title: Results of isolated lateral retinacular reconstruction for iatrogenic medial patellar instability.
abstract: OBJECTIVE
  The aim of this study was to assess the outcomes of an isolated lateral retinaculum reconstruction for iatrogenic medial patellar instability (IMPI) in patients with continued pain after failed lateral retinacular release (LRR), including associated psychometric analysis.
  
  
  METHODS
  Pain was assessed using the visual analog scale (VAS) and disability was determined with the Lysholm scale. Psychological variables such as anxiety, depression, catastrophizing, and fear-of-movement beliefs were studied by using self-administered psychometric questionnaires.
  
  
  RESULTS
  All 17 patients (13 women and 4 men) in this retrospective study had undergone LRR previously for anterior knee pain or lateral patellar instability. Four patients had undergone LRR plus proximal (Insall) realignment, and one had undergone LRR plus a medial tibial tubercle transfer. After their procedures, all had disabling symptoms. All patients underwent reconstructive surgery for IMPI. At a minimum follow-up of 2 years (range, 2 to 8 years), the mean preoperative VAS score was 7.6 (range, 5 to 9) and improved to 1.9 (range, 0 to 8) at the time of final follow-up (P < .001). The mean preoperative Lysholm score was 36.4 (range, 20 to 55), and the knee was described as bad (<65 points) in all cases. Postoperatively, it improved to 86.1 (range, 70 to 94) at final follow-up (P < .001). Before surgery, 4 patients (24%) had the clinical criteria for depression, 10 (59%) had anxiety, 7 (41%) had "catastrophizing" ideas concerning pain, and all (100%) had kinesiophobia (fear of movement). After surgery, none of the patients had depression or anxiety, none had catastrophizing ideation, and only 53% had kinesiophobia.
  
  
  CONCLUSIONS
  Reconstruction of the deep transverse layer of the lateral retinaculum (LR) using a central strip of the iliotibial band for IMPI in patients with continued pain after failed LRR can successfully treat these severely disabled patients.
  
  
  METHODS
  Level IV, therapeutic case series.
authors.affiliation: Department of Orthopaedic Surgery, Hospital Arnau de Vilanova and Hospital 9 de Octubre, Valencia, Spain. Electronic address: vicente.sanchis.alfonso@gmail.com.
authors.forename: Vicente
authors.initials: V
authors.lastname: Sanchis-Alfonso
authors.affiliation: Agoriaz Orthopedic Center, Riaz, Switzerland.
authors.forename: Erik
authors.initials: E
authors.lastname: Montesinos-Berry
authors.affiliation: Hospital Universitari Quirón Dexeus, Barcelona, Spain.
authors.forename: Joan Carles
authors.initials: JC
authors.lastname: Monllau
authors.affiliation: Department of Orthopedic Surgery (Emeritus), Stanford University School of Medicine, Stanford, California, U.S.A.; and the Department of Orthopedic Surgery (Emeritus), El Camino Hospital, Mountain View, California, U.S.A.
authors.forename: Alan C
authors.initials: AC
authors.lastname: Merchant
mesh_terms: D000328:Adult; D018771:Arthralgia / Q000523:psychology / Q000601:surgery; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D007593:Joint Instability / Q000523:psychology / Q000601:surgery*; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D010329:Patella / Q000601:surgery; D017847:Patellar Ligament / Q000601:surgery*; D011594:Psychometrics; D019651:Plastic Surgery Procedures; D012086:Reoperation; D012189:Retrospective Studies; D013977:Tibia / Q000601:surgery; D017211:Treatment Failure; D055815:Young Adult