Advertisement - Hide this advert





Author Topic: Lateral Release Surgery  (Read 4275 times)

0 Members and 1 Guest are viewing this topic.

Offline serissagpl

  • MICROgeek (<20 posts)
  • *
  • Posts: 6
  • Liked: 0
Lateral Release Surgery
« on: April 09, 2010, 12:45:42 AM »
I am new to this site and would welcome your opinion about something. I have significant pain in my right knee. While my knee has never popped out of joint, my doctor said that I needed lateral release and medial retinaculum release. First of all, could you please tell me what the chance of success is and the time of recovery? He had said 5-8 months.

Thank you for your time!

Deb

Offline doublemom

  • SuperKNEEgeek
  • *****
  • Posts: 814
  • Liked: 1
    • Andi's Website
Re: Lateral Release Surgery
« Reply #1 on: April 09, 2010, 01:19:03 AM »
Deb - I'll let others who are more coherent than I am at the moment answer you - I had surgery two days ago so I'm still fairly loopy from the pain meds.  The very most important advice I can give is to find out *exactly* what is causing the knee pain first.  You and/or your doctor can't know that a lateral release and MPFL reconstruction is what's needed to fix the pain, until you know what is causing the pain in the first place.  If it's a maltracking patella, then yes, that surgery might *possibly* fix the problem, but there are several things that can be wrong with kneecaps and there are different fixes for it, depending on what is causing it.  Does that make sense? 

Also, get second, and third, and even more opinions until you find a surgeon who is a patellofemoral specialist and can answer all of your questions.  Please don't just take the first surgeon's advice blindly and sign up for surgery until you know exactly the cause of the pain.  Have you had xrays taken of your knee bent at several different angles?  How about a CT scan?  Those are the two best tests for determining kneecap alignment.  An MRI, if you've had one, is fairly useless at showing patella tracking.

Ok... gotta get some more sleep as my meds are starting to hit me LOL!  Please just don't rush into anything, educate yourself and do a lot of reading of posts here on the KG forums, and make the best educated decision that you can for yourself when it comes to having surgery.

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 serissagpl

  • MICROgeek (<20 posts)
  • *
  • Posts: 6
  • Liked: 0
Re: Lateral Release Surgery
« Reply #2 on: April 09, 2010, 02:19:37 PM »
Thank you. I have had xrays taken with my knee at different angles. I have had an MRI and a CT scan. I have had PT, euflexxa shots and cortisone shots. The CT scan clearly showed that my kneecap was pulled to the right side by what looked like to me a 1/2 an inch or so. I also have the same problem in my left knee but by only a 1/4" or so. He told me that my tendon was pulling my kneecap to the right. While I have never had my kneecap go out of joint, I have extreme pain in the sides of my knees and radiating pain down the front of my leg, I also have pain in the actual kneecap with significant swelling. I have problems with stairs and cannot kneel or crouch down. I have seen three doctors all in the same practice which has led me to see the knee surgeon who has scheduled the surgery. My concern is that I am back in school and due to start the respiratory therapy program in the fall. This program requires me to be on my feet all of the time. My doctor told me that recovery would be 3-5 months. I don't want to make the wrong decision but I don't know what to do! With my knee the way it is now, I will not be able to do the program because I cannot stand for long periods let alone walk.

Thank you!

Offline Lottiefox

  • SuperKNEEgeek
  • *****
  • *
  • *
  • *
  • *
  • Posts: 2393
  • Liked: 16
Re: Lateral Release Surgery
« Reply #3 on: April 09, 2010, 02:43:29 PM »
Welcome from another kneecapper

