LR Questions...

[allyd]

I think the key word is excessively one way or the other. To share my experience, pre-surgery: My patella would move into the 4th quadrant laterally. But medially... as my OS said, it hardly moved at all, and there is supposed to be some glide medially. Hence the need for a LR in my case. It was explained that If I had just done the MPFLr without the LR, the restraints would have just been pulling against eachother. Post surgery, there is definitely more movement medially due to the LR, and less laterally due to the MPFLr. But nothing excessive.

[spilsey]

my knee moved alot both medially and laterally, however not as much on the medial side. I am worried that maybe any further instability may be put down to the trochlea dysplasia instead of seeing if the lateral release is the problem as a trochleoplasty was talked about at one stage. My knee has given way a few time but i think that is because of the weak quad muscles. So i guess we'll have to see..

Also how did everyone fine getting ROM back. I know I am only about 7 weeks since the TTT but i cant seem to get my ROM past 90.

Thanks for all your replies, they are much appreciated

Rebeccca

[lisa424]

I think when you have Trochlear dysplasia you want the ligaments tighter so the patella stays in the shallow groove. That said, I don't know how bad yours is or if the lateral release will end up hurting you.

Is your knee subluxing? (when you say it gave way) If it is, in what direction does it go out? At this point it's too soon to tell. If you still have problems after you build up your quads then there could be something wrong. I wouldn't worry yet.

As far as your ROM, have you been on a stationary bike at all? It really seemed to help me.

[spilsey]

i'm not really sure, i dont think so though because it doesnt feel like before when the knee cap felt like it was going to dislocate. As my quads are getting stronger though it seems to be fine. I think its just weakness. I was really surprised at how weak my quads got, my actual leg looked so tiny compared to the other one.

I havent tried a stationary bike yet because i'm not supposed to be doing anything too strenuous as the bone hasnt knitted yet. But i am looking to buy one. What kind do you think would be good? Or is just a basic one fine?

Thankyou for all your replies

[clare hegg]

How are you doing now Rebecca?  You haven't posted in a few months just checking up.

[spilsey]

Hi Everyone

I've just been really busy with school and stuff but we are on holidays now for Easter so I've been able to get on. My RK is going well.. i'm still doing quite simple PT because my VMO are still weak. I dislocated my LK (not the operated one) last week on holiday so thats been a bit of a set back but apart from that everything is going well. The bone still hasnt knitted but there is progress and my OS says that it can take a while so i'm still being a bit careful.

Thanks for checking up

Rebecca

[captainruss]

Spilsey,

You should definitely call him/her and/or visit them and ask any/all questions you have.

You should also take your patella and move it left and right.  If it moves half its length to the left or right, you might have a problem.  I am not a doctor, but going thru this with my daughter.

Never be shy about asking questions.  If you don't get answers or feel uncomfortable, you need to get more opinions. 

Keep us informed what your OS says next.

Russ

[spilsey]

Hi Russ,

My OS told me that to get the patella to sit in the right position he needed to perform the LR as bringing it down wasnt enough to make it sit in the groove (even though mines not really there). My physio has told me that i really need to strengthen my VMO in both my knees as the other muscle is just pulling it out laterally.

So far everything's going well for the knee that was operated on, apart from the fact it gets sore if i leave it bent for too long.

Thanks for your concern and I hope everything is ok with you

Rebecca

[RLE]

Take everything with a grain of salt. It's a good reminder/reality check to remember that many of the frequent posters are those with chronic problems, failures and ill advised surgeries. I won't take anything away from their experiences, but it definitely doesn't mean you will have a failed surgery. If you are concerned, you could discuss with your OS. 

Overall, don't worry until you have a reason to worry. Be patient and work on your rehab... at five weeks, how are you doing?

I had a Lateral Lengthening (version of a LR) in combo with my MPFLr. I was skeptical, and have some hypermobility as well. As my knee is feeling better, I'm glad I let my OS perform this portion of the surgery as I can see the benefits.

I asked 3 physical therapists about LR, my first PT said "sometimes it works." My next one said it doesn't work especially if your quads are weak and the guy who works with her who isn't my PT said it doesn't work but sometimes it's ok for a few years then it doesn't work. He said the few years of mobility are not worth the end result down the line. I did my own research and everything I read said it was a controversial surgery but PF techniques have not kept pace with other knee improvements in surgical techniques and technology for some reason so that's all doctors know what to do. If LR don't fail immediatey they often fail several years down the line which is why people seek out this group for support. I've spent the last 8 months daily researching this topic and it's scary. Unless you have the very rare patella tilt and true tightness it's not indicated.

[allyd]

A LR is more often indicated in a combo procedure, (i.e. w/ TTT, MPFL, etc) as in the discussion in this thread – not to say the Doctor’s always get these indications right.

