KNEEtalk

The WAITING ROOM => GENERAL KNEE QUESTIONS and comments (good for new threads) => Topic started by: emmi on June 30, 2011, 08:53:53 PM

Title: lateral release for recurring dislocations
Post by: emmi on June 30, 2011, 08:53:53 PM
I am new to this site and I've been trying to research the pros and cons of having a lateral release to improve the problems I have experienced with my knees. 

I have had numerous dislocations since the age of eleven and am very limited in what sports and activities I can do.  Recently dislocated my right knee - which was my stronger knee, so decided to try to get something solved.

I have seen a physio and a consultant and am booked in to have a lateral release on my left knee to establish whether this is going to help.  I will have the other knee done if it improves, and if it doesn't then the suggestion is to have realignment surgery.

I have seen a lot of posts and messages from people who have had bad experiences with lateral release.  I've also read that this surgery is not recommended for people who only have problems with dislocations.  At the moment I am not sure what is the best thing to do.

I have tried various physiotherapy and exercise as much as I can - I regularly go spinning, and do resistance training so i really don't want to find that I cannot do this after having the surgery.  I would like to know whether anyone has found much improvement after this surgery.

Thanks
Title: Re: lateral release for recurring dislocations
Post by: Lottiefox on June 30, 2011, 10:11:23 PM
PLEASE be wary!! Smilie - where are you?!Crankerchick....please advise!  Lateral releases can create more instability if done for the wrong reason. They can make an unstable knee more unstable and they are extremely hard to try and correct.

Can I ask what tests/scans/X-rays and investigations have been done to look at why you dislocate? A lateral release is a quick catch all fix that in isolation is only recommended for lateral patella tilt and no instability. I know, I have tilt and no instability but I still put off having it done. There are MANY reasons why you may be dislocating - you need a proper set of investigations. Doing a lateral release to see if it helps, then if it doesn't doing re-alignment seems completely pointless to me. A proper patella specialist will tell you if it will help, not gamble with your knee health and put you through numerous surgeries.

Where in the world are you based? Are you seeing a patella specialist?

I'm not trying to scare you but please make sure you've had ALL the necessary investigations done first.  :-\

Take care,

Lottie  :)
Title: Re: lateral release for recurring dislocations
Post by: emmi on July 01, 2011, 12:58:29 PM
Thank you Lottie for your reply.

I am in the UK and I'm 37 so I have been back and forth to various consultants but not for a while.  This time the consultant said that as I had not found much improvement with physio the next option was surgery.  I had both knees x-rayed but I cannot say whether he mentioned to me about the tilt or not because I wasn't aware of it at the time.  I do know that he said the length of the tendon attaching below my knee was long.  He also said that my kneecaps are very mobile - and this has been said many times.

I haven't seen a patella specialist but I don't know if they exist here - I've never even heard of that until I looked at this site. 

I am very unsure about having this surgery I have to say because I am worried that I may end up with a worse situation.  But I'm not sure what do from here.

I'll look into patella specialists but I doubt if there is such a thing on the NHS and I don't have private health insurance - not many people do in the UK.

Thanks again

Emmi
Title: Re: lateral release for recurring dislocations
Post by: TwoBadKneesUSA on July 01, 2011, 01:38:02 PM
If the kneecap has been called mobile, I would think the last thing should be a LR.  This will make an already unstable patella unstable even more so.  I would get more options from a different consultant.
Title: Re: lateral release for recurring dislocations
Post by: Lottiefox on July 01, 2011, 03:10:26 PM
Agreed with Milly - if your kneecaps are mobile (and possibly your joints?!) then creating more mobility through a LR could be disastrous.

Before deciding you should have X-rays of full standing leg (to look at rotational issues), sunrise and merchant shots of the kneecap to show tilt and height. In addition a proper knee surgeon should do a CT scan of the kneecap tracking through various ranges of motion to look at whether there is tilt, tilt and shift (the kneecap jumps the groove but pops back again) and things like how far your tendon attachment is in relation to your kneecap and leg bones.

