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Updated: May 29 2021

Lateral Patellar Compression Syndrome

Images min tilt_moved.jpg
  • Summary
    • Lateral patellar compression syndrome is the improper tracking of the patella in the trochlear groove generally caused by a tight lateral retinaculum.
    • Diagnosis is made clinically with pain with compression of the patella and moderate lateral facet tenderness and sunrise knee radiographs will often show patellar tilt in the lateral direction.
    • Treatment is nonoperative with physical therapy focusing on quadriceps stretching and strengthening. Operative lateral retinaculum release is indicated in refractory cases. 
  • Etiology
    • Mechanism
      • Caused by tight lateral retinaculum
        • leads to excessive lateral tilt without excessive patellar mobility
    • Associated conditions
      • Miserable Triad
        • is a term coined for anatomic characteristics that lead to an increased Q angle and an exacerbation of patellofemoral dysplasia. They include:
          • femoral anteversion
          • genu valgum
          • external tibial torsion / pronated feet
  • Presentation
    • Presentation
      • pain with stair climbing
      • theatre sign (pain with sitting for long periods of time)
    • Physical exam
      • pain with compression of patella and moderate lateral facet tenderness
      • inability to evert the lateral edge of the patella
  • Imaging
    • Radiographs
      • patellar tilt in lateral direction
  • Treatment
    • Nonoperative
      • NSAIDS, activity modification, and therapy
        • indications
          • mainstay of treatment and should be done for extensive period of time
        • technique
          • therapy should emphasize vastus medialis strengthening and closed chain short arc quadriceps exercises
    • Operative
      • arthroscopic lateral release
        • indications
          • objective evidence of lateral tilting (neutral or negative tilt)
          • pain refractory to extensive rehabilitation
          • inability to evert the lateral edge of the patella
          • ideal candidate has no symptoms of instability
          • medial patellar glide of less than one quadrant
          • lateral patellar glide of less than three quadrants
      • patellar realignment surgery
        • Maquet (tubercle anteriorization)
          • indicated only for distal pole lesions
          • only elevate 1 cm or else risk of skin necrosis
        • Elmslie-Trillat (medialization)
          • indicated only for instability with lateral translation (not isolated lateral tilt)
          • avoid if medial patellar facet arthrosis
        • Fulkerson alignment surgery (tubercle anteriorization and medialization)
          • indications (controversial)
            • lateral and distal pole lesions
            • increased Q angle
          • contraindications
            • superior medial arthrosis (scope before you perform the surgery)
            • skeletal immaturity
  • Techniques
    • Arthroscopic lateral release
      • technique
        • viewing through superior portal will show medial facet does not articulate with trochlea at 40 degrees of knee flexion
        • be sure adequate hemostasis is obtained
        • postoperatively the patella should be able to be passively tilted 80°
      • complications
        • persistent or worsened pain
        • patellar instability with medial translation
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