LER - An isolated LR is what is rarely indicated as most often it simply fails to address the real problem, supported by your research and comments by your PT’s. So w/ isolated LR, patients are often left with a knee that hasn’t gotten better, still dislocates, etc., in more rare cases it causes more problems than you started with.

[RLE]

A LR is more often indicated in a combo procedure, (i.e. w/ TTT, MPFL, etc) as in the discussion in this thread – not to say the Doctor’s always get these indications right.

LER - An isolated LR is what is rarely indicated as most often it simply fails to address the real problem, supported by your research and comments by your PT’s. So w/ isolated LR, patients are often left with a knee that hasn’t gotten better, still dislocates, etc., in more rare cases it causes more problems than you started with.

Everything I've read and from discussions with my PTs these were not done in isolation, they were all done along with other procedures. Before I knew absolutely anything about any of this (and I don't claim to have much other than anecdotal evidence) my intuition told me not to let the first surgeon do a LR along with the other procedures he wanted to do. I started doing research and was appalled at patients' experiences so that's when I started (to the best of my ability) reading less biased studies and asking around including my therapists. It is not considered an effective procedure. And it's very difficult to reverse.

The interesting thing is that the top PF specialists in the country like Teitge don't do lateral releases all which tells me what I need to know which is that most doctors simply lack the knowledge to treat these problems. And having dealt with rheumatologists, infectious disease specialists, endocrinologists, pulmonologists and less exotic doctors such as gynecologists and dermatologists I must say that as a group OS are the bottom of the barrel. I truly have never seen such arrogance coupled with such a proud lack of knowledge even among the "best." If I wrote some of what I've been told by some of the "top" OS in Los Angeles here you'd seriously accuse me of lying. Other than the shock of my accident I have tell you that each time I see an OS I'm in shock at the things they tell me. If you ever want to hear them I'll be glad to post them. This also tells me that when dealing with one you need the absolute best you can find.
For the OP, there are people whose LR work forever and those whose LR last for years so I'm hopeful you'll be one of them. If you are please return and post a success story.

[allyd]

There is a time and place for everything - sometimes doctor's get the indicators right, and sometimes they don't. I stand by a LR more often indicated in combination than isolated. Many PF specialists will still perform when indicated and necessary. I've also heard Tietge doesn't, but many others do. But that doesn't mean they don't understand or have a disregard for the Lateral restraints. I simply think it's important not to scare the OP with doom and gloom stories. It is often more likely things will be fine, than not - especially when the procedure has already been performed, and she has reported good results thus far.

LER - Given your history with docs, I completely get your distrust and am sorry to hear about. Luckily, I've had good experiences w/ my OS(s). My thoughts are all based on my research, experience, OS advice, my individual knee, and what simply makes sense to me. When we educate ourselves, there should be right or wrong amongst us - We all have our own opinions, because we have different knees, different problems and ultimately different comfort/trust levels with our OS. When the specialists have different opinions, it shouldn't be too suprising to find different ones among patients.

[captainruss]

I  have had two OS completely disagree on LR and they are in the same practice 15 feet from each other.  My understanding is if you do not repair the underlying problem, straitening the leg bone so that the leg bone grows straigiht ane knee works better.  Stp one comleted.  I am getting her CT scans wednesday tomorrow to give the OS a clear picture of what is going on.

I always believed a LR loosens the knee cap when the female has a shallow groove and consistent pain, which she does. 

Russ

[lululocket]

Like everyone says, ask your OS.
But don't panic - my OS did a TTT and said that he would HAVE to do a LR at the same time because he was moving the tibial tubercle so far medially that it wouldn't reach its new position unless he did the LR. So the LR did loosen the lateral side, but then the kneecap was moved so far that it became taut again.

[spilsey]

Hi Everyone

Thanks for all the comments and opinions and taking the time out to answer my questions.. i really appreciate it.

LER - I understand that many people who have had this procedure done during their op have had problems and to be honest, thats why I asked in the first place. I woke up finding that I had had an LR when i wasnt expecting to have one and after reading on this board for many months before hand it worried me to find out that such a controversial procedure had occurred on my knee. However, so far the stability has been good - pain is still worse but i'm sure thats to be expected since it was only a few months ago when I had the op and things are still healing etc. I dont know if it will fail in the future, like you said, but I'm going to hope that it doesnt. Otherwise its going to be a depressing recovery haha

allyd- I agree with you that LR's have a time and place, otherwise why would they have been done in the first place? I hope that my op isnt doomed because of the LR

Lululocket - From what i've heard my situation was kind of similar - they couldnt get it in the correct position with out the LR What were your results?? Where you happy??

Thanks again,

Rebecca