What is the recommended treatment protocol for a medial retinaculum injury?

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Last updated: November 12, 2026 • View editorial policy

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Treatment of Medial Retinaculum Injury

For acute medial retinaculum injuries following patellar dislocation, arthroscopic-assisted surgical repair with direct suture fixation of the torn retinaculum is the recommended treatment approach, particularly in adolescents and young adults where anatomic restoration prevents recurrent instability.

Diagnostic Approach

Initial imaging should follow this sequence:

  • Plain radiographs of the knee to identify any osseous fragments along the medial patellar margin, which suggest prior or acute dislocation 1
  • High-frequency ultrasonography to precisely localize the tear site within the medial retinaculum—whether at the patellar edge, mid-substance, or femoral attachment 2
  • MRI without IV contrast when radiographs show medial patellar fragments or clinical suspicion exists for patellar dislocation, as this definitively assesses medial retinaculum and MPFL integrity, cartilage injury extent, and loose bodies 1

Surgical Treatment Protocol

The treatment strategy depends on injury location and patient age:

For Acute Injuries (within 2-3 weeks)

Arthroscopic-assisted repair is the primary approach 2, 3:

  • Mid-substance tears: Direct arthroscopic suture repair of the retinaculum 2
  • Patellar edge avulsions: Bone anchor fixation to the patella with arthroscopic suture reinforcement 2
  • Technique advantage: Minimally invasive with stab wounds using 18-gauge needles for plication, providing excellent cosmetic outcomes while avoiding donor site morbidity from reconstruction 3

For Adolescent Patients with Osteochondral Fracture

Arthroscopy-assisted medial retinaculum tightening suture with internal fixation of the osteochondral fragment provides superior outcomes 4:

  • This approach achieved stable patellofemoral alignment (patellar tilt improved from 23.55° to 11.23° at 3 months)
  • Functional scores (Kujala, Lysholm, IKDC) showed significant improvement by 3 months with continued gains at 1 year
  • Critical finding: No redislocation, subluxation, or patellar cartilage degeneration occurred during 36-month mean follow-up 4
  • This represents a viable alternative to MPFL reconstruction in this population

For Skeletally Immature Patients

Medial patellar retinaculum cable transfer with anchoring suture reinforcement avoids growth plate injury 5:

  • Harvest the longitudinal retinaculum cable along medial patella, keeping proximal attachment intact
  • Transfer free end to medial femoral condyle (distal to growth plate) through soft-tissue tunnel
  • Fix with absorbable suture anchor, then reinforce with sutures through patellar bone tunnels
  • Fasten vastus medialis oblique and remaining retinaculum through bone tunnels

For Habitual/Recurrent Dislocations

Medial patellar retinaculum plasty restores both static and dynamic stability 6:

  • Repair tailored to specific injury sites identified on MRI
  • Achieved good knee mobility recovery with no recurrence over 12-36 months follow-up in adolescents

Key Technical Considerations

Common pitfall: Assuming all medial-sided injuries involve the MPFL. Evidence shows traumatic patellar dislocation typically causes osteochondral avulsion at the inferomedial patella, implicating the inferior aspect of the deep medial retinaculum rather than the MPFL 7.

Preoperative CT examination reduces time to surgery and precisely locates fracture sites, particularly important when osseous avulsion is suspected 7.

Postoperative advantage: Arthroscopic techniques shorten knee immobilization time compared to open approaches, with ultrasonography at 18 months confirming continuous fiber restoration 2.

Expected Outcomes

Based on the highest quality recent evidence 4:

  • Kujala scores reach 64.80 at 3 months, improving further to excellent levels by 1 year
  • Patellar alignment normalizes by 3 months and remains stable
  • No evidence of accelerated cartilage degeneration on MRI
  • Recurrence rates approach zero with proper technique

The arthroscopic approach is less invasive than MPFL reconstruction, avoids graft harvest, preserves native anatomy, and provides excellent functional restoration with minimal cosmetic impact—particularly important in young female patients 7, 3.

References

1
Guideline

acr appropriateness criteria<sup>®</sup> chronic knee pain.

Journal of the American College of Radiology, 2018

2
Research

[Study on therapeutic effects of arthroscopic repair on medial patellar retinaculum acute injury].

Zhongguo gu shang = China journal of orthopaedics and traumatology, 2017

7
Research

A new minimally invasive surgical technique for medial retinaculum repair following traumatic patellar dislocation.

European journal of orthopaedic surgery & traumatology : orthopedie traumatologie, 2018

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.