Advertisement - Hide this advert





Author Topic: Trochlear groove microfracture and lateral release  (Read 1518 times)

0 Members and 1 Guest are viewing this topic.

Offline ZGknee

  • MICROgeek (<20 posts)
  • *
  • Posts: 3
  • Liked: 0
Trochlear groove microfracture and lateral release
« on: December 03, 2009, 07:42:29 PM »
I had a medial femoral condyle articular cartilage defect 12 months ago, which was successfully repaired with microfracture.  At the time, the OS said he "cleaned" the medial patella.  Results were good except for a "clunking" feeling in the joint occasionally.  I skied last week without problems but while walking afterwards, felt the usual shift.  Shortly afterwards, a huge effusion developed and on 3T MRI, there is a 5 mm trochlear groove articular cartilage defect.  All ligaments are stable and there is no other injury.

The OS is planning a smaller microfracture on the new site, probably just 1 or 2 holes and says the rehab won't be as intense.  I will be able to weight bear and probably ski again by February.  All that is fine but I am concerned that he says it may be necessary to do a lateral release of the retinaculum.  He says the patella may be tracking laterally and that it caused the defect. 

Is it possible that the patella is tracking off center because plica was cleaned medially.  Is a lateral release a bad idea if there was never pain as in patella femoral syndrome?  I don't want to screw up an otherwise stable joint!  Thanks!

Offline doublemom

  • SuperKNEEgeek
  • *****
  • Posts: 814
  • Liked: 1
    • Andi's Website
Re: Trochlear groove microfracture and lateral release
« Reply #1 on: December 03, 2009, 07:58:00 PM »
Not sure as I've never dealt with microfracture, but I'd definitely be getting a second or even third opinions by knee specialists before going through a lateral release.  Does your surgeon KNOW that the patella is tracking badly, or is it just a possibility?  How has this been diagnosed and what imaging studies have been done to show it?  There are far too many people who have had LR's done by surgeons who really didn't know what the problem was to begin with, and end up with more complications than if things had just been left alone.  A lateral release is done far too frequently by too many surgeons without good justification for it.

If the patella is not lined up correctly, you need to find out exactly WHY it is maltracking in order to know what the correct fix is for it.  A lateral release is not a "magic fix". There are several different things that can cause the patella to misbehave.  You and your surgeon need to figure out exactly what is causing it before knowing how to be able to fix it.

Hope that helps out some... there are definitely a lot of questions that need to be answered before permitting a lateral release. 

Andi
2000 R patella dislocation
2004 - Soccer injury - LK medial and lateral meniscectomies
2007 - Dx patellar tilt, lateral subluxation, grade III chondromalacia
5/13/08 - RK medial/lateral meniscectomies & patellar chondroplasty
4/6/2010 - RK TTT/LR scheduled

Offline ZGknee

  • MICROgeek (<20 posts)
  • *
  • Posts: 3
  • Liked: 0
Re: Trochlear groove microfracture and lateral release
« Reply #2 on: December 03, 2009, 08:34:37 PM »
Thanks, Andi.  I get the feeling  it's in the category of "we'll see when we get inside" and I'm not sure I'm comfortable with that.  A second opinion is good advice.  Has anyone out there seen a lateral release done to prevent future articular cartilage damage?  Also, does anyone have experience with repeated defects in different locations?