The patello-femoral joint :

Why do some say???? - - Posted by Linds (Linds), 12 September 2002

So I wonder after Rhea's latest appointment Folks, why some OS's say that a LR is obsolete where as other's still use them. Like are the ones who say they are obsolete on the cutting edge of orthopeadic medicine or is it just another medical view I wonder... My OS still uses LR, obviously because I had one.  And it seems to have done an okay job.  I mean I am not cured but I feel better than I did before surgery...I think!   I just don't understand why the attitudes vary so much. And with in one country too...Rhea's OS and mine are only a few thousand kilometers apart...not like countries or oceans or anything. Ohwell... I guess this almost builds on the why do LR have that reputation question but it confuses me.
Take care everyone...and rhea...you go girl!
Linds  
Posted by Iona_-Uk (Iona_-Uk), 12 September 2002

Hi Linds

I saw my OS this morning and he said to me that LR's are going out of favour over in the UK at the moment, most OS's would prefer not to have to do them, but still practice them regardless.

He suggested in a few years that the LR would be obsolete and replaced by other techniques.

Despite that he has put me down for my fourth!

Iona
Posted by Stacey (Stacey), 12 September 2002

I read this in a book that everyone was tlakign about on here (What your doctor doesnt tell you aobut knee pain an dsurgery).  They used to be very effective until new technology came into play.  With this new technology (arthoscopic surgery) the quality of LR's decreased as doctors tried to get more done.  The book also explained that there are many many ways in which a LR can be performed which also leads to a reputation.  It was an interesting section in the book.  Hope this helps I realize its kind of vague.
Posted by Linds (Linds), 12 September 2002

Thanks Iona and Stacey for your feedback, on my question. IT just disturbs me that some doctors are using it and some are not.  I guess though that it is just a matter of having faith in your surgeon and trusting that they will do what's right, for you!     Goodluck on your fourth LR Iona...wow I can't imagine how you do it...one was enough to put me out for a good few months...and I am still trying to recover now.
Take care guys, thanks for your feedback.
Linds
Posted by opal (opal), 12 September 2002

Hi there.  I'll add my 2 cents worth.  My OS (Massachusetts) talked about LR for me and said in the next sentence, that he just didn't know if it would work.  I couldn't seem to get him to explain WHY he felt that way, but I got the impression from his conversation that he felt it was such a JUMP from arthroscopy to TTT, and he wanted me to have an option.

From what I have read here, LR just doesn't seem to have a particularly high success rate.  Anyway, I'm glad I didn't opt for LR; I really wanted to get this knee thing behind me as soon as I could and I might have hung myself if after another 3-4 months, I was still in the same place as before.

BUT I'M NOT!!!  As I posted in Rehab., I had my 4 mo. post TTT check and OS is TRILLED with my progress and after next week, I'm done with PT.  

I hope that everyone's surgeries are as successful as mine.  It was well worth the time and effort!

My best,

Opal
Posted by Linds (Linds), 12 September 2002

thanks for that opal, I konw that that is some surgeons opinions. But I just wondered why some...like Rhea's surgeon...gave her a look like was she crazy...or had three heads.
Take care
Linds
Posted by Helen (Helen), 12 September 2002

I just had to join in with this one, because I have had both..an LR and a realignment...at once. From what I have read, the TTT or realignment procedure is becoming more popular because the success rate is better than with the LR. This seems to be because the LR has the potential to create greater problems due to scar tissue building up and healing the cut ligaments even tighter that before surgery. Therefore the problem returns and is often worse than before. I know a couple of people on the forum have experienced this.  I think the reason that the LR is still practised is that the TTT is such a brutal procedure involving the breaking of bones etc, that many OS's want to try the 'easy' route first.

I had both because the LR wouldnt have been enough to correct my problem on its own and the TTT would have failed without the LR.

Just my thoughts.
Helen
Posted by Iona_-Uk (Iona_-Uk), 12 September 2002

I remebered when I was put down for my first LR about 4 years ago, I asked the surgeon would it fail and the reply was "No, it is unlikely in any way this will fail"....hmm,think he was wrong there.