I hate to say it, but a surgeon will often suggest surgery if PT isn't working. It is their job after all. Then they see patella issues and suggest a LR. I can honestly say I have not read of anyone on here with dislocations that has been helped by an isolated LR. Some have been made worse, some have just not improved.

There is a brilliant patella specialist in Norfolk who does NHS work. I can PM you details. There are also other more patella friendly docs out there and under the NHS you can ask to see one, but you may need to battle a bit. They can't refuse you seeking a second opinion though with someone of your choice.

I did PT for many many months before things improved. I am SO glad I didn't rush into a LR. But I don't have instability and I can appreciate that dislocations are both painful and potentially create more damage.

Good luck with your search, I would certainly take your time....

Lottie
Title: Re: lateral release for recurring dislocations
Post by: emmi on July 02, 2011, 07:30:03 PM
thank you all for giving me your opinions

as a result I am going to book a consultation with a knee specialist at  the london Knee Clinic.  I think I can get an appointment pretty quickly so this wont effect my operation at the moment.  I've asked the hospital to get my x-rays put on to disc so that I can take that with me which may speed up a second diagnosis.

If I decide after the next consultation not to go ahead then I would like to know about the patella specialist in Norfolf if possible.

I will keep you posted.

thanks again, this has been a really helpful discussion as I didn't really know what to do even though I had a gut feeling the lateral release wasn't the right surgery for me.

Emma
Title: Re: lateral release for recurring dislocations
Post by: Lottiefox on July 02, 2011, 10:37:32 PM
I have seen Mr Glyn Evans at the London Knee Clinic - he does my Euflexxa injections. He is very experienced. Try and collate as much information as you can prior to the appointment about your knee and about patella surgeries in general. He usually is happy to spend an hour with you and to answer questions. I found him the most down to earth of all of the surgeons I saw and welcomes questions. This is YOUR chance to ask what you need to.

Trust your gut. It saved me from similar mistakes. When you have surgery make sure it is the right one, and your gut will probably tell you when it is. We know our bodies better than anyone.

Let us know how it goes,

Lottie (aka another Emma - PM if you want more details on Mr Evans if that is who you are seeing)
Title: Re: lateral release for recurring dislocations
Post by: emmi on July 06, 2011, 03:27:36 PM
Hi Lottie

Yes I am seeing Glyn Evans tomorrow - he has suggested I have an MRI scan but I can't afford it because I don't have private insurance but he will look at my recent x-rays.

I'm not sure what PM means - am I being very dim!?

I'll let you know how it goes.

Emma
Title: Re: lateral release for recurring dislocations
Post by: emmi on July 14, 2011, 01:54:43 PM
Hi

Just an update really.

I went to see a knee specialist in London for a second opinion who said that a lateral release probably would not help my situation and that the realignment surgery would be the best option.

However, he also suggested that I do not have any surgery before having my feet looked at by a specialist as he thinks this is what's causing the patella to squint outwards.  I have known for a long time that I my feet are not normal but thought that it was due to a lot of ballet when I was young.  It seems that I was probably born with feet deformaties that were not noticed until much later on.

So the saga continues.

Does anyone else have knee instability problems due to feet deformaties?  Apparently I have mild club feet with very high arches.

Thanks

Emmi
Title: Re: lateral release for recurring dislocations
Post by: Hooligan on July 14, 2011, 10:14:04 PM
Hi there -

I just wanted to put my two cents in.

