did any of you have a failed LR

[AARON14]

[/email]    aaron1453@gmail.com   

i had a lateral release 4 months ago . i feel today , and since the surgery , worse that i felt before it . all i care about is to be active again , to the fullest . i have been told this is the less invasive procedure , and i should have an A.C.I + OSTEOTOMY  procedure to feel good and pain less for the next 20 years . on tuesday 9/13/11  i am having the prelimanary procedure of biopsy - taking the sample of my healthy cartilage cells , and growth them in a lab in boston , for 4 weeks , till they are good to be implant again in my patela joint .

i would love to hear any bodys opinion / experience going through it

thanks !

[Driden]

I never understood the concept of getting more release as the remedy to failed lateral release.  I guess I messed up in seeking LPFLr. I should have found some crazy doc to cut out my iliotobial band and vastus lateralis entirely. The ultimate release.

[drmark]

ACI of the patella has a poor track record.  If someone was made measurably worse after a lateral release, then the release probably worsened lateral instability or created medial instability.

Cartlage has no nerve cells and is insensitive to pain, so plugging a "pot hole" in the cartlage is quite unlikely to effect the result.

Osteotomy may be a good idea, but I am distressed when I hear about it being used in a "shotgun" approach. 
Before I do an osteotomy, I have obtained quantative data which tells me what bone should be corrected, in what direction, and how many millimeters or degrees.  Not obtaining such data before an osteotomy, leaves the results in serious  doubt.
Mark Sanders MD FACS

[AARON14]

dr. sanders . are you an orthopedic surgeon ? i understand only some of what you explained . what do you mean , an A.C.I has a poor tracking record  ?

and why exactly you explain that i am doing worse after a lateral release ? i have been told by few doctors , that patients that had this procedure feel much better , and small percentage feel worse . i am with them . but the A.C.I PROCEDURE HAS ABOUT 85 % SUCCESS , AS I BEEN TOLD , and asked even if athletes who had it , went back to active and competitive sports , and the answer was yes .

what do you think  ?

aaron

[drmark]

When I was in training in the early 1980s, the lateral release was the considered the answer to most patella femoral problems.  Unfortunately, we are all taught wrong.  The lateral release is anything but the answer, and is rarely indicated for PF problems.  Not all doctors, are particularly interested in the patella femoral joint and havent' kept up. 

ACI's results in the medial or lateral joint are acceptable.  The results of ACI of the patella are not good.   Although it technically easy and profitable, I do not offer it to my patients.

Beyond that, the cartlage pot hole, is rarely the cause of the problem. 

If someone is made worse by the lateral release, it is usually a problem of PF instability and surgical attention should be addressed in that direction, rather than to filling the pot hole.


I suspect that your are a young person and may not be making your own healthe care decisions.  I advise you to read through this section.  There are some very intelligent lay person who post here, and many of them havelearned from their experience what works and what does not.  I would do this before laying down on the OR table again.

[AARON14]

when some of you say a patella femoral specialist , what exactly do you mean ?

[2cutekiddos]

Mostly we mean a Dr. who specializes in issues related to the patella (knee cap)...arthritis, cartilage loss, instability (subluxations/dislocations), pain (acute/throbbing), mal alignment (bones aren't in correct position, patella tendon in wrong position, trochlear dysplasia (knee groove malformations/flat), etc.

An Orthopedic Surgeon who says he/she specializes in the knee does not mean he/she specializes in how to treat problems related to the patella (knee cap). Most orthos I see who say they are "knee Dr's" tend to do a lot of total knee replacements, ACL and meniscus repairs...and like to throw in lateral releases. Basically Doctors that can't help me!

If you have instability of your patellas due to injury or just "lucky" to be born that way, then you really need a patella femoral specialist.

There are many good references you can obtain from the people on this board!

Good luck,
Andrea

[AARON14]

hi andrea , and thanks for you reply !

i had my A.C.I + T.T.O 10 weeks ago .  i had 6 cm of defect on my patella . the o.s who performed my surgery is one of the best and most know in the nation ( maybe in the world  ) . i get your explanation , about suergeons that are doing lateral release , a.c.l , knee replacement and meniscus problems . my suergeon specializes in the cartilage implantation procedures ! i guess not all of them for the patella , and mine was , but i am not sure what better to look for , if this is the procedure that i had  .

aaron

[allyd]

Aaron – as another point of view, further thoughts… Agree w/ everything andrea points out, but I’d also go further and suggest that a PF specialist doesn’t really exist as we speak/think of them. Most of the names thrown around as PF specialists are first and foremost “knee specialists” that take a special interest in PF problems – by and large I suspect the majority of them do their fair share of ACL’s, Meniscus, scopes, etc. It’s not an advertised or “board sanctioned” subspecialty I guess you could say.

I’m not overly familiar w/ ACI, but my understanding is that w/ any procedure you want a surgeon who has plenty of experience performing it, regardless of their specialty or interests. If you are currently with one of the best and most experienced w/ these techniques – don’t over think it!