The patello-femoral joint :

Lateral Release - - Posted by Jez (Jez), 3 March 2004

Hi,
Im due to have a lateral release in a couple of weeks after dislocating my knee  for the fifth time in 14 years. After previous dislocations i have simply waited for the swelling to reduce then, started training again and built up the muscle. Only after the last dislocation, I have no swelling but the knee feels very unstable. The knee now seems to 'click' into position if I put weight on it, or if the knee has been in one position for a period of time i.e. driving.
   Has anyone else had any similar symptoms, and as a result of a lateral release experienced any sucess/ nightmare stories? Any advice would be top as I'm concerned the lateral release will not have any effect!
Posted by Linds (Linds), 7 March 2004

Hi Jez, well I am quite surprised that no one responded to your post re: Lateral Release, but I will  . I had a LR on my right knee 23 monhts ago. I am not going to lie to you, at first it was a bit of  a nightmare, they nicked an artery during the release and I bled somehting awful.  I developed a large hematoma post op that had to be evacuated under anesthesia four days post op. HOWEVER... after a prolonged recovery due to this complication the LR has had the desired affect and corrected my subluxations. I still have pain and there is still alot of cartilage damage etc in the knee, but my knee cap for the most part stays in a farely safe area in the femoral trochlea. I am having another LR , this time on my left knee, that hasn't been touched up until now.   My OS says they do it differently now and use a hot blade when they make the cut so everything get's coterized in the process so there is alot less chance of the bleeding. The other GOOD news is, that my OS has been practicing for over 30 years and I was only the second person he had seen that happen to... so the odds are in your favor.  
The best advice I can give you is to insure your quads are as strong as possible going into the surgery, so rehab isn't too difficult.  Some people have great success with this surgery, some.. not so much.  WE did skyline xrays of both my knees about 5 weeks ago.  The right knee looks, in my OS's opinion to be the best LR result he's seen. my knee is not without it's problems..but ... the kneecap is sitting a little more "pretty" .   The LR is indicated they say when there is excessive Lateral tightness causing subluxation and/or tilt.   I am ... that definition they say Good luck with your surgery, let us know how it goes!  If you have any other questions, I'd be happy to try and help.
Hugs and Hope
Linds
Posted by ATsoccergirl (ATsoccergirl), 7 March 2004

Jez-

Lateral releases can be quite effective if done for the right reason.  The two main indications are a lateral glide or a lateral tilt of the patella.  These can be determined by x-ray studies.  They key is to rule out any structural problems that may be causing the problem.  LR are really only effective for the two conditions listed above when they are caused by a tightened lateral retinaculum.  

The problem with the LR is that it is done way too often and for the wrong reasons.  It is very often used as a "placebo" treatment when nothing else seems to be working.  There is a discussion about this concept in previous posts.   If there is a structural problem present, than simply cutting the retinaculum will not correct anything, and they could be complications.

I am an athletic trainer at a university, and our team physician has a very specific protocal to determine if a LR will be effective.  This includes various measurements such a Q-angle, and measurements taken off the x-rays.  We also do gait analysis, Isokinetic testing, and sometimes use taping to replcate the effects of the LR to allow the athlete to "try it out".  I have yet to see a non-sports related OS do such an extensive screening, but the LR that are done by our team physician are almost always effective.  

In terms of recovery, after the first couple of weeks the rehab is based on retraining the quads and addressing any strenght defiects which may lead to poor tracking.  The surgery may be the easiest part of the recovery since the best results are obtain when the quad has excellent strength and correct timing.  
Posted by Jez (Jez), 8 March 2004

Hi Linds/ Soccergirl,
                             Cheers for the reply and subsequent advice. Looks like it will be a while before i'm back on my bike! I have been training my quads quite heavily recently and my problems have eased slightly. I intend to se my OS before my op date and confirm that he thinks the LR is necessary. Good luck - Jez
Posted by duckstreet (duckstreet), 10 March 2004

Hi,
I am 33 and had LR when I was 18. (I had a dislocating kneecap for 11 years before.)  I will tell you that I never had it done on my other (also dislocating knee) b/c it did not work on the first. I was in great shape physically before surgery. I experienced a very painful recovery and lost a lot of muscle... frustrating since the knee still goes out.  
If yours dislocates to the outside, I have to tell you that what has SAVED me is stretching the IT band.  I went from having one episode per day to less than one per year... I just wish it was zero!  Dr.s usually prescribe exercises that tighten the area while PT's will show you how to stretch it out and make it less vulnerable. If you want to know what stretch I swear by, LMK.

I wish you the best no matter your decision. Good luck!
Take care,
Dee

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