After my second LR I had haemarthorosis, a bleed into the joint, and I had to have a second surgery to wash it out and clean it all up inside. The surgeon who did this was an OS specilising in hand and arm surgery, he told my mother that in his opinion, LR's were a form of uneccesary surgery especially in younger patients, they nearly always failed, caused a hell of a lot of pain and nearly always resulted in further surgery being needed. My mum told him he was being stupid and to leave it to the knee OS.

How right he was.

I think also, if you have a good, frankk, OS then it the choice may be wider, my first was like "I am GOD of the knee, I know what is best" and my second is more like" Well, we can do this, this and this, but then this, might happen but on the other hand the benefits are... and the alternative is....", which is great.

I am hoping that in a few years LRs will be phased of out commonplace surgery, they are unpleasant and do fail, in my case 2 of 3 have failed, which isn't  a great ratio, but then again  and even worse type of surgey could replace it...............

Iona
Posted by tazmanian_devil (tazmanian_devil), 12 September 2002

My understanding is a LR helps if the patella is tilted and looks like the Eifle (sp?) tower. But it won't help with subluxing or dislocating at all and you need a TTT for that.
Posted by Linds (Linds), 12 September 2002

Now there is a thought that I can agree with. The tilting thing. It scares me though...because my right patella did tilt and that was the problem you could see it in the Scope video the OS did before he performed the LR. That scares me because my left patella doesnt' tilt, it subluxes and slides right out onto the edge of the femur! Ohwell...thanks to all of you for your feedback...I just don't understand how there are so many different opinions, trying to understand.
Take care
Linds  
Posted by hmaxwell (Heather M.), 12 September 2002

I have a couple of thoughts on the subject--but keep in mind that I am one year post-LR and worse off than when I started.

Anyway, in my case, the damage to the articular cartilage on the back of my kneecap and on the condyles was so severe (grade IV chondromalacia) that even cleaning it up and correcting the patella position wasn't enough--I still had pain from the ruined stuff.  That damage causes swelling and pain, hence dissatisifaction with results of the surgery.

Second, the lateral release is done to varying degrees and the results can be later 'undone' if the body heals up the incision with scar tissue.  Or, as in my case, heals the incision and then some with tons of scar tissue.

Third, the ONLY good thing I can say about the lateral release is that I have not dislocated or subluxed my knee one single time since I had it.  That's got to count for something, as I remind myself daily.  Of course, my kneecap is so scarred down it doesn't move AT ALL, so I guess it's not a surprise that it no longer pops out of place....

Finally, my doctor says he really doesn't perform that many lateral releases, and only then for the right candidate (with what he called 'patellar compression syndrome' which I figure is a fancy way of saying poorly tracking kneecaps).  He said he would NEVER do one on a teenager.  Like many others, he believes that a TTT is sometimes too extreme when there is a chance that another surgery (the LR) will work.  It's basically a conservative approach, especially since a TTT is a way to guarantee arthritis in the distant future by overloading the knee surgically.  For some people, who already have athritis or are on their way in one compartment, the TTT is a good tradeoff.  But it is a tradeoff, and he said he'd prefer to see if an LR works first.  He also said that once LR's started being done arthroscopically and were suddenly 'easy,' the surgery was over-performed for people who weren't good candidates.  It seems like the belief is that perhaps if LR were still an open surgery, a lot less of them would be done.

At this point, I can't even say if my LR had failed or not--it did correct my tracking, but the complications from scarring have been worse to deal with in many ways than the original problem.  I do know I couldn't have continued like I was, but am unsure what options I have for the future.  It seems that a lot of my current mechanical problems are being caused by scarring, and no one is sure if a TTT would help.

Heather

This old Forum was so valuable that we have kept it as an archive. It is just for reference. If you want to ask questions or offer advice, there is also a current Bulletin Board which you can access from our home page.

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