title: Proposal of a therapeutic protocol for selected patients with patellofemoral knee osteoarthritis: arthroscopic lateral retinacular release followed by viscosupplementation.
abstract: BACKGROUND
  Lateral retinacular release has been demonstrated to reduce articular patellofemoral pressures, while intra-articular injection of hyaluronic acid can improve the biological and rheological knee pathway. We evaluated whether treatment protocol consisting on combination of these two therapies can provide significant symptomatic improvement in patients with patellofemoral osteoarthritis (PFO) and patellar tilt.
  
  
  METHODS
  We retrospectively analyzed the clinical and radiological data of 28 knees (25 patients with anterior knee pain) who underwent arthroscopic lateral retinacular release followed by viscosupplementation for isolated patellofemoral osteoarthritis without clinical or radiological signs of patellar instability. Clinical evaluation was performed at a mean follow-up of 32.4 months (range 24-47 months) by an independent surgeon using the Kujala score, visual analog scale (VAS), and patient satisfaction scale. Univariate and multivariate analysis was used to identify best determinants to have a good clinical outcome.
  
  
  RESULTS
  Mean Kujala score improved from 45.8 points before surgery (range 33-65 points) to 82.7 points after treatment protocol (range 52-100 points). VAS improved of 68.5 % from preoperative and all patients except one were satisfied. Linear multiple regression modeling showed that younger age (OR 1.134, 95 % CI 1.018-1.263, p = 0.022) and short time delay between the onset of symptoms and treatment (OR 1.207, 95 % CI 0.982-1.484, p = 0.007) were the best determinants for a good final outcome.
  
  
  CONCLUSIONS
  Arthroscopic lateral retinacular release followed by viscosupplementation is an effective treatment protocol for PFO, simple and minimally invasive with respect to other therapeutic options.
authors.affiliation: Department of Orthopaedic Surgery, San Clemente Hospital, Viale Pompilio 65, Mantova, MN, Italy. matteofosco27@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Fosco
authors.affiliation: Clinique des Lilas, Les Lilas, Paris, France.
authors.forename: E
authors.initials: E
authors.lastname: Dagher
mesh_terms: D000328:Adult; D001182:Arthroscopy / Q000379:methods; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D007719:Knee Joint / Q000601:surgery; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000175:diagnosis* / Q000601:surgery*; D010329:Patella / Q000601:surgery; D018579:Patient Selection; D012189:Retrospective Studies; D016896:Treatment Outcome; D055676:Viscosupplementation / Q000379:methods
keywords: Knee osteoarthritis; Lateral retinacular release; Patellar tilt; Patellofemoral joint; Viscosupplementation