LATERAL RELEASE IN MIDDLE AGED TO ELDERLY POPULATION WITH PATELLOFEMORAL OSTEOARTHRITIS: LONG-TERM FOLLOW-UP

Abstract

Introduction: The purpose of this study was to assess the effect of lateral release surgery in our middle aged to elderly population with advanced isolated patellofemoral osteoarthritis while the weight bearing part of the joint is well preserved. We hypothesized that lateral release is a helpful procedure in improving function and relieving pain and hence deferring the need for arthroplasty.

Material and Methods: This is a prospective study performed in patients with patellofemoral pain recalcitrant to conservative management. 57 Knees (11 Bilateral) had arthroscopic lateral retinacular release from October 1999 to Jan 2007. All patients had pain secondary to Patellofemoral osteoarthritis or ELPS (Excessive Lateral Pressure Syndrome) and had through arthroscopic evaluation of the knee prior to the lateral retinacular release. Decision was made after assessing the patella tracking from the superolateral portal using a 70 degree arthroscope. There were forty two females and 15 males with a mean age of 63 years (41 – 84 years). Thirty five procedures were done on the left knee and 22 on the right. The average body weight was 12.9 stone (9.7 – 16.5). The mean follow-up was 72 months (36 – 130). Clinical assessment tools used were the IKDC, Tegner, WOMAC and Knee Society Scores. Visual analogue pain scale and the need for reoperation were also recorded. All but one patient, who died of other medical reason, were asked to fill out questionnaires based on the above outcome measures.

Results: One patient developed swelling in the calf postoperatively. Doppler study ruled out deep vein thrombosis. No other complication (hemarthrosis or infection) was noted.

Mean pre and post operative functional score were compared. Tegner Activity scale was unchanged. Lysholm score was improved from 48(13 – 80) to 87(60–100) (p < 0.004). Post op IKDC Subjective knee score was 60(32–82). Post op WOMAC score was 42 (26–77), while The Knee Society and Functional scores were 86(63–100) and 86(45–100) respectively. Finally Visual analogue pain scale was 6(4–10) pre-op which improved to 2(0–6). At the final follow-up (mean 72 weeks), only seven patients (12%) require arthroplasty. Four patients require Total knee replacement while three patients required patellofemoral replacement at an average of 21 months (8–32) post op.

Conclusion: This procedure appears to improve function and provide significant relief of pain. The need for arthroplasty can be deferred in successful cases. Only 12 percent of our patients required arthroplasty at an average of seventy two months follow up.

Thus this confirms our hypothesis. With a low failure rate and morbidity, we do recommend this procedure in middle aged to elderly patients who has patellofemoral osteoarthritis.