It sounds like you have had some good investigations done. As Andi said (so coherently for 48 hours post LR and TTT!!!! ;D) kneecap issues are complicated and the lateral release got a VERY bad reputation as being done by surgeons for the wrong reasons. Done correctly (for tilt of the patella) it can have good results. You describe your kneecaps as being pulled laterally - mine do the same. I have a 19 degree tilt on my bad bad knee and 20 degrees on my good bad knee. I've had extensive MRIs, and CT scans at assorted degrees to show tilt, shift and tracking. Apparently mine track OK but they tilt and pull laterally. Afetr 7 months of PT, tablets, modifying activity (grrrrrrrrrrrrrrrrrrr that doesn't go well me, I'm a fitness freak!!) I am scheduled for a lateral release and scope on the 4th May with a general wash out of debris and sealing of the cartilage defects under the kneecap that have been caused by constant wear on the tilted edges. I too have bad pain on stairs, squatting is very hard, and also the pain radiates down my shins/legs at times. My knecap doesn't dislocate but I've reached the stage of too much compromise and being willing to take the surgical option to try and get things better. I am probably going to need the cartilage repairing at some stage but this will hopefully get me some time.

To be honest, you need to weigh up whether you can live with how you are now as compared to hopefully regaining function and reducing pain. I decided I wasn't prepared to keep missing things and after seeing three surgeons I have a fabulous one that I trust. I'm paying for his treatment as he is also pioneering repair techniques for the patella and I want him in my knee, not some NHS newbie waving a laser at my lateral structures!!

I was told I'd be on crutches for about 2 weeks, but weight bearing as tolerated as soon as I felt able (its sore after I am told, so people don't tend to slap their weight through the knee!), back to riding a bike hopefully in 6 weeks but that I MUST have a decent PT program after the op. I've kind of got 3 months in my mind. I will need the same doing on the right knee too, but one at a time!

Good luck with whatever you decide,

Lottie  :D
Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....

Offline smillie

  • SuperKNEEgeek
  • *****
  • Posts: 1438
  • Liked: 1
Re: Lateral Release Surgery
« Reply #4 on: April 09, 2010, 03:23:56 PM »
Hi!  It does sound like your docs have been thorough in checking you over and getting at your problem.  That's a good thing!  If you find a doc who glances at your knee and an xray or two and wants to do a LR, run (or limp) away!  Have you read the informational articles on this website yet?  Look up at the top of the screen for the links to the Homepage and Information Hub.  I don't know how familiar you are with the anatomy and mechanics of the knee.  If you aren't, then start with the general knee information.  And especially read the whole section on the patella.  Many of us have found it so beneficial when educating ourselves about our knee problems and procedures.  If you want to know what recovery from the surgery is like, look around in this patella section and also go to the post-op diaries page and look for people who have had your proposed procedures.  Knowing that everyone recovers differently, and keeping that firmly in mind, try to read the experiences of several different people and you can get an idea of what you are facing.  Ask lots of questions of your OS until you are comfortable with what he wants to do and why he wants to do it.  Find out what the rehab process will be like and find a physical therapist that you can work with, trust completely, and knows the proper protocols for your procedure.  Just educate yourself and be active in your process.  Sometimes they are startled with a patient who asks lots of questions and requests things specifically, but they should be OK with it.  When I had my surgery 15 years ago, I didn't realize that I could question and request different people and all that.  I ended up with a PT after my surgery whom I hated working with and didn't trust and that was a miserable experience.  I eventually changed therapists, but I could have gotten results sooner had I just spoken up.

Good luck!
patella pain began early teens
'94 TTT/LR/VMO adv.
'94 MUA
'10 tried PT again
1/11 scope/hardware removal
4/11 (Finally!) dx medial instability due to LR
5/9/11 LPFL reconstruction scheduled

Offline crankerchick

  • SuperKNEEgeek
  • *****
  • *
  • Posts: 1861
  • Liked: 24
  • How 'bout them Cowboys!
    • Derotation osteotomy & TTT Post-op diary
Re: Lateral Release Surgery
« Reply #5 on: April 09, 2010, 06:37:56 PM »
Quote
I don't want to make the wrong decision but I don't know what to do!
For this reason alone, you should get a second opinion (and a third...and maybe a fourth) with a patella specialist, even if your current doctor is a patella specialist. Andi hit it on the head (quite well I must say, for being so soon post-op) when she said to get multiple opinions. This means opinions from different patella specialists not part of the same practice.

