Lateral Release Reversal

[TOMMAX]

Has anyone had this done before? Can it restore the kneecap back to its previous alignment prior to a lateral release?



I had a lateral release 9 months ago. I expected my surgeon to only clean up a band of scar tissue (medial plica) but he ended up doing a lateral release because he said I had slight patellar tilt and mild chondromalacia.

Now the kneecap cartilage is worse than ever and it gets crushed within the groove during extension and flexion. I went from being a very active person and managing my pain with minor amounts of pain killers to hardly being able to walk because it feels like my kneecap is in a vice and is getting crushed. My leg also feels crooked like it is pointed inward. I have re strengthened all of the quad muscles and the knee is stable but the patellar articualting cartilage surface is getting crushed and I am on a boat load more pain killers than I was before surgery. This surgery has basically ruined my quality of life.

[nwc07]

I am sorry to hear you are going through this.  My OS told me I need this as well but I have refused.  I do know it was specifically written on my consent form...although it also gives authroization for any "additional procedures the Dr considers necessary or "advisable". " From my reading on this procedure, it is controversial and no longer recommended as routinely as it once was yet it seems everyone is getting it!    I googled it and came across many journals (recent) where this procedure must be discussed in detail with the patient so that they understand the risk and an informed consent must be signed.  It seems, however that this is rarely done.

In my research I did come across someone on this board who has had the LR reversal.   I put in a search of lateral release in the bulletin board..

[crankerchick]

There are doctors that do lateral release repair and there are papers on the topic.

http://www.ncbi.nlm.nih.gov/pubmed/15525935

It's important to have an experienced doctor assessing your knee to determine what exactly is going on and if there are any alignment issues in addition to the potentially botched lateral release.

There are people on this board who have had the lateral patellofemoral ligament reconstruction (performed in a variety of ways) and there is at least one that I know of that managed to avoid surgery and find a better quality of life through aggressive and directed exercise.

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=41314.0

[TOMMAX]

I am sorry to hear you are going through this.  My OS told me I need this as well but I have refused.  I do know it was specifically written on my consent form...although it also gives authroization for any "additional procedures the Dr considers necessary or "advisable". " From my reading on this procedure, it is controversial and no longer recommended as routinely as it once was yet it seems everyone is getting it!    I googled it and came across many journals (recent) where this procedure must be discussed in detail with the patient so that they understand the risk and an informed consent must be signed.  It seems, however that this is rarely done.

In my research I did come across someone on this board who has had the LR reversal.   I put in a search of lateral release in the bulletin board..

Hey, thanks for your reply and glad to hear you were able to avoid the lateral release surgery. I have dislocated my patella before and that was a cake walk to recover from compared to the lateral release.
Do you think you would be able to link me to the google journals you mentioned in your post? I would be interested to see that if you would be able to find it, thanks.

Also, I did a search as well and found a lot of good info with people on here who had failed lateral releases. Im particularly interested in the outcome of the kneegeek poster "mypoorknee2" as it seems we have alot of the same complaints of increased pain and alignment that is too far medially after the operation.

[TOMMAX]

There are doctors that do lateral release repair and there are papers on the topic.

http://www.ncbi.nlm.nih.gov/pubmed/15525935

It's important to have an experienced doctor assessing your knee to determine what exactly is going on and if there are any alignment issues in addition to the potentially botched lateral release.

There are people on this board who have had the lateral patellofemoral ligament reconstruction (performed in a variety of ways) and there is at least one that I know of that managed to avoid surgery and find a better quality of life through aggressive and directed exercise.

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=41314.0

Hey crankerchick, thanks for responding. I have read a lot of your posts and you seem to know your stuff. My lateral release was performed using an electrocautery probe and was a 3 inch cut from the superior-lateral corner of the patella to the base of the vastus lateralis. Ive noticed that this is a bit different from other lateral releases ive read about where the surgeon cuts the tissue directly laterally to the patella. I will probably try to naturally strengthen my quad for a few more months and hope that my kneecap aligns more laterally before I consider the reversal procedure, like clippedwings did. Thanks for the links.

[nwc07]

This is one I think is most interesting...

http://www.udel.edu/PT/clinic/journalclub/old/sojournalclub/04_05/Nov04/Lateral%20release.pdf

I do remember reading somewhere that the cut should be 5 mm (?) 

[TOMMAX]

This is one I think is most interesting...

http://www.udel.edu/PT/clinic/journalclub/old/sojournalclub/04_05/Nov04/Lateral%20release.pdf

I do remember reading somewhere that the cut should be 5 mm (?) 

