Clinical outcome of lateral release and medial reefing in recurrent patellar dislocation: Case report

Clinical outcome of lateral release and medial reefing in recurrent patellar dislocation: Case report - In the population of underage children and young adults, recurrent patella dislocation is widespread, with limited studies examining the effectiveness of medial soft tissue strengthening and lateral release procedures in averting recurrent dislocation. A 16-year-old male with Down syndrome presented with a chief complaint of pain and deformity at the left knee, with a history of recurrent falls while walking, and was unable to sit cross-legged. Patient evaluated with the Kujala score which is of 57. X-ray revealed lateral patellar dislocation on the patellar skyline view. The patient was operated on for right-sided Recurrent patellar instability with lateral retinacular release and medial soft tissue reefing and had a good clinical outcome 4 years back, and had no residual deformity or recurrence occur for the right lower limb. A surgical approach involving the same procedure of Lateral release and medial soft tissue strengthening was employed to address the condition, keeping the MPFL repair as the standby procedure. An 8 cm vertical midline patellar incision was made, followed by transection of the patellar retinaculum and synovium along the lateral border of patella and Medial retinacular reefing aka soft medial tissue strengthening was then performed through advancement of vastus medialis obliquus muscle and medial retinacular complex over the patella. Post-operative management included compression dressing and cylinder splinting, followed by gradual weight bearing and knee exercises. A considerable improvement in Kujala score was observed, increasing from 57 pre-operatively to 91 at 6-month and 1-year follow-ups. The study demonstrates the effectiveness of lateral retinacular release and medial soft tissue strengthening procedures in preventing recurrent patellar instability in young adults and underage patients. The procedure yields the favorable outcome with No re-dislocation of the patella. This surgical approach is particularly beneficial in low-resource settings where access to advanced orthopedic care and specialized facilities may be limited, making it a viable treatment option for patients in various healthcare environments. Keywords: Lateral retinacular release, Medial retinacular reefing, Recurrent patellar instability, Recurrent patellar dislocation.