The first thing that is literally screaming out to me in your post is that you mention medial retinacular release. I'm not willing to bet the farm on this, but I'm fairly certain that this is NOT an MPFL reconstruction or medial reefing type procedure. Medial retinacular release is a release of the medial structures just as a lateral release is a release of the lateral structures. It is used to treat medial instability. Combining it with a lateral release makes absolutely no sense to me. That said, are you sure the procedure is medial and lateral release?

The other thing that screams out to me in your post is that you state that your OS said your tendon is pulling your knee cap laterally. If the tendon, presumably the patellar tendon, is pulling on the kneecap, then why not a tibial tubercle transfer surgery instead of a lateral release?

It also sounds like there are a few wild cards still out there. Did your x-ray work up include a true lateral (from the side) view of your knee to assess the height of the patella? What about a standing, leg length x-ray from the front. This would show your whole leg, from hip to foot, and reveal if you have any kind of knock-knee or bowed-leg malalignment. I'm sorry to throw so many variables at you, but as Andi said there are quite a few reasons for why your knees are like they are, and it is very important to get to the root reason before proceeding with surgery.

I know exactly how you feel about being afraid to make this decision. You have stated that you have a program you are ready to start and you really want your knee to be better. I can tell you from experience, as can many people here, that being in a rush is not the way to go when it comes to these things. Careful deliberation combined with extensive patient education and a skilled surgeon, are the keys to sorting these problems out for the long haul.
« Last Edit: April 09, 2010, 06:45:27 PM by crankerchick »
Mar '07 - plica excision
Oct '09 - femoral + tibial derotational osteotomy & TTT
Aug '10 - hardware removal
"You control your leg. Don't let it control you." -Smart trainer
"Get your a$$ in gear and go for it! Nothing will happen until you make it!" -Smart doctor

Offline Marantha

  • Regular Poster
  • ***
  • *
  • Posts: 94
  • Liked: 0
Re: Lateral Release Surgery
« Reply #6 on: April 11, 2010, 04:14:15 PM »
I have this type of surgery on the 10th March 2010...

Got 5 weeks off work, and am due back to work tomorrow which I love my work so that part doesnt bother me but I cannot sleep since this surgery and has made my knee worse than it was before my operation.  I cannot dirve currently and I wasnt told this, I can understand 2 weeks after surgery but 5 weeks has gone by and I cannot use the clutch.

Am having a few issues at the minute but what I will say is that physio is the most important part in this, a good rehab programme will work wonders.  Unfortunatley I am hypermobile and having this done seems to have made everything worse.....

Lateral Release are good for the right people.  But for the wrong people it makes everything worse.

Ask questions and make sure you know what your going into, unfortunately even though I did my research I found out some things a little too late, in which had I known this I would not have went through with my operation.

Important points:

Make sure your OS is a knee specialist (mine I found out 3 weeks after my surgery is a hip specialist)
Physio before and after the operation is important.
Do your homework (cannot go wrong with researching)
Ask plenty of questions not only to the OS but to the phyiso too...(they get paid to treat you so make sure they do)

I think thats it but like I said having the LR is good for the right people...on the up note I walked out of hospital and had no pain at all for about a week....
2009 Physio
30/10/2009 OS appointment confirmed patella tilt, very hypermobile, and a rare bone deformity called hypoplastic medial femoral condyle.
10/03/2010 LR preformed and chondromalacia grade 1 spotted

Offline serissagpl

  • MICROgeek (<20 posts)
  • *
  • Posts: 6
  • Liked: 0
Re: Lateral Release Surgery
« Reply #7 on: April 15, 2010, 04:01:16 PM »
Thank you all so much for your posts...and Marantha I hope that you feel better. I am going to visit my primary care doctor next week and am going to ask her opinion. I too have a standard and that is a concern for me. Unfortunately, my OS (while he is a knee surgeon) is not very nice. If I had a sendentary job, I wouldn't be so concerned but where I am going to be on my feet all day it makes this a very big decision. My mother had suggested that chiropractic might help...have you ever heard of that? And is it normal to have this same problem in both knees? Do we know what causes it?


Crankerchick,

This is what my surgery papers state:  Arthroscopic lateral release with medial retinacular release.


