The Role of Lateral Retinacular Release in Preventing Patellofemoral Malalignment in Double-Bundle Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Trial

Overview

Journal Clin Orthop Surg

Specialty Orthopedics

Date 2022 Sep 5

PMID 36061844

Authors

Ludwig Andre Pontoh

Ismail Hadisoebroto Dilogo

Erica Kholinne

Jessica Fiolin

Toto Suryo Efar

Affiliations

Soon will be listed here.

Abstract

Background: Loss of internal rotation stability is the major cause of pain after an anterior cruciate ligament reconstruction (ACLR). Many authors described measures to treat this problem to no avail. This is the first study evaluating the role of lateral release with double-bundle ACLR to prevent patellofemoral malalignment after ACLR.

Methods: A total of 100 patients were included in this prospective study between January 2018 and December 2019. We compared single-bundle ACLR (group 1, n = 30), double-bundle ACLR (group 2, n = 30), and double-bundle ACLR with lateral release (group 3, n = 40). Clinical outcome was evaluated with the Kujala score while radiological outcome was evaluated using the tibial tubercle-trochlear groove (TTTG) distance in magnetic resonance imaging. The preoperative and postoperative values were compared.

Results: At the final follow-up of 6-18 months, group 3 showed the lowest TTTG value (6.7 ± 4.69) compared to group 2 (9.1 ± 4.83) and group 1 (11.74 ± 1.76) ( = 0.03). The Kujala score was significantly improved in all groups: from 68.83 to 89.90 in group 1, from 70.02 to 91.23 in group 2, and from 69.71 to 95.05 in group 3 ( = 0.03). Group 3 showed the most superior improvement in the Kujala score (25.34) compare to group 1 (21.07) and group 3 (21.21) ( = 0.012).

Conclusions: Concomitant lateral retinacular release significantly improved the Kujala score. It may serve as a valuable option to overcome patellofemoral pain syndrome in ACLR.

Citing Articles

Optimal measurement method for anterior instability on stress radiographs in anterior cruciate ligament tear: Considering the effect of static anterior tibial subluxation.

Han J, Choi C, Jung M, Chung K, Kim S, Ha T PLoS One. 2024; 19(9):e0310428.

PMID: 39288145 PMC: 11407638. DOI: 10.1371/journal.pone.0310428.

Double-bundle ACL reconstruction versus anatomic single-bundle ACL reconstruction combined with anterolateral ligament reconstruction: a comparative study of clinical outcome.

Pontoh L, Dilogo I, Kamal A, Widodo W, Kholinne E, Rhatomy S Eur J Orthop Surg Traumatol. 2022; 33(3):489-495.

PMID: 36474084 DOI: 10.1007/s00590-022-03432-7.

References

Draganich L, Ho S, Reider B . The effects of removal and reconstruction of the anterior cruciate ligament on the contact characteristics of the patellofemoral joint. Am J Sports Med. 2002; 30(1):121-7. DOI: 10.1177/03635465020300010601. View

Fonseca L, Haruo Kawatake E, de Castro Pochini A . Lateral patellar retinacular release: changes over the last ten years. Rev Bras Ortop. 2017; 52(4):442-449. PMC: 5582814. DOI: 10.1016/j.rboe.2017.06.003. View

Zhang C, Xu H, Li X, Wang Y, Zhang Q, Zhu Q . Oblique femoral tunnel or oblique graft? A modified anteromedial portal technique to obtain vertical femoral tunnel and oblique graft in anatomic anterior cruciate ligament reconstruction. Eur J Orthop Surg Traumatol. 2013; 23(6):731-5. DOI: 10.1007/s00590-012-1046-4. View

Pandit S, Frampton C, Stoddart J, Lynskey T . Magnetic resonance imaging assessment of tibial tuberosity-trochlear groove distance: normal values for males and females. Int Orthop. 2011; 35(12):1799-803. PMC: 3224621. DOI: 10.1007/s00264-011-1240-8. View

Sonnery-Cottet B, Thaunat M, Freychet B, Pupim B, Murphy C, Claes S . Outcome of a Combined Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction Technique With a Minimum 2-Year Follow-up. Am J Sports Med. 2015; 43(7):1598-605. DOI: 10.1177/0363546515571571. View

Guenther D, Irarrazaval S, Bell K, Rahnemai-Azar A, Fu F, Debski R . The Role of Extra-Articular Tenodesis in Combined ACL and Anterolateral Capsular Injury. J Bone Joint Surg Am. 2017; 99(19):1654-1660. DOI: 10.2106/JBJS.16.01462. View

