Long-term clinical outcomes following arthroscopic lateral retinacular release with concomitant cartilage procedures in patients with isolated patellofemoral osteoarthritis: a mean 11-year follow-up study.

BACKGROUND: Isolated patellofemoral osteoarthritis (PFOA) remains a challenging condition, particularly in patients with persistent symptoms despite conservative treatment. Arthroscopic lateral retinacular release (LRR) has been considered a treatment option for patients with lateral retinacular tightness; however, long-term clinical outcomes following LRR combined with concomitant cartilage procedures remain insufficiently investigated. This study aimed to evaluate the long-term clinical outcomes of arthroscopic LRR combined with cartilage procedures in carefully selected patients with isolated PFOA. METHODS: This retrospective study included patients who underwent arthroscopic LRR combined with concomitant cartilage procedures between 2012 and 2018 and completed a mean follow-up duration of 11.66 ± 2.15 years. Patients with patellar instability, previous patellar dislocation, major patellofemoral anatomical abnormalities, increased tibial tubercle-trochlear groove distance requiring realignment procedures, or other conditions affecting reliable outcome assessment were excluded. Clinical outcomes were evaluated using the International Knee Documentation Committee (IKDC) score, Lysholm Knee Score, and Visual Analogue Scale (VAS) preoperatively and at 2-year, 5-year, and final follow-up assessments. An exploratory subgroup analysis was performed according to cartilage severity based on the Outerbridge classification. RESULTS: A total of 35 patients were included, with a mean follow-up duration of 11.66 ± 2.15 years. IKDC and Lysholm scores significantly improved from preoperative values to the final follow-up (both P < 0.001), while VAS scores remained significantly lower than baseline at the final follow-up (P < 0.001). The greatest improvement was observed at the 2-year follow-up, followed by modest declines at later assessments; however, all clinical outcomes remained significantly improved compared with baseline. No revision surgery or major postoperative complications requiring additional intervention were observed during follow-up. In the exploratory subgroup analysis, both Outerbridge grade II-III and grade IV subgroups showed favorable longitudinal trends in clinical outcomes; however, the small sample size of the grade IV subgroup limited statistical confirmation of specific time-point differences and precluded definitive conclusions regarding the influence of cartilage severity on outcomes. CONCLUSIONS: Arthroscopic lateral retinacular release combined with concomitant cartilage procedures was associated with improvements in patient-reported pain and knee function over long-term follow-up in carefully selected patients with isolated PFOA and lateral retinacular tightness. This combined arthroscopic approach may represent a minimally invasive treatment option for symptom improvement in patients without major patellofemoral instability or anatomical abnormalities.