As someone who also suffered reoccurring subluxations, I want to strongly encourage you to find out the root cause. Primarily, you need a surgeon who can tell you if you have patella alta and the typically corresponding trochlear dysplasia - the two go hand in hand. An x-ray will show the shape of your trochlear groove, and a simple measurement with a tape measure will tell you if you have high riding kneecaps. This condition is often what makes knees look knobby, and your kneecaps to look like they are off to the side. Some people also have tibial torsion, which compounds the problem. Bad knees often cause weak glutes...which then contribute to internal rotation of the femur and heel pronation (maybe this is why your feet look strange?)....all of which further make your knees unstable. It's a vicious cycle.

However, as my surgeon told me, "It's a stupid problem, that's easily fixed." A tibial tubercle transfer is the definitive corrective surgery for this condition - not a lateral release. I had a TTT done last year - its been a rough recovery, but life changing nonetheless. My only regret is that I wasn't able to have the surgery sooner before the knee instability took over my life.

There are lots of reasons why kneecaps are unstable and patella alta is just one - but it's important to know if you have it.

Good luck!
Hooligan
Title: Re: lateral release for recurring dislocations
Post by: Hooligan on July 14, 2011, 10:18:48 PM
Just one other thing - I reread in your posts that your patellar tendon is long. That is possibly a sign of patella alta. My tendon was almost twice as long as it should have been. This long tendon makes the kneecap sits above the trochlear groove  - making the kneecap appear loose when really, it's just sitting above its rightful home! When I had my TTT done last year, the surgeon moved my kneecap down two centimetres.
Anyway, just thought I'd point that out!

Hooligan
Title: Re: lateral release for recurring dislocations
Post by: smillie on July 15, 2011, 12:21:48 AM
PLEASE be wary!! Smilie - where are you?!Crankerchick....please advise!  Lateral releases can create more instability if done for the wrong reason. They can make an unstable knee more unstable and they are extremely hard to try and correct.

Sorry, I just saw this!

Emma, a lateral release can make your patella even more unstable. I didn't even have an isolated LR. Mine was in combination with a TTT and medial tightening. It caused my patella to sublux medially and I couldn't ride a bike any more (you mentioned that was important) or a whole bunch of other things. I've had a LPFL reconstruction now to un-do the effects of the LR and I can now ride the bike again. But the years between the LR and the reconstruction were filled with pain, instability and a lot of frustration. I'm glad you're seeking further opinions.

Title: Re: lateral release for recurring dislocations
Post by: kaci74 on July 15, 2011, 01:16:14 AM
Hi Emmi.

I think you've had some great responses already, but I will tell you about my lateral release and subsequent TTT to give you another perspective.

I am currently 36 and overweight which causes tremendous strain on my knees.  I had issues with my knees starting in elementary school and never quite grew out of the "growing pains."  My patellas ride high and I have tight muscles.  After spending 6 months in physical therapy I had my first lateral release.  I had an easy recovery with minimal PT after the surgery.  Things were well as long as I kept up with the exercises.  As soon as I changed  to a sedentary job my knee pain came back.  I went to a patella-femoral specialist and started working with another physical therapist.  I had orthotics made for me which helped, but never quite got rid of the pain.  After working with the PT and the surgeon, I had the TTT another poster mentioned.  That was almost 3 years ago.  I have a lot of atrophy which I'm trying to overcome now.  It's painful trying to build muscle back while maintaining the proper balance.  I had the hardware removed almost 2 years ago which helped, but I still have days where I am in considerable pain (weather changes or exercising the leg too much).

So, the advice to collect as much data as possible is very important, as well as understanding the mechanics of your own knee.  Had I known that my patella rides high I may not have opted for the first lateral release.  It did it's job, but I think I was told it would not be a fix.  There is a long recovery with the TTT, be cautious with that.

Ask as many question as you can think of.  This board has helped me tremendously while making decisions, but the best advice is to learn as much and trust your instincts.

Best of luck,
Kaci
Title: Re: lateral release for recurring dislocations
Post by: emmi on July 21, 2011, 12:14:50 PM
Thank you all very much

I had obtained far more information from this board then from the consultants.  That isn't a criticism of the consultants I've seen as I am confident they are very experienced but you only get a short time with them and it's so difficult to absorb everything.

