Retropatellar chondral lesion as a long time consequence of lateral release for lateral hyperpression syndrome.


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)


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.


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.


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.