Pain may be a problem when the lateral retinaculum is tight.
Pain may be a problem when the lateral retinaculum is tight.
Retinacular anatomy
The retinaculum is a fine but strong sheet of fibrous tissue communicating on both sides of the knee between the patella and the muscles and other supportive structures around the knee.
The retinacula (plural) are distinct from the medial and lateral patellofemoral ligaments.
Peer-reviewed papersQuote from peer-reviewed paper:
Medial and lateral "....[p]atellofemoral ligaments and retinacula are separate structures macroscopically and in imaging....The retinacula....[have]....a higher nerve fibre content and higher number of elastic fibres compared to the ligaments."
Citation: Biz C, Stecco C, Crimì A, Pirri C, Fosser M, Fede C, Fan C, Ruggieri P, De Caro R. Are Patellofemoral Ligaments and Retinacula Distinct Structures of the Knee Joint? An Anatomic, Histological and Magnetic Resonance Imaging Study. Int J Environ Res Public Health. 2022 Jan 19;19(3):1110. doi: 10.3390/ijerph19031110. PMID: 35162134; PMCID: PMC8834464.
Is the patellar retinaculum important?
The patellar retinaculum is an important stabiliser of the patella.
During a traumatic patella dislocation event, the retinaculum may become damaged, together with the medial patellofemoral ligament (MPFL). Such damaged supports may allow the patella to chronically sublux.
Peer-reviewed papersQuote from peer-reviewed paper:
....Lateral retinaculum tightness is assessed with the patellar glide test. The knee is flexed 20-30⁰, the quadriceps is relaxed, and the patella is pushed medially. Medial displacement less than one-fourth of the patellar width is indicative of a tight lateral retinaculum...."
Citation: Samelis PV, Koulouvaris P, Savvidou O, Mavrogenis A, Samelis VP, Papagelopoulos PJ. Patellar Dislocation: Workup and Decision-Making. Cureus. 2023 Oct 9;15(10):e46743. doi: 10.7759/cureus.46743. PMID: 38021800; PMCID: PMC10631568.
What is a lateral retinacular release?
A lateral retinacular release is a surgical procedure performed in patients who are suffering from excessive lateral pressure syndrome, where the patellar cartilage is under stress due to tight structures on the lateral side.
It has proven important that this procedure should only be done for very specific indications, and should be avoided if there has been any previous episode of patellar instability.
Peer-reviewed papersQuote from peer-reviewed paper:
....Surgeons should bear in mind that lateral retinaculum tightness should be diagnosed with caution, since inconsiderate lateral retinacular release (LRR) may lead to iatrogenic medial patellar instability...."
Citation: Samelis PV, Koulouvaris P, Savvidou O, Mavrogenis A, Samelis VP, Papagelopoulos PJ. Patellar Dislocation: Workup and Decision-Making. Cureus. 2023 Oct 9;15(10):e46743. doi: 10.7759/cureus.46743. PMID: 38021800; PMCID: PMC10631568.
Forum discussions
- Lateral release made by mistake: is there a way to fix it?
A very full thread of discussions about lateral retinacular release surgery.