Arthroscopic Lateral Retinacular Release and Modified Goldthwait Technique for Patellar Instability

Abstract

Surgical options for patellofemoral (PF) disorders include proximal or distal realignment, cartilage restoration techniques, open or arthroscopic lateral retinacular release, and medial soft-tissue reefing. Skeletal immaturity and donor-site morbidity can be of concern in most reconstructive procedures. The Goldthwait procedure with hemi-patellar transfer and medialization combined with arthroscopic lateral retinacular release results in medialization of the PF contact point in flexion and corrects maltracking to prevent recurrent patellar dislocation. This functional procedure is indicated for PF instability and has historically been used in children to accommodate the immaturity of the tibial tubercle and physis. The purpose of surgical correction is to improve PF tracking, reducing the lateralizing forces on the patella with the correction of the Q angle (angle between the quadriceps tendon and patellar tendon). The purpose of this Technical Note was to describe, in detail, arthroscopic lateral retinacular release combined with the modified Goldthwait procedure for recurrent patellar instability.