Resection of clinically localized segments of painful retinaculum in the treatment of selected patients with anterior knee pain

We reviewed the long-term results of 25 patients who had localized soft tis sue resections for refractory anterior retinacular knee pain. Patients comp leted visual analog scales to determine their activity and pain level chang es, 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 havi ng 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 t hey would repeat the surgery under the same circumstances. Five patients (2 0%) 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 av erage activity level dropped 60% after knee symptoms developed and increase d 40% after surgery. Pain levels decreased 50% after surgery. The patients with the best overall results had lesions that were in the medial, inferome dial, 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.