Thank you!

Deb

Offline crankerchick

  • SuperKNEEgeek
  • *****
  • *
  • Posts: 1861
  • Liked: 24
  • How 'bout them Cowboys!
    • Derotation osteotomy & TTT Post-op diary
Re: Lateral Release Surgery
« Reply #8 on: April 15, 2010, 04:46:40 PM »
Quote
This is what my surgery papers state:  Arthroscopic lateral release with medial retinacular release.
Curious indeed. I'm just sayin, if it were me I would want some good clarification from my doctor about why he wants to treat a subluxed patella by basically releasing the tissues around the patella both laterally medially. It is more common to do a procedure that releases laterally and tightens medially.

It's very important in these situations to have a very good understanding of what a doctor is proposing and why he is proposing it before making a decision to do it.

The next thing that bothers me is this:
Quote
Unfortunately, my OS (while he is a knee surgeon) is not very nice.
When dealing with your health, it is important to be your own advocate. Not sure where you are located, but if you have the option of seeking more opinions, it is worth it for multiple reasons, one being choosing a surgeon you are comfortable with. Too many people put blind faith in a doctor and/or put up with doctors they aren't satisfied with, and some cases it doesn't have to be that way. I would never let a doctor I didn't care for chop on me.

As for your other questions. It is definitely not uncommon to have similar problems in both knees. When the condition is due to something structural (versus injury), the structural abnormalities can be in both legs. Sometimes, like in my case, the symptoms are more prevalent in one limb over the other, but it is not uncommon at all for both legs to be problematic.

As for what causes it. I don't think even the doctors can agree on all the reasons for what and why. That is why it is so important to get multiple opinions. Because different doctors check for different reasons for the problem and they can differ in what approach to take to fix it. There is no standard "if this then that" treatment path. One doctor may perform lateral releases for this problem, so thus every patient he sees with this problem he recommends lateral release. Another doctor may think TTTs are best, so that is what he pushes. It's important to find a doctor that does a thorough evaluation for all the different reasons for why the problem exists and will treat the patient accordingly.

When is your surgery?
« Last Edit: April 15, 2010, 04:55:13 PM by crankerchick »
Mar '07 - plica excision
Oct '09 - femoral + tibial derotational osteotomy & TTT
Aug '10 - hardware removal
"You control your leg. Don't let it control you." -Smart trainer
"Get your a$$ in gear and go for it! Nothing will happen until you make it!" -Smart doctor

Offline crankerchick

  • SuperKNEEgeek
  • *****
  • *
  • Posts: 1861
  • Liked: 24
  • How 'bout them Cowboys!
    • Derotation osteotomy & TTT Post-op diary
Re: Lateral Release Surgery
« Reply #9 on: April 15, 2010, 04:51:40 PM »
Try searching this board for 'lateral release' and see what you get. Keep in mind it can be a little lopsided because most people that come here because they either have questions or are having problems after having the procedure. There are plenty of people that have this done that never come online and are doing fine. So just keep that in perspective.

But i think a quick read of a few threads and I think you'll see why we are encouraging you to exercise caution and just thoroughly educate yourself on the procedure first.

This is a tricky one.
« Last Edit: April 15, 2010, 04:53:38 PM by crankerchick »
Mar '07 - plica excision
Oct '09 - femoral + tibial derotational osteotomy & TTT
Aug '10 - hardware removal
"You control your leg. Don't let it control you." -Smart trainer
"Get your a$$ in gear and go for it! Nothing will happen until you make it!" -Smart doctor

Offline serissagpl

  • MICROgeek (<20 posts)
  • *
  • Posts: 6
  • Liked: 0
Re: Lateral Release Surgery
« Reply #10 on: April 15, 2010, 07:18:33 PM »
Thank you very much for your input Crankerchick. I am just getting started on researching this so please bear with me. My surgery is on 5/19. My concern was that he said that there is a 70% success rate. So, I question the other 30%. Will I be worse or stay the same? I will begin looking at posts on here. Would it be ok if I ask you all if I have further questions?

Have a great day!

