- Swelling at the synchondrosis.
- Painful range of motion of the knee.
- Standing or jumping may cause pain.
- The second surgical treatment is a lateral retinacular release. The surgeon cuts the connective tissue holding the quadriceps to the outer edge of the kneecap. This releases the traction force put on the patella by the vastus lateralis muscle. The vastus lateralis is the outer most tendon of the four tendons that make up the quadriceps muscle.
- In some cases, a lateral release allows the two bone fragments to join together and heal. Pain is relieved within four weeks. Athletes are able to return to their pre-injury level of sports participation. This procedure can be done arthroscopically, thus avoiding an open incision. Studies show that results are improved with this technique. There is less swelling after surgery and faster recovery of muscle strength postoperatively.
- A third surgical technique is the subperiosteal detachment of the vastus lateralis insertion. This method accomplishes the same thing as a lateral release but without weakening the vastus lateralis muscle. By just releasing the tendon from the fragment and from under the first layer of bone, the action of the muscle is not altered. The fragment may or may not be removed. This depends on how severe the condition is. In some patients, the fragment can and does join with the rest of the patella.
- And finally, there is a more invasive approach, called open reduction and internal fixation (ORIF). An open incision is made. The fragment is attached to the main patella with wires or screws. This procedure is used when the fragment is large and removing it would cause patellofemoral arthritis later.
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