NOTES - Surgical Procedures :

Lateral Release Surgery - - Posted by smelton5 (smelton5), 11 September 2004

Hello all!  I have suffered from dislocating patellas since I was six.  Now that I am 20 the pain in my knee is dibilitating sometimes.  I feel like my grandma can do more than me! My OS recommended that I have an arthroscopic lateral release and medial tightning.  I was just wondering from those of you out there who have had this procedure done what it was like.  Was it done on a outpatient basis or did you stay in the hospital? Did you have a drain?  Big scars?  How long before you were in PT and how long did you continue going to PT?  Was it really painful (more painful than dislocations? ?  Thanks all for your help!!
Posted by Helena (Helena KTF), 11 September 2004

Hey!!

I have had a lateral release + chondroplasty via arthroscopy which wasn't very painfull and I have had a lateral release and medial reefing combined with a TTT (open realignment) which is major open knee surgery and that wasn't fun HOWEVER I never had unbearable pains and rehabbed very nice and quick. With both my surgeries I stayed overnight in the hospital but a lot of people have these done outpatient. We are running a bit behind the US/UK but we're coming!!

You can find lots of info on both procedures in the patellofemoral section. You'll get lots of responses over there! And I hope the dislocations will stop soon! My R knee starts to sublux really bad sometimes so i might be in for some more work sooner than I thought! We'll see, I am not jumping into anything BUT I will have treatment sooner the 2nd time around! (Had problems with my L knee since I was 14 and as I didn't grow out of it only had treatment age 23 after I finally changed OS ).

Good luck and Welcome!!
Posted by smelton5 (smelton5), 11 September 2004

Thanks so much for your quick response!  I feel a little bit better since you said that the lateral release wasn't so painful!  I hope your knee gets better soon!  Thanks!
Posted by smelton5 (smelton5), 18 September 2004

I have a few more questions if anybody can help me.  My knees are really hurting me (especially my left) and obviously when they dislocate (now my L on a weekly basis)  it hurts REALLY bad.  I can't do alot of things that 6 months ago I could do, like run.  My concern is I don't want to have surgery unless I really need it, or if it is going to make my condition worse.  But then again, if I wait longer is it going to get worse?  Aghh!  Not only do my kneecaps mal-tracking and dislocating, my patella groves are really shallow.  Has anyone heard of a procedure to may them deeper?  I have been to 2 OS's in phx. and I still have 2 more appts. next week.  Both OS's said a lateral release would be beneficial to me and one wanted to do medial reefing too.  Is surgery worth it to fix the pain?  Any insight or personal experiences would be wonderful!  Thanks and sending get better vibes to all you KG's!
Posted by anasta5ia (anasta5ia), 19 September 2004

There is a procedure that can be done to deepen the trochlea, well actually it doesn't deepen it but raises up the walls of it.  It is called a trochleoplasty.

There are very, very few surgeons that will perform this surgery.  There is a very high risk of failure due to the grafts not taking and the patient ending up with severe bone necrosis.  Once the necrosis sets in and stuff goes wrong, you are pretty much in MAJOR trouble.

I am in the same boat as you as far as having VERY shallow grooves.  My OS said ABSOLUTELY not for this surgery and went over a lot of literature with me.  He has done some cases of this at USC because of them having such an extensive research program and the body just does not like this surgery.  They have used many different techniques and materials and they always have the same result.......at 75% failure rate.


Even with everything I have been through with my dislocations and stuff, there are two things that my OS says are not options for me........a trochleoplasty and a patellectomy.  He would rather try to develop a procedure for me using wires to tether my patella in place than to put me through either of these procedures.


If you end up with a surgeon that suggests this procedure, I would run away as fast as you possibly can (well, I guess it would be more appropriate to limp away) and get another opinion.  You are much better off with having a TTT and possibly a TTA with a combination of the soft tissue procedures like a MPFL repair or reconstruction if needed or medial reefing or a VMO advancement.

Also, keep in mind......Thankfully, most people don't need additional work done after a TTT, but if you do, you can always get a revision of the TTT (or two or three revisions if needed as I well know since my body really doesn't like to cooperate).  You can't get that with a trochleoplasty.

Please, if you have any questions about the realignment procedures, don't hesitate to ask me.....I have had personal experience with most of them and would be very happy to share with you what I have learned.

Hugs-
Heather G.
Posted by smelton5 (smelton5), 19 September 2004

Thanks Heather!! You always give me such good advice.  I am seeing 3 OS's in the next 2 weeks for opinions.  So I am sure I will have more questions to pick your brain with!  Thanks again for all of your help!  It is nice to know I am not alone.  

Stacy
Posted by RGrelsamer (RGrelsamer), 2 October 2004

You're not likely to find agreement among orthopedists. But everyone would agree that a trochleoplasty of any kind is not the first operation to be recommended.
A lateral release is simplest but chances are the kneecap will dislocate again at some point. Cinching up the medial side helps somewhat and reconstructing the medial pf ligament probably helps most - but adds complexity to the procedure. The latter is a relatively new procedure.
Good luck!
Posted by smelton5 (smelton5), 4 October 2004

Thanks Dr. Grelsamer.  I have deceided to not do a lateral release.  I found a Dr. in phx. that treats a lot of patients with mal-tracking and dislocating patellas.  He told me that a LR probably would just make things worse because I have hypermobility and it would just make my knee looser.  He told me that my VMO was probably really stretched out and that he wanted to go in and tighten it.  So, I have surgery scheduled for 01/10/05, but I am still in PT and seeking other opinions.  Thanks for your help Dr. Grelsamer.  I have been trying to google the procedure about reconstructing the medial pf ligament.
Stacy
Posted by Kris (Kris), 11 October 2004

I've never had the dislocations of the kneecap, but I do have maltracking issues in both knees.  It had come to the point where the only question my doctor asked me was, "which one first".  I had the right knee done.  I'm not sure why I choose it.  It was the weakest of the two so I guess I thought if the LR failed, my left leg could still handle the burden of carrying the weight until I got some strength back into it.  All three of my LR's were done on an outpatient basis.  I was in and out of the surgical center within 3 to 4 hours.  My left one, I'd consider a success, although it's not perfect.  My right one is a failure for both times I had it done.  Foolish me because I've decided to go in again 11/5.  I'm not sure whether my OS is just cleaning it out or whether or not he really is going to LR this one again.  I arranged all the surgery over the phone and only was given messages from doctor through his nurse.  I go in for pre-op on 25th so I guess that is when I'll find out.  I'm also going in on the 25th for a consultation about having a Maquet procedure done in the summer.  Not sure if that will happen or not, but we'll see.  I never did regret my decision of having 2 LR's on my right knee.  It did feel somewhat better for the first 3-4 months, but I was never patient enough for it to heal.  I guess it might be part my fault for pushing it too much.  I'll never know.  Anyway, is hypermobility the same thing as hyper extension of the joint.  I have hyper extension on my right knee (not too bad on the left).  I was put in a protocal (sp) brace that would help with the hyper extension and at the same time help guide my kneecap on the right track.  It looks like the ACL braces from BREG, but it also has a patella strap device worked in to help the patella.  BREG has a picture of it on the website.  When I has given it, it was free because it was still a prototype and I had to write down things and talk with guys about it.  You might want to look into it if it sounds like it may help.  It worked pretty good for about awhile, but I don't think it could help all the pain that I have.  I still wear it on really, really bad days.  I hope this is at least some help to you.  

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