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Knee News

New Method for Keeping Kneecaps on Track with Total Knee Replacement Surgery

Doctors are getting good results with a new method to keep the kneecap on track when doing total knee replacement surgery. This new method is called a mesh expansion release of the lateral patellar retinaculum. The patella is your kneecap. The retinaculum is a fibrous band on either side of the patella. Lateral means it's along the outside edge of the patella.

If the quadriceps muscle along the front of the thigh pulls too much to one side, the patella starts getting off track. The result can be a painful loss of knee motion. One treatment method for poor patellar tracking is to release the lateral retinaculum. The doctor does this by cutting through the retinaculum.

But problems can occur with this operation. Blood vessels and nerves can be damaged. The patella can get broken. Tenderness over the bone, numbness of the skin, and loss of strength are also possible problems. Anyone getting a knee replacement needs a patella in good balance and without extra problems. A traditional lateral release may not be a good choice for these patients.

This is where the mesh expansion release comes in. Instead of cutting through the retinaculum, the surgeon makes several slashes through the fibrous band. The cuts are staggered in several rows side by side. There are two or three slash cuts in each line. As the knee moves, the retinaculum stretches or expands. The result is that the patella stays more in the middle, where it belongs.

In this study, doctors at an orthopedic surgery center used the mesh expansion method in 13 patients getting a total knee replacement. All 13 patients had good results with pain relief and improved function. Even after two years, there were no problems from the mesh expansion.

The authors conclude the mesh expansion is safe and effective. This treatment method to balance the patella can be used during total knee replacement surgery. The advantage is less damage to the joint capsule and faster healing than a full retinaculum release. It probably shouldn't be used for patients with severe joint deformity or severe retinaculum tightness.


William L. Healy, MD, et al. Mesh Expansion Release of the Lateral Patellar Retinaculum during Total Knee Arthroplasty. In The Journal of Bone and Joint Surgery. October 2003. Vol. 85-A. No. 10. Pp. 1909-1913.

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