ISSN: 2640-2734
Authors: Basaran T*, Atay OA, Doral MN and Basaran PO
Introduction: Pain is the main indication for surgical treatment of release in patellofemoral pain syndrome of knee. Arthroscopic lateral retinacular release in patellofemoral pain syndrome using the electrocautery or a new technique for arthroscopic lateral release with scissors. In this study we compare the VAS scale before and after the surgery in 1 month in electrocautery and scissors group and the amount of hemorrhage and time of release between the groups. Methods: 120 patients included in this prospective randomized controlled study. Inclusion criterias are over the age of eighteen and have anterior knee pain syndrome. Tightness in lateral part of knee. Despite receiving conservative treatment for 6 months. Exclusion Criteria: Diseases that prolong bleeding time. Drugs that prolong bleeding time. Abnormal APTTINR levels. Patients underwent anterior cruciate reconstruction surgery, microfracture surgery, meniscus repair surgery; synovectomy due to inflammatory diseases is excluded from the study. In this study 120 (42M 78W med age 50,24 ± 15,37 ) patients divided into three groups which was similar in age and sex. All patients underwent standard arthroscopic surgery for patellofemoral knee syndrome and meniscal debridement Group 1(Electrocautery) (n:40) Lateral Retinacular Ligament (LRL) was released with electrocautery. Group 2(Scissors)(n:40) LRL was released with Scissors .Group 3(Control)(n:40) LRL was preserved. Results: There was no difference between the groups in terms of socio-demographic characteristics. All lateral ligaments releases were performed under tourniquet. The release is not considered to be complete unless the patella can be stood on its medial edge without difficulty. In all patients, surgery duration was recorded. To calculate the amount of bleeding the blood in the drainage tube was recorded for 24 hours after surgery. For 80 patients based on clinical examination at surgery and in the immediate postoperative period, all releases were felt to be adequate. For all groups total bleeding at 24h postoperatively is the statistically same (p:0.8). In first 8 hours the amount of bleeding is more than scissors group (p:0.002). Lateral release time is longer in electrocautery group (370 seconds) than in scissors group (22 seconds). In release with electrocautery sometimes we used additional techniques for enough release. There was no difference between groups in terms of complications such as deep vein thrombosis, hemarthrosis or severe complications. Visual analog scale (VAS) was used to assess the pain in all patients before surgery and after surgery in 1 month. There were no statistically differences between the VAS in the groups before the surgery. VAS was improved in all groups after surgery, but the improvement was less in control group and this change is statistically significant. At 1 month after the surgery there was no statistically significant difference in electrocautery and scissors group. Conclusion: In this study the amount of bleeding was the same in the groups but surgery duration was longer in electrocautery group. Pain decreased after surgery at all patients but we find further improvement with lateral retinacular release. Lateral retinacular release decreases pain. Our new technique for intraarticular arthroscopy guided lateral retinacular release uses with scissors which is simple, effective, rapid and have resulted a few surgical complications such as superficial skin infection which responds oral antibiotics. Electrocautery is difficult and needs experience.
Keywords: Arthroscopy; Lateral Release; Lateral Retinacular Release; Anterior Knee Pain
