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Author Topic: Lateral Release Reversal  (Read 7502 times)

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Offline TOMMAX

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Lateral Release Reversal
« on: January 18, 2011, 10:21:56 AM »
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.
March 2005: LK Plant & twist injury (full lateral patellar dislocation)
April 2010: LK scope (LRR, posteriolateral meniscus, medial plica)
Current: Medial instability
May 24, 2012: LPFL + MPFL recon scheduled

Offline nwc07

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Re: Lateral Release Reversal
« Reply #1 on: January 18, 2011, 01:02:13 PM »
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..
09/10- left knee subluxation..

Offline crankerchick

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Re: Lateral Release Reversal
« Reply #2 on: January 18, 2011, 07:05:09 PM »
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
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 TOMMAX

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Re: Lateral Release Reversal
« Reply #3 on: January 19, 2011, 03:35:40 AM »
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.
March 2005: LK Plant & twist injury (full lateral patellar dislocation)
April 2010: LK scope (LRR, posteriolateral meniscus, medial plica)
Current: Medial instability
May 24, 2012: LPFL + MPFL recon scheduled

Offline TOMMAX

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Re: Lateral Release Reversal
« Reply #4 on: January 19, 2011, 03:41:07 AM »
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.
March 2005: LK Plant & twist injury (full lateral patellar dislocation)
April 2010: LK scope (LRR, posteriolateral meniscus, medial plica)
Current: Medial instability
May 24, 2012: LPFL + MPFL recon scheduled

Offline nwc07

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Re: Lateral Release Reversal
« Reply #5 on: January 19, 2011, 03:45:27 AM »
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 (?) 


09/10- left knee subluxation..

Offline TOMMAX

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Re: Lateral Release Reversal
« Reply #6 on: January 19, 2011, 05:36:28 AM »
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.
March 2005: LK Plant & twist injury (full lateral patellar dislocation)
April 2010: LK scope (LRR, posteriolateral meniscus, medial plica)
Current: Medial instability
May 24, 2012: LPFL + MPFL recon scheduled

Offline nwc07

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Re: Lateral Release Reversal
« Reply #7 on: January 19, 2011, 04:22:14 PM »
Did he tell you why he felt the need to do it?   

 
09/10- left knee subluxation..

Offline TOMMAX

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Re: Lateral Release Reversal
« Reply #8 on: January 20, 2011, 12:22:17 AM »
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.


March 2005: LK Plant & twist injury (full lateral patellar dislocation)
April 2010: LK scope (LRR, posteriolateral meniscus, medial plica)
Current: Medial instability
May 24, 2012: LPFL + MPFL recon scheduled

Offline TOMMAX

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Re: Lateral Release Reversal
« Reply #9 on: January 20, 2011, 12:20:35 PM »
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.
March 2005: LK Plant & twist injury (full lateral patellar dislocation)
April 2010: LK scope (LRR, posteriolateral meniscus, medial plica)
Current: Medial instability
May 24, 2012: LPFL + MPFL recon scheduled

Offline crankerchick

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Re: Lateral Release Reversal
« Reply #10 on: January 20, 2011, 01:53:00 PM »
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.
« Last Edit: January 20, 2011, 02:05:14 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 texel

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Re: Lateral Release Reversal
« Reply #11 on: October 03, 2020, 11:02:06 PM »
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.
« Last Edit: October 04, 2020, 11:18:39 PM by texel »
2019/10 unnecessary LR (failed), medial & infra patellar plica removed
2021/07 Scars removed (didn't help)

After LR I can't walk anymore. Tremendous pain. 1,5 years pt failed. I was a half marathoner before. Desperately looking for a way out.

Offline Brandon123

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Re: Lateral Release Reversal
« Reply #12 on: October 05, 2020, 09:00:05 AM »
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! 
RK sharp pain while running, diagnosis chondromalacia patellae 6/09
RK arthroscopic chondroplasty 9/09
RK rehab, recovery, 90% normal, started running again -> back to square one 5/15
RK diagnosis patellofemoral arthritis + LK diagnosis chondromalacia patellae 8/15 -> conservative treatment

Offline JJPies

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Re: Lateral Release Reversal
« Reply #13 on: October 15, 2020, 12:07:24 AM »
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

Offline texel

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Re: Lateral Release Reversal
« Reply #14 on: October 18, 2020, 12:06:22 AM »
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.
2019/10 unnecessary LR (failed), medial & infra patellar plica removed
2021/07 Scars removed (didn't help)

After LR I can't walk anymore. Tremendous pain. 1,5 years pt failed. I was a half marathoner before. Desperately looking for a way out.