I found this sentence interesting:

"most respondents (89%) indicated
that isolated lateral release is a legitimate treatment,
but only on rare occasions (1% to 2% of surgeries
performed, < 5 lateral releases per year)."

My now former surgeon told me he does 1 in 20 knee surgeries as a lateral release when I confronted him about my dissatisfaction a few months ago. Seems to be complete overkill compared to that data.

[nwc07]

Did he tell you why he felt the need to do it?   

 

[TOMMAX]

Did he tell you why he felt the need to do it?   

 

He told me the reason was because of slight patellar tilt, instability, and mild chondromalacia (softening of the knee cap cartilage).

Apperantly the patella tends to slightly tilt when the arthroscopes portals are placed into the knee so even a normal knee would tilt slightly when portals are placed into the knee. I think it was a terrible judgement call on his part because of this reason.

Also, I know I didnt have instability because my kneecap was not wobbling within the groove (I have experienced instability in the past after I dislocated my knee and know how it feels and I was able to resolve it with physiotherapy).

In regards to the chondromalacia, apperantly the theory with this is that it takes pressure off of the articulating cartilage of the kneecap, allows it to track better, and relieves symptoms but I think that is a flawed theory. In my case it has put more pressure on my knee cap and now it feels like my knee cap is getting crushed within the groove and hurts terribly like I ran a marathon.

[TOMMAX]

Just to update this thread, Im lying in bed and my kneecap is getting crushed and aches (even hopped up on percocet) so I thought Id research some specialists who are capable of doing the lateral release reversal/ repair. So far Ive found these doctors:

-Dr. David Shneider, East Lansing MI

-Dr. John Fulkerson, Hartford CT

-Dr. Robert Teitge, Detroit MI

-Dr. Elizabeth Anne Arendt, Minneapolis MN

-Dr. Fredrick Flandry, Columbus GA


Im in winnipeg canada so Im gonna try to go with either Dr. Shneider or Dr. Arendt since they seem very knowledgeable and would be the 2 closest doctors to my location. Ill be calling them in the near future to see what kind of info they can give me and if they can get me in for an appt. to consult with them. Im first going to see my NEW OS here in winnipeg (not the one that did my surgery, Im done with him) to see what he thinks about my current situation and what I should do about my knee in the mean time.

[crankerchick]

From that list you've compiled, without a doubt you would do well to head to Dr. Teitge if you are going to come to the Northern US. He will have a wait, but he's worth it. If you are going to come to the US as a whole, there are a few other names I would add to your list.

[texel]

I had a lateral release 9 months ago. I expected my surgeon to only clean up a band of scar tissue (medial plica) but he ended up doing a lateral release because he said I had slight patellar tilt and mild chondromalacia.

Now the kneecap cartilage is worse than ever and it gets crushed within the groove during extension and flexion. I went from being a very active person and managing my pain with minor amounts of pain killers to hardly being able to walk because it feels like my kneecap is in a vice and is getting crushed. My leg also feels crooked like it is pointed inward. I have re strengthened all of the quad muscles and the knee is stable but the patellar articualting cartilage surface is getting crushed and I am on a boat load more pain killers than I was before surgery. This surgery has basically ruined my quality of life.

Dear TOMMAX,

your text describes the horror I'm into the last 12 months. Had a surgery for plica removal but the doc decided to do a LR with disastrous results for me. I can't walk anymore, I was a half marathoner before surgery.
My kneecap cartilage also crush within the groove during flexion and extension. And it pops everytime and hurts so much.

So I wanted to ask about your progress. I'm thinking about a risky LR repair. I would be very thankful for your advice. Thanks.

[Brandon123]

Hi Texel,

Sorry to hear about your problems. Please note that this thread is 9 years old and people might not be active anymore. You can try to PM the poster (after you have posted 20 times on the forum - use game section if necessary). Lastly, there are alot of discussions about LR and reversal surgeries on the forum, try to use the search function to find these (newer) discussion threads. You might also find some relevant info in the Learning Portfolio! 

[JJPies]

Hi Texel,
Did you get a response from Tommax or make any progress? I am suffering as well after LR cannot walk and wondering if you can share more about your situation. I had subluxated kneecap and tilt, terrible pain and elected this surgery out of desperation for relief. Thanks in advance

[texel]

Hi Brandon123, thanks for your advice. I've noticed the date bit since the story of the thread opener was so equal to mine I had hope for a answer. I'll do my research, thank you.