral patellar translation (62.2% vs 49.1%; P = .012). Intraoperatively, patients with LR/LL more often dislocated in extension during examination under anesthesia (70.4% vs 57%; P = .017) and underwent a tibial tubercle osteotomy (TTO) (35.7% vs 9.4%; P < .001). A total of 168 patients had preoperative imaging measurements available, and patients with LR/LL showed greater patellar tilt (24.1°± 7.7° vs 18.5°± 16.7°; P < .001). CONCLUSION: Approximately 23% of patients who underwent MPLFR from a large multicenter cohort underwent LR/LL. The LR/LL appears to be associated with less ligamentous laxity, lateral patellar apprehension, surgeon completion of a sports fellowship, and concomitant TTO. These data may elucidate some of the relative factors associated with performing these procedures in patients undergoing primary MPFLR.