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Arthroscopic Release of the Vastus Lateralis Tendon for Recurrent Patellar Dislocation

G. William Woods, MD^*,, Hussein A. Elkousy, MD and Daniel P. O’Connor, PhD^,

From the ^* University of Texas Health Science Center at Houston, Department of Orthopaedic Surgery, Houston, Texas, the Fondren Orthopedic Group LLP, Texas Orthopedic Hospital, Houston, Texas, and Joe W. King Orthopedic Institute, Houston, Texas

Address correspondence to Daniel P. O’Connor, PhD, Joe W. King Orthopedic Institute, Texas Orthopedic Hospital, 7401 South Main Street, Houston, TX 77030-4509 (e-mail: dano{at}jwkoi.com).

Background: Arthroscopic release of the vastus lateralis tendon for treatment of recurrent patellar dislocation has been criticized on the grounds that it may weaken the quadriceps.

Hypothesis: Quadriceps strength and outcome measures improve after arthroscopic release of the vastus lateralis tendon in patients with documented patellar dislocation.

Study Design: Case series; Level of evidence, 4.

Methods: Twenty patients who had recurrent patellar dislocation underwent arthroscopic lateral retinacular release that included a complete release of the vastus lateralis tendon from the superior pole of the patella and were observed prospectively. Bilateral quadriceps strength was tested preoperatively and at follow-up with an isokinetic dynamometer. Patients also completed the International Knee Documentation Committee Subjective Knee Form and the Short Form–36 preoperatively and postoperatively.

Results: Follow-up averaged 27 months (range, 24–43 months). There were no redislocations. Mean quadriceps strength improved by a mean of 28% (from 32.3 to 41.4 N·m). The mean quadriceps torque ratio (involved/uninvolved) improved significantly from a preoperative value of 63% (31/51 N·m) to 80% (42/52 N·m) at follow-up (P = .017). Fourteen patients (70%) increased quadriceps torque, and 6 patients (30%) decreased quadriceps torque. Only 1 patient failed to improve on International Knee Documentation Committee and Short Form–36 scores. The International Knee Documentation Committee scores improved from 45 points preoperatively to 76 points at follow-up (P = .001). The Short Form–36 physical component summary scores improved from 38 points preoperatively to 50 points at follow-up (P = .007), and the Short Form–36 physical functioning subscale scores improved from 53 points to 86 points (P = .015).

Conclusion: Arthroscopic release of the vastus lateralis tendon and lateral patellar retinaculum in patients with recurrent patellar dislocation can improve quadriceps strength and knee function.

Key Words: lateral release • knee • strength • outcomes

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