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.
Bram et al. (Sun,) studied this question.