Lysis of pretibial patellar tendon adhesions (anterior interval release) to treat anterior knee pain after ACL reconstruction

Abstract

We report the clinical results of an anterior interval release for recalcitrant anterior knee pain associated with decreased patellar mobility after anterior cruciate ligament (ACL) reconstruction. Thirty consecutive patients with recalcitrant anterior knee pain and decreased patellar mobility after ACL reconstruction underwent an arthroscopic lysis of adhesions and scar of the distal patella tendon from the proximal anterior tibia (anterior interval release). Anterior knee pain was initially treated nonoperatively. Failure of nonoperative treatment was defined by recalcitrant anterior knee pain and no improvement in functional outcome, assessed by Lysholm scores and patient questionnaires. Minimum clinical followup was 2 years. All anterior interval release procedures were also performed by the senior author using a high inferolateral viewing portal in order to arthroscopically evaluate the anterior interval between the patella tendon and tibia. Prior to anterior interval release, Lysholm score averaged 68 (range 18-90). Postoperative Lysholm score averaged 85 (range 68-100) (P < 0.0001). Postoperative range-of-motion did not change significantly. Postoperative instability examinations were all graded zero using the International Knee Documentation Committee (IKDC) system. Average patient satisfaction at follow-up was 8.0 (1 = very dissatisfied; 10 = very satisfied). Early operative intervention with an anterior interval release has been shown in this series to result in significantly improved functional outcomes in the treatment of recalcitrant anterior knee pain after ACL reconstruction. © 2006 Springer-Verlag London Limited.