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Author Topic: lateral release complications  (Read 3284 times)

Offline arizona

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lateral release complications
« on: February 17, 2005, 12:32:51 AM »
I am 41 years old and I had been a middle distance runner, but for the last 4 years I have had minor patellar tracking problems in my left knee so a I had to stop running. I was able to do stairmaster and hike and climb mountains. On and off I tried PT and different types of braces. Nothing worked. In the past year I began getting patellar pain doing leg extentions. It was a pain similar to tendenitis but continued up through the kneecap. I was frustrated because I could not run. After 4 years and consultations by 3 different docters. I was told a lateral release would help. My docter said I may not be able to run again but I would definately feel better. I was told I would not get worse from the surgery. Since I was reassured I wouldn't lose my abilty to hike I decided to go ahead with the surgery. On November 3, 2004 I had my lateral release. My surgery was said to go well except for a burn from the lazer which caused a blister. It is now 3 months later and I have pain going up stairs, extending and contractting my quads brings pain under the kneecap, and even riding the bike makes my kneecap slightly ache. I took an MRI on January 26. My docter said the patella looked like it was sitting in the groove correctly I just had some synovial fluid. He gave me a cortisone shot and it gave me some relief for three days. He said I should try taping while doing PT. I got a second opinion this docter said I need another lateral release, a scope to get rid of scar tissue, and a TTT because the patella was still tilted. My docter lectures on lateral release. In his lectures he talks about how many docters perform them for the wrong reasons. I know he's a good docter. He's done surgerys on many people I know. My second opinion docter specializes in TTT surgery my PT said he has heard nothing negative about him. Who do I believe? I am getting another opinion and a dynamic ct scan. I know that a TTT moves the tendon medially but I'm not sure that's what I need. When I manually push the top of the patella medailly and rotate it so the bottom of my patella moves laterally I can extend and tighten my leg with no pain. I'm afraid more surgery will make my condition worse. I also read arthritis is a result TTT surgery. Please help. :'(
Lateral Release in Nov 2004

Offline tamter

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Re: lateral release complications
« Reply #1 on: February 17, 2005, 01:02:31 AM »
Well I don't know if I can really help you with your question, but I have had 4 LR 2 each on both knees my last round was 10/04 had a few complications.  I went and received 2nd opinion he said that he is going to give me about a year to heal because of the chrondoplasty they did on my patella.  But he told me I am a canidate for the Faulkerson modified TTT, he said to decompress my patella.  My first OS didn't say anything about the TTT, because he does not do them but my current OS has done quite a few.  So I guess on my case we will wait and see, I don't know it does sound kind of scary what I would like to know is there kneegeeks out there that they really feel that it was beneficial to them to have this procedure and what is the post op and rehab like?  Maybe some of the more experienced geeks out there can give us both some information on this.
Good Luck Arizona sounds like we are somewhat same situation.  Thanks Tammy

Offline Linds

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Re: lateral release complications
« Reply #2 on: February 22, 2005, 11:22:36 AM »
It's hard to know what to do in this sort of situation,... i've had a LR on both of my knees, but both of them are still not doing well. However, i'd say a second opinion is a good thing, but i'd give the knee a little more time to heal. One of my PT'shad a LR on her left knee and it took 8 months for it to really turn around for her, but with hard work in PT it did. ;) It's just a thought. i'm 6 months post op from my left knee LR and well.. almost 3 yeasr post op from my right knee... the left one is still struggling not doing what it should be, but it's improved since 3 months post op. At 3 months I didn't have full extension passively or actively my knees was still very swollen and I couldn't do much of anything.  Now with hard work in my PT i've gained extension (i'm losing it again for some reason) the swelling has gone down tremendously and I can atleast walk to the stable to see my horse again.  I think the second opinion is a GOOD idea and you know there are options, but i'd give the knee awhile to heal if it were me.  My OS always said it takes a good 6 months before we'll know for sure if the LR has worked. In my case, the LR did correct the tilt of my patellae, but I have other rotational problems with my leg bones which no one aknowledged before.  Keep up the good work in PT, have they tried taping the patella? Sometimes this can make a big difference for the PT work. I can't handle the downwards pressure anymore, but I used to have mine taped and it did help.

Hey my second LR was done with a Laser too, cause after the first one I almost bled out.. and I got a burn on my kneecap... from the laser too. :p

Goodluck...

