Schonholtz G J, Zahn M G, Magee C M
Department of Orthopaedic Surgery, George Washington University, Washington, D.C.
Arthroscopy. 1987;3(4):269-72. doi: 10.1016/s0749-8063(87)80122-6.
From October 1977 through January 1984, 2,330 arthroscopic procedures of the knee were performed by one of the authors (G.J.S.). Among these procedures, 35 lateral retinacular releases were performed through minimal, lateral incisions. Twenty-two knees in 22 patients were available for follow-up evaluation, and these cases were reviewed retrospectively. The average age of the patients at the time of surgery was 22.6 years. The average follow-up period was 48 months. The patients were divided into three subgroups on the basis of their preoperative diagnosis. Group I (eight knees) had a history of patellar dislocations; group II (seven knees) had recurrent patellar subluxation, identified by history and physical and radiographic examinations; and group III (seven knees) had patellar pain without a history of dislocations or subluxation and with no symptoms of instability. All of these patients underwent diagnostic arthroscopy and lateral retinacular release, as well as arthroscopic treatment of associated pathology. Postoperatively and at the time of followup, all patients were evaluated for pain, function and patellar instability. In 15 patients with a history of patellar dislocation or subluxation, 67% were found to have had significant improvement in their symptoms, which was borne out by the findings during physical examination. None was worse following treatment. Among the seven patients with no history of patellar dislocation or subluxation, only one of the seven had a satisfactory result. Based upon the findings of this study, it was concluded that arthroscopic lateral retinacular release is a reasonable, initial step in the surgical treatment of patellar dislocation or subluxation, resistant to conservative treatment. Its efficacy in cases of recalcitrant patellar pain without a history of instability is doubtful.
从1977年10月至1984年1月，作者之一（G.J.S.）进行了2330例膝关节镜手术。在这些手术中，通过最小的外侧切口进行了35例外侧支持带松解术。22例患者的22个膝关节可供随访评估，对这些病例进行了回顾性分析。手术时患者的平均年龄为22.6岁。平均随访期为48个月。根据术前诊断将患者分为三个亚组。第一组（8个膝关节）有髌骨脱位病史；第二组（7个膝关节）有复发性髌骨半脱位，通过病史、体格检查和影像学检查确定；第三组（7个膝关节）有髌骨疼痛，但无脱位或半脱位病史，也无不稳定症状。所有这些患者均接受了诊断性关节镜检查、外侧支持带松解术以及相关病理的关节镜治疗。术后及随访时，对所有患者的疼痛、功能和髌骨不稳定情况进行评估。在15例有髌骨脱位或半脱位病史的患者中，67%的患者症状有明显改善，体格检查结果证实了这一点。治疗后无一例病情恶化。在7例无髌骨脱位或半脱位病史的患者中，7例中只有1例结果满意。根据本研究结果，得出结论：关节镜下外侧支持带松解术是治疗对保守治疗无效的髌骨脱位或半脱位的合理的初始手术步骤。其对无不稳定病史的顽固性髌骨疼痛的疗效值得怀疑。