I have gleened that I have patella alta in both knees and my patellas ride high but the trochlea groove is deep enough.  The second consultant (who I paid to see for a second opinion) suggested a TTT bringing the patella down 1.5cm but thought I should see a foot surgeon first as he thought I have mild equinovarus deformaties (club foot).

I have seen the original consultant again and explained my concerns but he still thinks that the lateral release should be the first option, although he has referred me to see a foot and knee specialist who can offer another opinion and comment on whether my feet should be operated on before knee surgery. In the meantime I have postponed the lateral release op.

I am slowly coming to the conclusion that the TTT is probably my best option for any kind of improvement but I do need a bit of time to get my head around it as it sounds like a long and painful recovery from looking at all of your comments.

Thanks again

Emmi

Title: Re: lateral release for recurring dislocations
Post by: Hooligan on July 21, 2011, 06:32:10 PM
Hi Emma,

I know getting the news of possibly needing major (or any) surgery is disheartening. But don't despair! A lot of us come on to this board because we need to complain or express our worry sometimes. We don't always write about the good things. Yes, my knee super ticks me off and my muscles are not happy yet with moving normally. But yesterday I did a very hard work out (40 squats, tonnes of one legged bridging, x-band walking, planking, pushups...to name a few) and it really didn't bother me. I know a guy who had TTTs on both knees done and he plays hockey now. There are crazy, wonderful outcomes to knee surgeries.

In my life, I've probably seen 8 or 9 orthopaedic surgeons. None ever gave me a viable surgical option to correct the subluxations.

As a result, I went down the road of having a partial lateral release 2 and half years ago. For me personally, it didn't work and it made me even more nervous on my knee. My current surgeon tells me most of his TTT patients have a failed lateral release before they even get to him. My current surgeon looked at my knee and told me I had patella alta. I told him I'd always been told I have shallow grooves. He explained that patella alta and shallow grooves go together. Your kneecap and the groove are live a ball and socket - the kneecap has to be sitting in the right place when you are developing for the groove to form properly. Make sense? But he said that in most cases even the shallow groove is usually deep enough to help hold your kneecap in place. They just have to move it down there surgically - in my case a whopping 2 cm! And the condition is typically bilateral, meaning it's in both knees. The TTT is my surgeon's thing. As he said to me, "It's a really knee stupid problem that causes a lot of awful problems for people....and you don't have to live like this."

No one can tell you what to do, but gather as much information as you can and find the best surgeon you can. For example, the doctor that suggested the TTT - ask him how often he's done the surgery. Ask him for outcomes. Ask to meet patients face-to-face who have had the surgery. My surgeon, for example, has written many publications as well and he wanted me to read them. My physiotherapist found someone who had had the surgery for me to talk to.

On a final note, yes the rehab is not fun. The pain passes. But the surgery is just the first step. Don't have the surgery if you aren't willing to do the rehab afterwards. You've got to really bust your butt (literally!!) afterwards building strength, otherwise the surgery will be a waste of time. Someone gave me that advice before the surgery and it has held very true.

Hooligan
Title: Re: lateral release for recurring dislocations
Post by: emmi on July 22, 2011, 12:21:36 PM
Thanks for that Hooligan

So I have bilateral petella alta then, and surgery will take a long time to recover from as it will take twice the amount of time.

But the thought of being able to do a wider range of activities is what will keep me going I think.  Currently I do a lot of spinning but have reduced the bodypump classes as lunges and squats are pretty difficult.  I'm hoping that one day I will be able to regain my ability to do this and I would love to be able to run.........just a little bit!

Yes, I will have to start saving some money now to pay for plenty of physio. 

Thanks for the advice, I will ask how many times the surgeon has performed this op - he did say that he likes doing the TTT as it has always had a good result - but he still thinks the LR should be done first! 

Emmi