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Resection of Clinically Localized Segments of Painful Retinaculum in the Treatment of Selected Patients with Anterior Knee Pain

Nader Kasim, MD and John P. Fulkerson, MD

Department of Orthopaedic Surgery, University of Connecticut School of Medicine, Farmington, Connecticut

Presented at the annual meeting of the American Academy of Orthopaedic Surgeons, New Orleans, Louisiana, March 1998.

Address correspondence and reprint requests to Nader Kasim, MD, 1656 Oak Tree Road, Edison, NJ 08820

We reviewed the long-term results of 25 patients who had localized soft tissue resections for refractory anterior retinacular knee pain. Patients completed visual analog scales to determine their activity and pain level changes, subjective assessment of their results, and whether they would have the surgery again under the same circumstances. Five of the 25 patients (20%) had had no knee surgery before the soft tissue excision, with the rest having had an average of two prior operations (range, 1 to 6). Subjectively, 22 patients (88%) noted moderate-to-substantial improvement after surgery; 3 patients (12%) declared no long-term benefit. All 25 patients stated that they would repeat the surgery under the same circumstances. Five patients (20%) noted a decrease in their results over time, but only two patients (8%) decreased their job level after surgery because of their knee pain. The aver2age activity level dropped 60% after knee symptoms developed and increased 40% after surgery. Pain levels decreased 50% after surgery. The patients with the best overall results had lesions that were in the medial, inferomedial, or inferolateral retinaculum. The histologic results of the specimens included fibrosis, vascular proliferation, and small nerves with decreased myelin (neuromata). Our results show that specific soft tissue excision of painful tissue can often lead to successful clinical outcomes.

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