AANA Lab Course 910 - Patellofemoral Joint Preservation-Lateral Anatomy and Soft Tissue Balancing-Dr. Elizabeth Arendt, M.D.

Lateral Anatomy and Soft Tissue Balancing-Dr. Elizabeth Arendt, M.D.

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This presentation by Elizabeth A. Arendt from the University of Minnesota discusses the anatomy and soft tissue balancing of the lateral patellofemoral joint, with a focus on the clinical decision-making around lateral retinacular (LR) release procedures.<br /><br />Key points include recognition of the balance between medial laxity and lateral tightness in patellar instability. The lateral side anatomy involves the lateral retinaculum, vastus lateralis tendon, and lateral patellofemoral ligament, which collectively influence patellar tracking.<br /><br />Physical examination, including the patella tilt test, alongside imaging studies (such as early flexion views like Laurin’s and Merchant’s), are tools used to assess lateral tightness. However, imaging alone cannot definitively predict the need for LR release. Typical indications for considering LR release include persistent excessive lateral patella tilt that does not correct with knee flexion or high-grade trochlear dysplasia.<br /><br />Intra-operative assessment ultimately guides the decision to perform LR release, as not all cases of patellar dislocation present with lateral tightness. The surgical approach should be individualized based on direct physical evaluation during surgery rather than relying solely on imaging.<br /><br />The take-home message emphasizes the complexity of lateral patellofemoral soft tissue balancing: surgical management must be tailored, ensuring that lateral releases or lengthenings are reserved for cases demonstrating true lateral tightness confirmed with intra-operative examination. This careful approach aims to optimize outcomes while avoiding unnecessary interventions.<br /><br />In summary, lateral patellofemoral anatomy and soft tissue considerations are critical for treating patellar instability, and decisions regarding lateral retinacular release require a nuanced clinical and intra-operative assessment beyond imaging findings alone.

Keywords

lateral patellofemoral joint

patellar instability

lateral retinacular release

medial laxity

lateral tightness

patella tilt test

trochlear dysplasia

intra-operative assessment

soft tissue balancing

patellar tracking