Treatment for Medial Retinaculum Tear
Arthroscopic medial retinacular release is the most effective treatment for painful medial retinaculum tears, providing excellent outcomes with minimal complications. 1
Diagnosis and Assessment
Clinical Presentation:
- Pain, swelling, and giving way of the knee
- Increased medial passive patellar mobility
- Positive gravity subluxation test
- Positive medial apprehension test 2
Imaging:
- CT examination may help locate fracture sites more precisely and reduce time between diagnosis and surgery 3
- MRI may be useful to confirm the diagnosis and rule out associated injuries
Treatment Algorithm
1. Conservative Management (First-line approach)
Patient Education:
- Explain the nature of the condition, its course, and prognosis
- Discuss activity modifications to avoid exacerbating symptoms 4
Physical Therapy:
- Quadriceps strengthening exercises
- Patellar stabilization exercises
- Proprioceptive training
Anti-inflammatory Measures:
- Topical or oral NSAIDs
- Ice application
- Rest and activity modification
2. Surgical Management (For cases failing conservative treatment)
Arthroscopic Medial Retinacular Release:
- Indicated for painful, recurrent medial subluxation of the patella
- Technique: Release of retinaculum 2 cm medial to the superior pole of the patella down to the anteromedial portal
- Success rate: 100% relief of medial subluxation and knee pain (6 excellent and 3 good results in a study of 9 knees) 1
- No complications or further realignment surgery needed after this procedure
- Mean follow-up of 2.7 years showed sustained results 1
Reconstruction of Lateral Retinaculum:
- Alternative approach for medial subluxation occurring after lateral retinacular release
- 80% of patients show complete resolution of instability symptoms
- Results: 3 excellent and 2 good outcomes in a study of 5 patients 2
Minimally Invasive Repair Technique:
- For acute patellar dislocation with medial retinacular tear
- Reinforced reattachment of the torn region
- Average Kujala score of 89.2 after 2 years
- No recurrent patellar dislocations in most cases 3
Post-Treatment Rehabilitation
Early Phase (0-2 weeks):
- Protected weight-bearing as tolerated
- Range of motion exercises
- Quadriceps activation exercises
Intermediate Phase (2-6 weeks):
- Progressive strengthening exercises
- Proprioceptive training
- Gait training
Late Phase (6+ weeks):
- Sport-specific exercises
- Return to activity protocol
- Maintenance exercises
Follow-up and Monitoring
- Regular follow-up at 2 weeks, 6 weeks, 3 months, and 6 months post-treatment
- Assess for recurrence of symptoms, patellar stability, and functional outcomes
- Monitor for complications such as recurrent subluxation or persistent pain
Prognosis
Arthroscopic medial retinacular release has shown excellent outcomes with minimal complications, making it the preferred surgical approach for medial retinaculum tears that fail conservative management 1. Early intervention leads to better functional outcomes and decreased risk of recurrent instability.