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Author Topic: Open lateral release and medial reefing?  (Read 2374 times)

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Offline wsdmskr

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Open lateral release and medial reefing?
« on: July 28, 2006, 06:02:15 AM »
Hey everyone, I'm new to this site and I was hoping that perhaps someone may be able to put my mind to rest.  I have recently dislocated my right patella and have been told that I need a "open lateral release and medial reefing".  I followed up this doctors opinion with a second and he concurred.  My problem is that I have a general distrust of most doctors and this, compounded with the fact that this is a work related injury, makes me worried that my doctor may be eager to do the surgery because he knows the bill is going to be paid by the insurance co.  The questions that I ask are A:  How serious of an operation this is? B:  What does it entail? ( I think it involves "loosening" one ligament and rebuilding a new one on the other side), and C:  How succesfull can this surgery be if I pay my dues in physical therapy afterwards?  I'm 29 years old and an avid athlete who plays baseball, basketball, and soccer quite regularly.  Will I be able to resume my normal active lifestyle and be as competitive as I used to be?  Thank you all for your insight and help. - Mike

Offline Natalie.D

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Re: Open lateral release and medial reefing?
« Reply #1 on: July 28, 2006, 12:29:32 PM »
Mike,

Hi and Welcome. 

There is a lot of controversy over whether or not a lateral release should be done to correct dislocations, in a lot of cases it doesn't work, a LR can be great if you have a patella tilt but if there's no tilt and the patellas are dislocating due to other problems, ie, maltracking, hypermobility etc, then it seems to be 50-50 or less whether it will work, there are people who have had a success with this type of procedure, unfortunately I'm not one of them, I had the LR and medial reefing to correct dislocations but it failed, I think I got nearly a year out of it before I started dislocating again and it wasn't until I had a LR and medial reefing in conjunction with a TTT (tibial tubercle transfer) that my dislocations stopped and this seems to be typical of a lot of folks on these boards.

The LR is not one of the most major operations but still not one to be jumping into lightly, it can go horrendously wrong with the patellas dislocating in the other direction if too much is released - sorry, I don't want to scare you but I have heard of it happening, so it is vitally important to make sure that your OS is a specialist in knee surgery and really knows what he's doing.  Basically they cut along the lateral retinaculum and put strong stitches in the medial side to try to move the kneecap to the centre of the trochlear groove, but as I said, too much or too little and it can fail.  The PT regime is very very strict and you MUST work your butt off otherwise the patellas can scar down very very quickly and you can have some major problems.

Have you dislocated many times or was it just the once?  If its just the once, perhaps you don't need any surgery and can maybe get by with intense PT, bracing and taping?

Hope I haven't scared you, it can work for some people and I'm sure these people will also post to tell you about their experiences.  Whatever you decide, good luck and I hope it all goes well and you can get back to sports very soon.

Natalie.
« Last Edit: July 28, 2006, 12:32:59 PM by Natalie.D »
Dislocations since age 12
Trochlear Dysplasia
Maltracking
Hypermobile
LR/MR-failed
TTT, LR, MR L knee 95-Success
TTT, LR, MR R 02-Success
Screws out
Partial tear ACL
Severe end stage OA
4 Debridements
Partial Meniscectomy
Failed Microfracture
11mm Defect LFC
Bone Spurs, Kissing Lesions

Offline wsdmskr

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Re: Open lateral release and medial reefing?
« Reply #2 on: July 28, 2006, 06:52:51 PM »
Hi Natalie and thank you for your response.  This was the first dislocation of this patella.  I have had multiple (read 3) dislocations of the other knees' patella.  The doctor told me that I was born predisposed to this happening due to my bone structure and ligament development.  Both doctors did mention a tilt and maltracking.  The doctor I saw initially wanted to do bone work as well, which I take to mean a TTT?  The second opinion doctor suggested to wait and see if the LR and medial reefing would work before doing anything to permanetly change the bone structure and that sounds like good advice to me.  The injury happened about 6 months ago and I followed a pretty rigorous therapy routine for another 2 months after that.  Unfortunately the progress made with the therapy did not satisfiy the doctor or myself, which has led to the possibility of the surgery.  Any more advice or stories about peoples personal experience with this type of surgery and their recovery will be greatly appreciated.  Thanks again. - Mike

Offline Natalie.D

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Re: Open lateral release and medial reefing?
« Reply #3 on: July 31, 2006, 09:53:38 AM »
Mike,

If you have a tilt then your chances of success are much greater, I have heard that a lot of people with patella tilts have great success with the LR.  A lot of surgeons, mine included, do prefer to start with LR and see if it works before going onto the bigger procedures, which is logical, obviously it didn't work for me due to all my other problems (trochlear dysplasia, hypermobile etc), I hope it is a success for you.  Good luck.  Let us know how it goes.

Natalie.
Dislocations since age 12
Trochlear Dysplasia
Maltracking
Hypermobile
LR/MR-failed
TTT, LR, MR L knee 95-Success
TTT, LR, MR R 02-Success
Screws out
Partial tear ACL
Severe end stage OA
4 Debridements
Partial Meniscectomy
Failed Microfracture
11mm Defect LFC
Bone Spurs, Kissing Lesions