NOTES - Surgical Procedures :
Failed LR... Now what? - - Posted by sjugradgirl (sjugradgirl), 6 December 2004
Well, I got my Op report that my OS has been requesting from my old OS from 99. Turns out not only did I have a patellar tendon repair but I also had a lateral release. Well, obviously the LR failed b/c my patella has a mind of its own and just travels north, west, south, and east as much whenever it wants. The clicking, popping, shifting and sticking won't stop. So whats next? TTT? or another LR? What are your thoughts and experiences. I am impatient and waiting for my OS to get back to me.
Posted by vicuae (vicuae), 14 December 2004
I have teh same thing - my OS is going to repair the release - not back to where is was before but enough to hold the patella in place (as well as microfracture surgery to repair cartilage). Then I will do PT to rebalance the knee and restore some of the supportive muscle.
There is a risk that if not done carefully will be too tight again - so needs someone experienced in this procedure. MY OS says that when my op was done 4 years ago it wasn't the wrong thing that they are just learning more about it now.
The other knee has same problem but as no LR done on it I can do PT without need for repair.
Posted by hmaxwell (Heather M.), 14 December 2004
I just posted links to various journal articles dealing with exactly this topic. The language is a bit dense, but it's worthwhile to learn the words and understand the concepts so that you can participate actively in the decisions for your care.
http://www.kneeguru.co.uk/cgi-bin/KNEEtalk/YaBB.pl?board=operations;action=display;num=1103003476
By the way, I'm not sure how you can say so soon that the surgery has failed. Just an observation--I was told it would be 12 months before we could make that assessment. And while I'm worse off than I was before my lateral release, technically it was a success. No joke. My tilt was corrected. But it turns out that wasn't the source of my pain. So there are multiple reasons for a surgery to 'fail' and the answer to the question of 'what do we do now' lies in determining what is going on in the knee now, and why exactly the surgery 'failed.' In my case it was a failure in terms of the outcome because it caused so many complications that are worse than the original problem--so I developed serious scar tissue problems which are at the root of my current pain and lack of function. The approach in my case involves resolving the scar tissue and the problems it left behind.
Other people have their LR's fail because it wasn't enough of a procedure to address their serious mechanical problems--this type of person might go on to a TTT, or perhaps start with a VMO advancement and medial reefing.
Still other people have had bad outcomes from lateral release because it created additional instability in their knees--in this case, a lateral retinaculum reconstruction along with a medial reefing might be the appropriate choice for next steps to fix the problem. Potentially this type of patient would need further work to stabilize the joint--like MPFL reconstruction, in which case you could really say the LR was an inappropriate procedure in the first place...
Very complicated things, these knees are. And finding the source of your pain or problems would be the key to determining the solution. The surgery that I had after a failed LR would do nothing to address your problems unless your procedure failed for the same reasons that mine did. Only a skilled knee specialist could get to the bottom of that!
Heather
Posted by sjugradgirl (sjugradgirl), 14 December 2004
I had my LR done 5 years ago. Not less than 12 months. So I think 5 years is a good time for them to realize that the LR failed. sorry for any misunderstandings with the post.
Posted by hmaxwell (Heather M.), 14 December 2004
Sorry, it was late.
An LR knee that starts having pain years later could be an indication that your articular cartilage problems have progressed beyond the point that your LR could fix.
I would think that intensive physical therapy would be your key for now, to see if you've got a muscle imbalance or soft tissue problems that can be readily resolved, or whether bigger interventions are called for.
I guess the big question would be, can you live with the knee as it is now? That's the big question.
Heather
Updated Thu Apr 29 2010