Linds
« Last Edit: March 01, 2005, 09:34:09 AM by Linds »
1997 Scope RK
2002 LR RK
2002 Scope and hematoma evac RK
2004 LR LK
May 06 Fall from Horse, partial ACL tear and meniscus injury, Tibial plateau injury
2007 Scope, Plica Excision and Debride LK
2009/2010- Possibly Ankylosing Spondylitis?

Offline cat

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Re: lateral release complications
« Reply #3 on: February 22, 2005, 01:34:10 PM »
Hey Arizona,
Quote
[In his lectures he talks about how many docters perform them for the wrong reasons./quote]
My current OS gave me one of those lectures when I first saw him for a 'second' opinion. (I actually had more than a second. ;D)
I think it's wonderful that you are able to get a dynamic CT scan. I dont' think those are even available in my area. Let us know what you find out and good luck.
cat
"Miserable malalignment"
 Lateral release, medial reefing, VMO advancement, and TTT-  3/2/04
Screw removal- 5/24/05
Cortisone injection to pes anserine- 7/27/05
Femoral derotation osteotomy, TTT revision- 10/18/07

Offline arizona

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Re: lateral release complications
« Reply #4 on: February 22, 2005, 05:33:22 PM »
Thanks for the replies. I will be getting my ct scan today and I will post an update. My pt just started taping my patella; it helps a little. But here is something strange, my pt looked at the way I step up on my good leg (Right leg). He said it turns in. he checked my Q angle. My right leg is 23 and my left leg, the knee that hurts is 13. He said the normal range for women is 15 or lower. He said he's calling my OS for info. Has anyone ever heard of this situation before?
Arizona ???
Lateral Release in Nov 2004

Offline Linds

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Re: lateral release complications
« Reply #5 on: February 22, 2005, 05:57:15 PM »
Hey Sounds like you have femoral anteversion. I have this too... but on both legs not just one. Both of my q angles are in the low 20's.  However, my PT has suggested that q angles are a point of interest but don't mean TOO much.  but it is strange that only one of your legs turns in. :-\ I know that my right knee the q angle did improve a little..after my LR, like from 23 to 20 or something around there... so maybe that's where you are at. Hopefully the CT goes well and your PT is able to talk to your OS and give you some answers.

Take care and goodluck, glad that taping is helping some
Hugs
Linds
1997 Scope RK
2002 LR RK
2002 Scope and hematoma evac RK
2004 LR LK
May 06 Fall from Horse, partial ACL tear and meniscus injury, Tibial plateau injury
2007 Scope, Plica Excision and Debride LK
2009/2010- Possibly Ankylosing Spondylitis?

Offline arizona

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Re: lateral release complications
« Reply #6 on: February 24, 2005, 10:07:03 PM »
I don't think I have femoral anteversion in the left knee. That's the one I have the problem with. The Q angle is 13 which is good. I never had a problem with ROM, it came back within a month. My pt has been taping my patella all different ways. He thinks I might have patella alta. I will run this by my OS's this week when I see them to consult about my dynamic PT scan. Hopefully your recovery is going well.
Arizona
« Last Edit: February 25, 2005, 10:44:32 PM by arizona »
Lateral Release in Nov 2004

Offline Kicker_Kiki

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Re: lateral release complications
« Reply #7 on: February 25, 2005, 06:15:44 PM »
I think the CT scans are a good idea - a good surgeon can tell a lot from the CT scans - I am encouraged that your OS ordered them - a lot of surgeons don't and if they did probably could not interpret the results.  There is a lot of information on this site about TTTs and other surgeries for other problems.  If you have a surgeon who has performed a number of TTTs and recommends one for you I think you should consider it.  Most surgeons will only recommend it if they really think it is indicated - the recovery from a TTT is supposed to me more protracted and difficult than for a TKR.  My OS ran a number of tests and didn't want to do the TTT.  He suggested that we prepare for it but that if he could slide my knee cap home and fix the tilt with a LR that he wouldn't perform the TTT.  You can see from my pics on http://www.picturetrail.com/gallery/view?p=999&gid=6471012&uid=3175001&members=1 that after the lateral release my knee was still not in the femoral groove.  My OS had to move my patellar 2cm medially to get my knee cap centered.  You might have the same type of problem - perhaps you are centered almost enough but have patella alta?  Both could cause pain during activiites.  How are you going down stairs??  That for me is the definitive test - my knee cap would not stay put when I would descend stairs - it would always pull laterally and sublux.  Good luck to you.  dawn
Patella Alta (L&R)
Lateral Subluxation (R)
Osteoarthritis Grade III (L&R Patella)
TTT  1/25/05 (R only)
Broke Osteotomy/Ruptured Patellar Tendon 1/29/05
TTT Revision 2/5/05 (R only)
LR (L only) 9/30/05
Screws out and Scope R knee 3/15/06
Ex-Avid soccer player