Deb

Offline crankerchick

  • SuperKNEEgeek
  • *****
  • *
  • Posts: 1861
  • Liked: 24
  • How 'bout them Cowboys!
    • Derotation osteotomy & TTT Post-op diary
Re: Lateral Release Surgery
« Reply #11 on: April 15, 2010, 07:56:03 PM »
The question of will you be worse off if you fall into the category of people LR doesn't work for is of course a question nobody can answer. Some people with a failed lateral release just end up having the same instability and pain they always had. Some people see an improvement in their pain and instability, but find that they still aren't "fixed." Some experience stiffness and weakness but get significant reduction in pain. And for some, they are worse off, with either awful instability and pain, and for some, medial instability which can be debilitating. I have seen all of these stories on this site in addition to the ones with favorable outcomes.

It's important to look at the medical research and publications when you are searching on lateral release, and not just the "google hits." I got a very different picture of the effectiveness of the procedure when I looked at the medical journals versus when I looked at various web sites.

Many of the top patello-femoral specialists out there have moved away from isolated lateral release as a treatment option.
Mar '07 - plica excision
Oct '09 - femoral + tibial derotational osteotomy & TTT
Aug '10 - hardware removal
"You control your leg. Don't let it control you." -Smart trainer
"Get your a$$ in gear and go for it! Nothing will happen until you make it!" -Smart doctor

Offline doublemom

  • SuperKNEEgeek
  • *****
  • Posts: 814
  • Liked: 1
    • Andi's Website
Re: Lateral Release Surgery
« Reply #12 on: April 15, 2010, 11:31:42 PM »
Hello - If I may wave a large red flag here... the lateral release I understand (though it's very often over-used and not done for the correct reasons by many surgeons).  The "medial release" is totally confounding to me and doesn't make any sense at all.  I'd be getting a lot more information on the actual procedure your surgeon is recommending, with all the detail you can handle, before signing on for surgery. 

If the kneecap is not tracking properly, and 99% of the time it's pulled to the lateral side, or outside of the knee, then the lateral release helps the kneecap to reposition by releasing the tightness and pulling in that direction. The medial release, on the other hand, just doesn't make sense.  Many people actually have medial *tightening* or reconstruction to help pull the kneecap further in that direction toward the inside of the knee. 

Do your research and homework, and just make perfectly sure that this is the correct surgery for you.  Also incredibly important is that you have a very clear understanding with your surgeon of what he is going to do, and don't be afraid to seek another surgical opinion, and another, and another, if that's what it takes for you to find someone you are confident with.

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 crankerchick

  • SuperKNEEgeek
  • *****
  • *
  • Posts: 1861
  • Liked: 24
  • How 'bout them Cowboys!
    • Derotation osteotomy & TTT Post-op diary
Re: Lateral Release Surgery
« Reply #13 on: April 15, 2010, 11:37:02 PM »
Quote
The "medial release" is totally confounding to me and doesn't make any sense at all.
What she said.
Mar '07 - plica excision
Oct '09 - femoral + tibial derotational osteotomy & TTT
Aug '10 - hardware removal
"You control your leg. Don't let it control you." -Smart trainer
"Get your a$$ in gear and go for it! Nothing will happen until you make it!" -Smart doctor

Offline KW

  • SuperKNEEgeek
  • *****
  • *
  • Posts: 1408
  • Liked: 1
  • My new PFJR...Love It!!!!
Re: Lateral Release Surgery
« Reply #14 on: April 16, 2010, 12:08:50 AM »
Quote
The "medial release" is totally confounding to me and doesn't make any sense at all.
What she said.

I have to TOTALLY AGREE....Please give thought to getting another opinion.

Karen
Right Knee
2000 - 2002 - Scope,LR,TTT,Unscrewed
01-10-12 - PFJR

Left Knee
04/07 TTT/LR
08/07 Bone Grth Stim
10/07 Loose/Bent Screw
1/08 Unscrewed/MRI~NON-UNION
02/19/08 Lt  TTT Revision W/Graft
12/09/08 Scope
05/15/09 Scope
09/04/09 PFJR/Unscrewed















support