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Author Topic: Interesting article on indications for lateral release alone  (Read 918 times)

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Offline amy1

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Interesting article on indications for lateral release alone
« on: August 04, 2005, 09:28:17 PM »

Source
Quadriceps pull test: an outcome predictor for lateral retinacular release in recurrent patellar dislocation

L. R. IRWIN AND T. K. BAGGA



The subjects of the trial were assessed by the quadriceps pull test (Figure 1). For this test the patient lies supine and relaxed. The central point of the patella is marked and a line drawn on the skin from this point to the centre of the tibial tubercle. This line is the reference line. The patient is then encouraged to contract the quadriceps mechanism in an isometric fashion, with the leg remaining immobile and in extension. The centre of the patella is again determined and its horizontal deviation from the reference line measured. This measurement gives the test result.

When the test was first used, a series of three assessments was carried out on each knee and the average value used as the result. Once we had become familiar and confident with the test, it was found that only one test on each knee was necessary as the results were consistent for each observer and each patient.

Patients were allocated to one of two groups. Lateral movement of 15 mm or more placed the patient in group 1 and lateral movement of less than 15 mm placed the patient in group 2. The control group showed an average lateral movement of the patellar centre of 3 mm (range 0-8 mm) on the quadriceps pull test.

Arthroscopic lateral retinacular release was performed on each patient. The success or otherwise of these procedures was assessed by direct questioning and clinical examination over a period of not less than 2 years. A satisfactory result was regarded as the complete resolution of pain and the subjective absence of episodes of subluxation or dislocation.

 Figure 1 Anterior views of a left leg. The line marked 'A' is drawn through the centres of the patella and tibial tubercle at rest with the knee extended. The line marked 'B' is drawn through the centre of the patella, parallel to line 'A', when the quads mechanism is isometrically contracted. The horizontal distance between the two lines (marked 'x') in millimetres is recorded as the test result.

RESULTS

For the patients in group 1, the average lateral movement of the centre of the patella on performing the quadriceps pull test was 20.3 mm (range 15-23 mm). Lateral release did not resolve the symptoms in 15 of 18 knees (83%). It was successful in only three knees (17%). Post-operatively, the average lateral patellar movement on lateral release was 19.5 mm (range 13-23 mm). Analysing the pre- and post-operative measurements using Student's one-tailed t-test, the difference in the values was barely significant at the p < 0.05 level.

For group 2, the average lateral movement of the centre of the patella on performing the quadriceps pull test was 9 mm (range 4-11 mm). Lateral release alone successfully resolved the symptoms in 9 of 11 knees (82%). Post-operatively, the average lateral patellar movement on lateral release was 7.1 mm (range 0-9 mm). Analysing the pre- and post-operative measurements using Student's one-tailed t-test, the difference in the values was significant at the p < 0.001 level.

More than 15 mm horizontal movement of the patellar centre indicates a marked imbalance between the forces pulling the patella laterally and the medial restraints (vastus medialis, shape of trochlea, patellar articular surface, etc.). Lateral release alone did not achieve this balance in most of our patients.

Many studies appear to suggest that lateral release will be unsuccessful in the face of anatomical irregularities

6/2004 partial lateral meniscus removal and microfracture left knee
7/13/05  open lateral release, medial plication, spur removal right knee
12/06  re do proximal realignment right knee (scar tissue formed ) 5 days post op - fell and fractured elbow
08/2009 - feeling good so far work 50 hrs a week

shadehawk

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Re: Interesting article on indications for lateral release alone
« Reply #1 on: August 04, 2005, 10:12:09 PM »
Amy,

Great article.

This is how an LR was explained to me - An LR will only treat patellar tilt......

Shade


 
« Last Edit: August 04, 2005, 10:47:11 PM by Shade »

Offline amy1

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Re: Interesting article on indications for lateral release alone
« Reply #2 on: August 04, 2005, 10:45:39 PM »
I like your graphic.  I am thankful that I was armed with information before going for my second opinion who wanted to do only a lateral release
6/2004 partial lateral meniscus removal and microfracture left knee
7/13/05  open lateral release, medial plication, spur removal right knee
12/06  re do proximal realignment right knee (scar tissue formed ) 5 days post op - fell and fractured elbow
08/2009 - feeling good so far work 50 hrs a week