Info on Open Lateral Lenghthenig of the Retinaculum

[hugo]

Here's some info I found on this procedure.

http://www.wheelessonline.com/ortho/lat ... ar_release

From what I understood this procedure is recommended for subluxating or tilted patella caused by a short or tight retinaculum.

If anyone here had the Open Lateral Lengthening done it would be helpful if you could comment on it...




Also found some info on Z-plasty release:
http://www.ncbi.nlm.nih.gov/sites/entre ... stractPlus

Don't know to what extent a Z-plasty release is recommended for subluxating or tilted platelas.

[austinknee]

Are you asking if anyone has had a lateral release? I havent heard it called a lateral lengthening of the retinaculum? Might be the same as a lateral release? I dont know...If so..you might change your subject title b/c lots of people have had LR on this site. Hope that helps

[hugo]

No.

It is not the same as an LR, but the end effect is somewhat the same (realignment of the patella)

In a LR the reticaculum is literally released/cut. In Open Lateral Lengthening a cut, sort of like a stair way step, is made on the retinaculum and then the longer parts of either side are sutured. Theoretically the retinaculum is lengthened.

Mind you I'm no doctor, this is just what I gathered from those links I posted.

I'm looking for people who have had this done or have any additional information on the procedure

[austinknee]

Ah...I think that would have been a WONDERFUL alternative to the Lateral Release. I had a lateral release and ended up with absolutely NO stability at all...they just had to put mine back together. I had never heard of that surgery before. Best of luck to you and I hope that someone replies to you!

[WorkinWings]

Oi, Hugo!


Many, many kudos to you for being in a much better position than some of us "victims the lateral release," in that you are getting yourself informed about your options before taking the big plunge! I am so happy for you and wish you all the luck in fixing your knee. And I second Austin's remark 100% lengthening the retinaculum might have been a much better option for us… although in my case I am not even sure that I actually ever had any problem with the retinaculum at all… Don't think I'll ever know that, now.

In any case, I know that I have an article somewhere here written by the doctor I saw last month that mentions both of those procedures. He is also adamant in that and many more of his papers, about stressing the importance of proper diagnosis and, most especially, about exhausting all possible conservative measures before even considering surgery.

I'll see if I can find the article here for you; I'll post the link/reference once I do.

Abraxc3xa7os p/ ti!

[WorkinWings]

Sorry. Still looking. But maybe you could tell me the title of the first article you mention the one pdf file, in rapidshare because I wasn't able to open the file, and if it's the same article I'm trying to send you, then I'll stop searching on my end, txc3xa1 bom?

In the meantime, here's a quote (from: "Role of Lateral Release in Patella Femoral Instability," by P. PLANNING - Techniques in Knee Surgery, 2006) that might be of interest to you (and several others here):

"…The technique of lateral retinacular lengthening is evolving and has theoretical advantages over lateral retinacular release in not sacrificing normal anatomy, maintaining a lateral restraint and preventing the potential post lateral retinacular release complication of medial patellar instability."

I would carefully note the use of the words "evolving" and "theoretical"… But it sounds promising, doesn't it?

AsinhasCortadinhas

[hugo]

I've read that quote before somewhere. If you end up finding that article please link it or upload it...



I had no problems downloading the article I uploaded to Rapidshare, but I put it up on YouSendIt for you:
http://download.yousendit.com/416EF1023DF4EF74

If this doesn't work, just PM me your email I'll send it to you.

Or maybe whatever pdf reader you're using is broken? Dunno. If this is the case try Foxit Reader (it's free)

edit: BTW the title of the article is

"CASE STUDY 3
Lateral patellar hypercompression
tilt and mild lateral subluxation"

It discusses the procedure of Open Lateral Lengthening of the Retinaculum as having specific indications, for those who have tight or short retinaculum as the cause of later subluxation or tilt.

I've talked to an OS about this procedure. He was aware of it, but though it was too complicated and would only do a Lateral Release. Maybe he just doesn't have experience with Lateral Lengthening

BTW the article is part of a book titled: Patellofemoral Disorders: Diagnosis and Treatment:
http://eu.wiley.com/WileyCDA/WileyTitle ... tents.html
http://www3.interscience.wiley.com/cgi- ... 1&SRETRY=0

I've ordered myself a copy. I'm going to have a read and maybe consult some other doctors about it.