Fu F, Van Eck C, Tashman S, Irrgang J, Moreland M . Anatomic anterior cruciate ligament reconstruction: a changing paradigm. Knee Surg Sports Traumatol Arthrosc. 2014; 23(3):640-8. DOI: 10.1007/s00167-014-3209-9. View

Li G, DeFrate L, Park S, Gill T, Rubash H . In vivo articular cartilage contact kinematics of the knee: an investigation using dual-orthogonal fluoroscopy and magnetic resonance image-based computer models. Am J Sports Med. 2004; 33(1):102-7. DOI: 10.1177/0363546504265577. View

Tajima G, Iriuchishima T, Ingham S, Shen W, van Houten A, Aerts M . Anatomic double-bundle anterior cruciate ligament reconstruction restores patellofemoral contact areas and pressures more closely than nonanatomic single-bundle reconstruction. Arthroscopy. 2010; 26(10):1302-10. DOI: 10.1016/j.arthro.2010.01.034. View

10.

Gong X, Jiang D, Wang Y, Wang J, Ao Y, Yu J . Second-look arthroscopic evaluation of chondral lesions after isolated anterior cruciate ligament reconstruction: single- versus double-bundle reconstruction. Am J Sports Med. 2013; 41(10):2362-7. DOI: 10.1177/0363546513496064. View

11.

Wittstein J, Bartlett E, Easterbrook J, Byrd J . Magnetic resonance imaging evaluation of patellofemoral malalignment. Arthroscopy. 2006; 22(6):643-9. DOI: 10.1016/j.arthro.2006.03.005. View

12.

Delaloye J, Murar J, Vieira T, Saithna A, Barth J, Ouanezar H . Combined Anterior Cruciate Ligament Repair and Anterolateral Ligament Reconstruction. Arthrosc Tech. 2019; 8(1):e23-e29. PMC: 6408622. DOI: 10.1016/j.eats.2018.08.025. View

13.

Saper M, Popovich Jr J, Fajardo R, Hess S, Pascotto J, Shingles M . The Relationship Between Tibial Tubercle-Trochlear Groove Distance and Noncontact Anterior Cruciate Ligament Injuries in Adolescents and Young Adults. Arthroscopy. 2015; 32(1):63-8. DOI: 10.1016/j.arthro.2015.06.036. View

14.

Colombet P, Jenny J, Menetrey J, Plaweski S, Zaffagnini S . Current concept in rotational laxity control and evaluation in ACL reconstruction. Orthop Traumatol Surg Res. 2012; 98(8 Suppl):S201-10. DOI: 10.1016/j.otsr.2012.10.005. View

15.

Misonoo G, Kanamori A, Ida H, Miyakawa S, Ochiai N . Evaluation of tibial rotational stability of single-bundle vs. anatomical double-bundle anterior cruciate ligament reconstruction during a high-demand activity - a quasi-randomized trial. Knee. 2011; 19(2):87-93. DOI: 10.1016/j.knee.2011.01.003. View

16.

Smith T, Davies L, ODriscoll M, Donell S . An evaluation of the clinical tests and outcome measures used to assess patellar instability. Knee. 2008; 15(4):255-62. DOI: 10.1016/j.knee.2008.02.001. View

17.

Slette E, Mikula J, Schon J, Marchetti D, Kheir M, Turnbull T . Biomechanical Results of Lateral Extra-articular Tenodesis Procedures of the Knee: A Systematic Review. Arthroscopy. 2016; 32(12):2592-2611. DOI: 10.1016/j.arthro.2016.04.028. View

18.

Kidera K, Yonekura A, Miyaji T, Nakazoe Y, Gamada K, Yoneta K . Double-bundle anterior cruciate ligament reconstruction improves tibial rotational instability: analysis of squatting motion using a 2D/3D registration technique. J Orthop Surg Res. 2018; 13(1):111. PMC: 5956752. DOI: 10.1186/s13018-018-0825-y. View

19.

Ferretti A, Monaco E, Labianca L, De Carli A, Maestri B, Conteduca F . Double-bundle anterior cruciate ligament reconstruction: a comprehensive kinematic study using navigation. Am J Sports Med. 2009; 37(8):1548-53. DOI: 10.1177/0363546509339021. View

20.

Georgoulis A, Ristanis S, Chouliaras V, Moraiti C, Stergiou N . Tibial rotation is not restored after ACL reconstruction with a hamstring graft. Clin Orthop Relat Res. 2006; 454:89-94. DOI: 10.1097/BLO.0b013e31802b4a0a. View