| Purpose:
To shed some light on a problem which has as yet
not received attention in the scientific debate on the treatment
of lateral patella hyperpression syndrome with lateral release.
Material and Methods:
In the years 1980-1996 200 lateral patella release operations
for lateral hyperpression syndrome were performed. Results
for the first 80 operations have been published already. Most
were performed in the 80s.
In the past 10 years 8 patients were reseen as, after many
years without discomfort, they were suffering with pain in
the knee that had been operated on. The symptoms were
not those of hyperpression but more like simple chondral lesion
pain. These patients were all offered a new diagnostic
arthroscopy to evaluate the situation in the knee.
In all cases the arthroscopy was videoed. In 4 cases
it was possible to compare the new video with the video from
the earlier lateral release operation. The other 4 were
compared with the case notes.
In none of the cases was there any chondral lesion on the
patella before the lateral release was performed. (no patient
with chondral lesion is offered a lateral release operation
in the clinic)
Results:
All 8 had at least a chondral lesion grade2 (Ogilvie-Harris
classification) on the infero-medial facet of the patella. There
was corresponding synovitis in the area.
Discussion:
Destruction of chondral tissue on the patella is something
that all orthopaedic surgeons observe and are familiar with.
What is remarkable about these patients is the rapid development
of the lesion to such a severe extent.
A possible mechanism could be changed pressure on the medial
side of the patella where the former chondral no longer participates
in the distribution of pressure from patella to femur. Suddenly
the medial facet must transfer a lot of pressure from patella
to femur. It can be too great a pressure for the horizontal
collagen fibers on the surface. The fibres are destroyed,
and thereby the chondral tissue.
8 patients from 200 is not any. Some patients, like
these 8 may have been seen by other orthopaedic surgeons as
is customary in Denmark.
It does mean, though, that the exact extent is probably unknown
but needs fuller evaluation and comparison with the many successful
results through surgery.
Resumé
8 patients with fresh knee pains, who had been operated on
previously for lateral release of patellar hypertension, were
given fresh arthroscopies. These showed severe degree
2 chondral lesions. An evaluation needs to be made comparing
the negative effects of the operation with the positive effects. |
