The SPECIALIST'S OFFICE > The patello-femoral joint

IT Band Problems after Lateral Release Surgery

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OSuzanne:
I had LR surgery on my right knee Jan 8th and started developing ITB problems about a month later.  It started with pain and tightness from the hip all the way down to my knee.  Then I noticed a lot of cracking/snapping noises on the lateral part of my knee once the swelling subsided and my activity increased.  Finally on my 6 month recheck my OS diagnosed me with ITBS.  I am wondering if this is a complication of the LR surgery.  (He did a very aggressive release down to the joint.  I watched the video and timed the procedure and the LR itself took a full 5 minutes).  I had a LR done on the left knee in 2005 and did not develop these symptoms.  All I can say is that I get very tired of hearing and feeling that snapping sensation.  Some days are pretty good but other days it will snap 1000's of times (literally every step I take).  I have had 8 PT sessions for this problem.  The sessions include ultrasound, deep massage, and stretching.  It gets better for a few days and then comes back once I resume my gym program.  How long should it take to get better?  I was just wondering if anyone else developed ITBS following a LR.  Could this be due to weakness of my quads?

Kaputt_Knee:
I've developed ITBS after a result of a Lateral Release I had in March this year. I am so glad that I have it finally identified as I thought my back and hip were packing up on me as well after 18 months of crutches and limping.

I am using a topical Ibuprofen Creme on the whole of my IT band, across the tensor/extensor area of my hip and across the small of my back where the ligaments connect the hip and spine. I'm also taking one Ibuprofen tablet (occasionally 2 when it gets bad at night) per day and it seems to have started to help.

I have used warmth/heat - I have found that using a grain cushion more effective than a hot water bottle plus I have switched from gym work to swimming in my local thermal spa water has also helped.

From what I have read here it is a long haul to getting rid of the problems but at least I now have the pain under control!  :D

My quads are weak as a result of my original knee injury but are getting their mass back and the ITBS seems to be related to this. I had graduated from controlled strength exercises (supervised by my PT) to using the gym and generally working on my total fitness when this blew up.

Good luck with controlling the situation

Sue

Quinkin:
A tight ITB and retinaculum causes my patella femoral pain and "chrondomalacia". I haven't had srugery.
I've been obsessive about stretching and massaging my lateral retinaculum to keep it loose. I get a lot less knee pain and my knee capcks better

plantgeek58:
Hi OSuzanne,
I had LR almost a month ago and my PT had me begin working immediately on the IT band to loosen it up and prevent problems. It's not uncommon for it to tighten up after trauma to the lateral retinaculum. He told me the body's response to injury in a joint is to try to immobilize the joint, to prevent further irritation. That's why the IT band tightens up like that. You have to start working on it right away to reverse the process. It does take a while. We started with me running a tennis ball up and down the length of the tendon twice a day for a couple of minutes and my PT would dig his fingers into it at each session. Then he had me do the finger massage at home, both lengthwise and side-to-side. When I could stand that without gritting my teeth so much, my PT gave me a hard foam roller. I have to lay with my thigh on it and use my arms to roll myself back and forth over it. I've been doing all this since 3 days post-op and my IT band is almost back to normal now.
Don't give up. It's a long process, but you'll get there. Sometimes a cortisone shot into the bursa under the IT band helps.
Terre   

OSuzanne:
Thanks for all the comments, it helps to hear that this problem is not unusual.  I had my 9th PT session today.  I now have a hard foam roller of my own to use at home.  It takes some coordination to use and it kinda hurts to roll on it!  Hopefully it will help me treat myself since my therapy will end on Thursday.  I told my PT today that I think I will have to live with this ITB problem (it's been 7 months since my surgery and I still am trying to get over it).  He tried to assure me that I will get over it.  He did say that there is a PT who specializes in ASTYM therapy where they use tools to work on the ITB.  He might try to get more therapy sessions approved for me so that I could see this other PT.  I am willing to try almost anything.  I am not sure if I would be willing to get a cortisone injection though  :P.  (I hate shots).

It makes sense that the ITB would get tight after the trauma from the surgery.  (See attached photo if you want.  It was taken 6 days post op.  It shows my bruising.  These are the same areas where I am still having pain). 

I think that with the LR you lose some stability in the knee.  Does anyone know if you could be over-corrected with the LR surgery to the point where a surgical repair would be needed to tighten up the lateral side again?  Just wondering...

Suzanne

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