[hugo]

I've made so many edits to my previous post...

so I'll bump the thread, if you read a previous version of my post

[WorkinWings]

Thanks! YouSendIt worked for me. My newer computer is being fixed, so I'm having to use the old one--which I had replaced for many reasons, all of which I am having to deal with again... So I don't think there is a problem with the rapidshare link; the problem is at my end.

So that is not the article I'm trying to find for you--I'll keep looking.

I still need to read the article you sent, but it is interesting, as is a lot of stuff Biedert has been publishing--have you gotten a hold of his book, yet? The title is "Patellofemoral Disorders: Diagnosis and Treatment" It was published in 2004 by John Wiley & Sons. Go to books.google.com and take a look at their preview.

As for what your OS told you, I would definately try to look into several more opinions--are you sure that you definitely do need surgery on that knee? If that is so, you might want someone with a larger skill-kit to draw from...

Keep up the good work!
And thanks again for sharing--what else you got? :)

[WorkinWings]

hahaha! That's what happens when you try to multi-task, then come back to an old screen to finish writing a post!
(Warning - while you were typing a new reply has been posted. You may wish to review your post. )

So, no need to reply about whether you know of the book!

[WorkinWings]

Hi, Hugo.

Here are a few more references. I will not be able to actually send links, right now, but I know that if you google the first one I mention, for ex, you will get the pdf file listed as the third result from the top.


Lateral retinacular release for anterior knee pain: a systematic review of the literature.
C Lattermann, GN Drake, J Spellman, BR Bach Jr - J Knee Surg, 2006. J Knee Surg. 2006 Oct;19(4):278-84.


Diagnosis and Treatment of Patients with Patellofemoral Pain
JP Fulkerson - The American Journal of Sports Medicine, 2002


And this is the article that I've been referring to, that I know mentions both lengthening of the retinaculum, and z-plasty. I don't remember where I was able to download it from, but it is available:

OPEN OR ARTHROSCOPIC LATERAL RELEASE Indications, Techniques, and Rehabilitation
DH Ford, WR Post - Clinics in Sports Medicine, 1997


Sorry I can't do more for now.
Let me know if you need more info.

I'd love to hear your comments once you read the literature, too.

Take care.

[hugo]

I have received the book I ordered and have been able to read a good part of it.

I'm finding it very insightful and although it's not exactly cheap (paid 210 Euros + shipping) I would recommend it to any one with knee or alignment issues....



The authors seem not to indicate a lateral release in the whole book.

In cases where the retinaculum tightness or shortness exists and a course of physical therapy does not solve the issues the authors seem to prefer lengthening of the retinaculum as opposed to a Lateral Release. There are also 2 chapters on medial subluxation following Lateral Release surgery.

The book also discusses various other knee problems and surgeries. It would be too hard for me to try to condense it all in a post. The best thing for any one interested is to get a hold of the book or buy it.

[WorkinWings]

Hi Hugo -

Biedert's book sounds like a great resource.

It does not surprise me that they don't recommend simply 'getting rid of' the lateral retinaculum... It alarms even the most experienced PF specialists that it is still done so often (see Fithian, Paxton, Post and Panni, 2004 - Arthroscopy: The Journal of Arthroscopic and Related Surgery).

So you say: "There are also 2 chapters on medial subluxation following Lateral Release surgery"?
Thanks! I really do have to read those! And I definitely think that the book is well worth the money you paid. As Austinknee said somewhere else, this is our life... We need to do all we can to get it back.
I am hoping, though, that I might be lucky enough to find it at a public medical library that is a few miles north of here... If not, I'll be doing what you did, for sure.

Any luck yet on finding someone with enough experience to be able to advise you on the option of lengthening the lateral retinaculum?

Thanks so much for letting us know what you have thought of the book, so far. I really appreciate the sharing of knowledge--keep it coming!!

Abraxc3xa7os,

Angela

[WorkinWings]

Hey, again!

I was 'cheating' a bit and looking at images of the book on googlebooks, and I must say...

[align=center]Scott Dye--he is one CRAZY dude! LOL![/align]

Good for us that he is willing to turn himself into a guinea pig!!

[hugo]

Hey nice find!

Didn't know about Google books and that it allows for a preview of a few pages of book...


Yeah looks like Scott F Dye is an American OS. He is credited for the first chapter (part I) of the book. Seems like he provided pictures of an arthroscopy of his own knee to demonstrate tha his grade III chondromalacia could be asymptomatic.