Offline texel

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Re: Lateral Release Reversal
« Reply #15 on: October 18, 2020, 12:12:20 AM »
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

Hi JJPies, I'm so sorry for you. Unfortunately I have no response from TOMMAX. But 12 months after surgery I'm desperately looking for someone to repair the LR here in Germany. My situation was pain in the medial area after running. The doctor said it's just a plica, he will do a small surgery and after three months I'll be back on track. Well, I'm 12 months in hell, about to lose my job and I can't barely walk. I opened a facebook group "Lateral Release victims". Keep me updated, mate.
« Last Edit: October 18, 2020, 12:23:49 AM by texel »
2019/10 unnecessary LR (failed), medial & infra patellar plica removed
2021/07 Scars removed (didn't help)

After LR I can't walk anymore. Tremendous pain. 1,5 years pt failed. I was a half marathoner before. Desperately looking for a way out.

Offline claus6778

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Re: Lateral Release Reversal
« Reply #16 on: December 18, 2021, 12:11:50 AM »
Lateral release is the worst and most unnecessary thing you can do to your knee. It will cause tremendous amount of pain and disability.  You pretty much will not be active again.

The only hope is LPFL reconstruction by Dr. Robert LaPrade.

Offline texel

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Re: Lateral Release Reversal
« Reply #17 on: December 18, 2021, 08:28:27 AM »
Lateral release is the worst and most unnecessary thing you can do to your knee....You pretty much will not be active again.

Hi claus6778, thanks for your advice. I second that. LR ist the worst thing a doctor did to me. After two years I still can't walk, lost my job and getting insane by 24/7 pain. My quad muscle is gone, lots of pain. My new doctor suggested a repair with a "z plastic method". I'm not sure about that. But I can't live like that, my life is destroyed.

Since I'm from Germany Dr. LaPrade is unfortunately too far for me. Haven't found a specialist around yet. I've read your postings here. What's your status? Have you done the LPFL?
2019/10 unnecessary LR (failed), medial & infra patellar plica removed
2021/07 Scars removed (didn't help)

After LR I can't walk anymore. Tremendous pain. 1,5 years pt failed. I was a half marathoner before. Desperately looking for a way out.

Offline vickster

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Re: Lateral Release Reversal
« Reply #18 on: December 18, 2021, 08:43:40 AM »
If looking for a PF specialist in Europe, contact Lars Blond in Copenhagen
https://www.kneeguru.co.uk/KNEEnotes/knee-surgeon/dr-lars-blond?action
He’s made a number of contributions to Kneeguru including articles around lateral release (see tab in link)
« Last Edit: December 18, 2021, 08:45:13 AM by vickster »
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffa’s fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone

Offline texel

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Re: Lateral Release Reversal
« Reply #19 on: December 18, 2021, 11:45:49 AM »
Thanks vickster, I will get more informations about Dr. Blond. So far a MPFL specialist seems to be my last chance.
2019/10 unnecessary LR (failed), medial & infra patellar plica removed
2021/07 Scars removed (didn't help)

After LR I can't walk anymore. Tremendous pain. 1,5 years pt failed. I was a half marathoner before. Desperately looking for a way out.

Offline claus6778

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Re: Lateral Release Reversal
« Reply #20 on: December 18, 2021, 09:43:44 PM »
Lateral release is the worst and most unnecessary thing you can do to your knee....You pretty much will not be active again.

Hi claus6778, thanks for your advice. I second that. LR ist the worst thing a doctor did to me. After two years I still can't walk, lost my job and getting insane by 24/7 pain. My quad muscle is gone, lots of pain. My new doctor suggested a repair with a "z plastic method". I'm not sure about that. But I can't live like that, my life is destroyed.

Since I'm from Germany Dr. LaPrade is unfortunately too far for me. Haven't found a specialist around yet. I've read your postings here. What's your status? Have you done the LPFL?

I had LPFL reconstruction by LaPrade.  I wish I had done it immediately after my disastrous lateral release, which pretty much destroyed my life. Instead I had a couple failed surgeries to fix the issue. At that time, I traveled alone from Asia to Colorado (including a fun ride from denver airport up to the mountain) to see him and I stayed in a German style hotel for a month after the surgery all by myself. It was the most brave thing I ever did and I wished I had approached other things in my life the same way. Perhaps I was younger and more determined.  Fate favors the braves. That's all I can say.

There are several methods to fix lateral release. None of them is perfect. LaPrade's method makes most sense to me and he had done at least dozens of these reconstructions. He's even published a fairly simple to understand paper available on pubmed.

