Lateral Retinaculum Lengthening or Release

Tightness of the lateral patellofemoral (PF) soft tissues is associated with many PF disorders, including lateral patellar compression syndrome, lateral patellar instability, and PF arthritis. Thus, it is an important component of many PF disorders. Although excessive lateral patellar tilt can be recognized on imaging, the contribution of lateral tightness must be verified by physical examination, that is, restraint to medial patellar displacement and lack of neutral patella tilt on physical examination. The indications for lateral release or lengthening for treating PF conditions begin with PF pain; diagnoses are made by physical examination and imaging. Taping and patellar unloading braces can be useful to simulate lateral patella unloading and thus may be predictive of outcome. Lateral lengthening is a more precise balance of the PF forces, and one can titrate more precisely the exact tissue that is being lengthened or released, reducing complication rates. Complications can include overrelease of the lateral structures leading to medial patella instability. Treatment options are closure of the lateral retinaculum, reconstruction of the lateral PF ligament, or lateral patellotibial ligament reconstruction.