Offline arizona

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Re: lateral release complications
« Reply #8 on: February 25, 2005, 10:43:11 PM »
Kiki,
Thanks for sharing your pics. I still don't know about the TTT. My patella pics look like yours after theTTT. I will be taking my CT to a few OS's. In the meantime I'm taping and hoping for the best.
AZ
Lateral Release in Nov 2004

Offline Teresa_S

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Re: lateral release complications
« Reply #9 on: February 28, 2005, 04:11:33 PM »
Just  a  different slant (no pun intended) on the subject of LR.  Mine were never mentioned to me, it always seemed like they were thrown in as an incidental procedure at the end of the other procedures because the knee did not move, and still mal tracked.  In 1996, at my first OS appt for pain in my knees, I found out with a scope to clean it up that I, basically, had already, after a lifetime of just walking and working,no big time sports , a little horsebackriding for pleasure, basketball, and softball, that my knee was worn out at the age of 42. I do think the fact that I had 5 pregnancies contributed to the fact. I continured to just work, wear out braces, from the simple pullon, to the German model to the hinged ones, and didn't do much about it, but hurt all night, and spend 2 days recovering for every one I worked. But when I had my second auto accident (the first was a 4 time rollover) in FEB 2002,and hit the heck out of both knees,and fractured the left, and tore the heck out of it,and they neglected to find the problems for 4 months, I started in on the LR procedure. The scope was actually diagnostic to figure out why it was so swollen and hurt so much. THE slant was even more obvious with the inside of the knee (tibia) being worn down to the point my spacer required quite a slant to even it out. SO at the completion of the synovectomy, repair of medial and lateral meniscus, and the fracture, he did a lateral release to help the mal tracking. I was given NO instructions for recovery, other than bear weight to tolerance, see me in a couple of weeks.  NO PT , NOTHING,  wasn't actually even told about the LR.  Then it didn't get better, and three months, same surgery again. Again, no discharge instructions, LR wasn't even mentioned. BUT that is when I had a post op bleed, and it is all down hill from there. Somewhere over the next 6-7 months, the pcl also went to shreds LITERALLY, as it was almost GONE completely by the time I was approaching the tkr date. OF course, nobody worried about  the pcl, as I would "not need it after the tkr" but I have to wonder how I managed to "shred it" when I could barely walk, BUT I certainly had my share of falls, as that left knee gave out almost routinely, if I used it to step out first.  When I read the op report for my tkr, imagine that I was NOT surprised to read:" Then a lateral release was performed utilizing a electrocautery. "  How in the world I needed that procedure 7 times in  18 months is beyond me. BUT most likely because he never gave me therapy, or took proper precautions post op. So my consideration would be that you have the proper post op care and therapy to make it successful. I would also have the OS outline, and draw on paper what was going to improve with the lateral release. AND what recovery it was going to take on your part to make it work. Teresa
On going instrumentation failure, chronic infection,
Arthroscopes Left 11 Right 2, MRSA, L TKR  ,  Revision, LR x5, Medial and lateral meniscus repair, Broken prosthesis
Osteochondral Fracture,untreated 6 mths. Revision new tkr 01-07 awaiting new hip and right knee
R TKR pending

Offline arizona

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Re: lateral release complications
« Reply #10 on: March 02, 2005, 11:19:21 PM »

I got my CT scan. No subluxation in any of the angles except 0 degrees at 4mm. My os says that's within normal range when the leg is straight. The 2nd opinion OS still says I need a TTT, scope, and another LR. I think I'll continue going to therapy and taping for awhile, it seems to help a little. Also, your after surgery MRI's look like mine. My patella looks like it is sitting correctly in the groove at all degrees.my OS also gave me a second cortisone injection. I'm hoping that it's just taking my vmo a long time to fire up because It's been dormant for 4 years.
Arizona
Lateral Release in Nov 2004