LPFL reconstruction will be slowly phased out because no one sensible now will perform a lateral release. It only exists to fix an inhuman and debilitating surgery. One can actually tore every major ligament in the knee and recover better than lateral release.

MPFL reconstruction specialists will not be be able to help you. These two surgeries are completely different. Believe me, I thought about that too.

Lastly, I want to say that I dont believe anyone who is actually better after lateral release. There might be people who are relatively unaffected by the release if they had a small release or lengthening but their knees will never actually be better or stronger.

Offline texel

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Re: Lateral Release Reversal
« Reply #21 on: December 19, 2021, 06:49:10 PM »

MPFL reconstruction specialists will not be be able to help you. These two surgeries are completely different. Believe me, I thought about that too.


Claus, thanks so much for sharing your experience. I got many questions:
When was your MPFL reconstruction?
How do you feel now?
How was your recovery? 
What do you mean with "MPFL reconstruction specialists will not be be able to help you"? I thought reconstruction works better then fix. Do you suggest to visit Dr. LaPrade exclusively because of his skills and method?
And how much are the costs for the surgery and treatment in summery?
I mean I'm so desperated, I would travel around the world to reverse this inhumane mistake they did to me.
« Last Edit: December 19, 2021, 07:32:21 PM by texel »
2019/10 unnecessary LR (failed), medial & infra patellar plica removed
2021/07 Scars removed (didn't help)

After LR I can't walk anymore. Tremendous pain. 1,5 years pt failed. I was a half marathoner before. Desperately looking for a way out.

Offline claus6778

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Re: Lateral Release Reversal
« Reply #22 on: December 19, 2021, 10:10:07 PM »

MPFL reconstruction specialists will not be be able to help you. These two surgeries are completely different. Believe me, I thought about that too.


Claus, thanks so much for sharing your experience. I got many questions:
When was your MPFL reconstruction?
How do you feel now?
How was your recovery? 
What do you mean with "MPFL reconstruction specialists will not be be able to help you"? I thought reconstruction works better then fix. Do you suggest to visit Dr. LaPrade exclusively because of his skills and method?
And how much are the costs for the surgery and treatment in summery?
I mean I'm so desperated, I would travel around the world to reverse this inhumane mistake they did to me.

I had LPFL reconstruction quite a few years ago, not MPFL. Lateral release results in medial subluxation - your kneecap tracks medially, so you need lateral retinaculum reconstruction using grafts. Simplying repairing LR won't do and will always end up failing after a while. When the tissue is cut with during arthscropy, there is no way to savage it except with hardcore reconstruction using IT band and/or part of patellar tendon to support the kneecap.

MPFL reconstruction is fairly common but that's not what you need.

I feel ok for someone who had 5 surgeries. In fact, ironically, my knee is the least of my concerns now.

My recovery was tough but that was because I left the clinic in Colorado too soon and didnt do enough therapy.

You are probably going to have to pay out of pocket unless you have insurance in the states. It actually isn't a complicated or time consuming surgery. It just that hardly anyone performs the surgery. LaPrade's paper outlines every detail and even includes a video of the surgery. You can ask LaPrade to recommend someone in Europe if you dont want to travel. Where I live, there is not a surgeon who has even heard of the surgery.

The PF forum used to be flooded with lateral release comments but most people who had reconstruction left already. Like I said, lateral release is being phased out. I only came back because of the torrid memory of trying to finding fixes and some sentimental reasons.

A funny annecdote is that I didnt talk to LaPrade for a very long time in the whole process (I doubt he still remembers me). He pretty much just saw me for 20 min or less and just decided LPFL reconstruction (not like there is any other choice). There are surgeons whom I consulted much longer and willing to spend more time talking to me but didn't help me at all. At the end of day, it's all about the method and experience. That's another lesson in life, which I learnt the hard way.

Lastly, try "Reverse McConnel taping" or wear a kneecap brace the opposite way which forces your kneecap to track laterally instead of medially. If it helps, then you are a candidate for the surgery.

I wore a kneecap brace (for opposite knee) for years before and even after the surgery.

Offline vickster

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Re: Lateral Release Reversal
« Reply #23 on: December 19, 2021, 10:30:13 PM »
This forum article by Lars Blond talks about lateral release and the LPFL reconstruction. From previous posts on the forum, he is experienced in the surgery
https://www.kneeguru.co.uk/KNEEnotes/articles/expert-views/2019/lateral-release-why-bad-reputation#worse-instability
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffa’s fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone