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Author Topic: Waiting on lateral release knees started clicking !  (Read 3055 times)

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Offline Tinkerbell11

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Waiting on lateral release knees started clicking !
« on: October 18, 2011, 10:40:13 AM »
Hiya really looking for any advice ! On waiting list to get a lateral release for a tilted knee cap ! Have had two MRI scans both showing no damage just that my knee cap has a tilt and I partially dislocated it once with no problems just alot of pain for the past year:(  but I am now having problems with my knee clicking from when it's bent to straighting it which I have never experienced Before and the pain is alot worse has anyone expierenced this ? Could it be because of the tilt and its doing more damage ? Or could this be something new ? Any help and advice appreciated x
Right Knee Lateral Release

Offline Driden

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Re: Waiting on lateral release knees started clicking !
« Reply #1 on: October 18, 2011, 02:33:07 PM »
LRR is never appropriate in an unstable knee.  The lateral retinaculum helps stabilize the patella both laterally and medially.  If the patient history includes dislocation/subluxation, or a good clinical exam shows excessive patella glide and therefore laxity, LRR will likely make the problem worse. Why make an excessively loose patella even looser by cutting the LPFR and surrounding tissue?  So-called tilt on a sunrise xray can be due to abnormalities other than contracted lateral retinaculum. Unfortunately, there are a lot of docs out there who somehow Dx tilt and tight retinaculum where it does not exist. Even "well regarded" doctors do this.  An entire generation of OSs were mistakenly taught that LRR is a cure-all for PF problems and poses little downside risk. Plus, it is technically simple compared to other procedures. It is now known to be potentially dangerous and less commonly done among PF specialists. So, before you lay down on the operating table, I would get more opinions, including from docs who have done LPFLRs (reversal of lateral release) and know how to look for all bony deformities including torsion of the long bones and flat trochlear groove. It takes time and money (and probably travel).  But it is better than disability.

Offline Tinkerbell11

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Re: Waiting on lateral release knees started clicking !
« Reply #2 on: October 18, 2011, 02:59:28 PM »
Yeah all I have heard is had stuff regarding lateral release but feel confident my os knows what he is doing I am from the uk and my os is one of the best specialist so a have been told by a number of people I have only partially dislocated it once so think I am a good candidate from my research just looking for advice for my clicky knee only 20 and seems my problems are getting worse thanks for ur advice though !
Right Knee Lateral Release

Offline aaa

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Re: Waiting on lateral release knees started clicking !
« Reply #3 on: October 18, 2011, 03:01:08 PM »
Hi Tinkerbell11,

For the clicking your getting, its better to see a professional to check your knee.

The clicking could be many different things, we can only guess here and ask some questions.  Is it around your kneecap on the lateral side? If thats the case, it might be your kneecap is maltracking laterally, and so its moving in places it shouldn't be, then you can get popping and clicking.

Maybe think of it like a train (kneecap) thats running of its tracks (femoral groove) a bit, and then at some point 'hops' back on.  Its going to grind and then pop.

What sort of physiotherapy are you doing?

You've had a million warnings about the lateral release in the patello-femoral boards.  I've been in your situation where I had a lateral release despite people here warning me about it.  It failed for me, and I have to get it repaired.  Its a long road and really frustrating and agonizing.

I don't know why I was so stubborn.  I think back in hindsight to when I bought my car.  I checked out every single model, read all the reviews, negotiated about the price and did a bunch of test drives.  But when it came to my knee I just trusted the surgeon blindly and it failed.  It was really stupid, and I'm paying the price for not using my brain and reasoning.
« Last Edit: October 18, 2011, 03:04:24 PM by yb »

Offline allyd

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Re: Waiting on lateral release knees started clicking !
« Reply #4 on: October 18, 2011, 03:10:32 PM »
It takes time and money (and probably travel). 
Not this. There are good (and great) PF specialists all across the world. I am confident you could easily get a quality second opinion if you wanted it in your backyard.

To answer your actual question. I too get the clicking/popping when extending my knee. (It actually happens in my “good” knee). My understanding is this is a direct symptom of the tight lateral retinaculum – and for me at least the combination of loose medial restraints (which is why I needed the MPFLr, combined with a Lateral Lengthening, which is similar to a Lateral Release). What I believe is happening is that the kneecap is popping out of the groove a bit, rather than gliding smoothly out of it as you extend your knee. 

As for damage, I’m no doctor, but it surely can’t be good for it? There is friction happening in an area where it’s not meant to be. Depending on the person it could take years for damage to happen, or for it to become symptomatic… As I said, this happens in my good knee. And has been doing so for years, but I have no pain or other symptoms associated with it.
04/09 RK - Dislocated Patella & Grade III MCL Tear
06/10 RK - Re-Dislocation Patella
09/11 RK - MPFLr + Lateral Lengthening

Offline aaa

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Re: Waiting on lateral release knees started clicking !
« Reply #5 on: October 18, 2011, 03:36:05 PM »
One thing to ask about, and I think it should be supervised with a PT, is prone quads stretching.

http://www.patellofemoral.org/pfoe/c12/st.html

This can be quite effective, and can reduce patella tilt

Offline Tinkerbell11

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Re: Waiting on lateral release knees started clicking !
« Reply #6 on: October 18, 2011, 03:41:33 PM »
Thank you allyd and yb the physio I was doing was strengthen my quad muscles and working on my hip muscles  but physio discharged me saying there was nothing else she could do and that I was just really unlucky ... But been going to the gym and using the bike but there's no difference in the whole year a have been doing it yb I hope u get things sorted with ur knee so frustrating been in pain :( ally d that's very useful advice and wondering if a lateral release would stop any more damage happening did u feel ur lateral release worked !
Right Knee Lateral Release

Offline allyd

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Re: Waiting on lateral release knees started clicking !
« Reply #7 on: October 18, 2011, 04:09:21 PM »
Honestly, I can’t tell you yet if it has been “successful” as I am only about 3 weeks post-op. My main goal of surgery was to fix my instability, so the primary procedure was the MPFLr. The lateral lengthening was done in combo to balance the restraints out. My OS basically said she’d be hesitant to do one without the other in my case. During the op, she did find mild cartilage wear on the patella where it was grinding against the groove, but it actually wasn’t as bad as my scans (and even pain) suggested pre-surgery, I’m tentatively hopeful that correcting everything now will prevent issues down the road.
04/09 RK - Dislocated Patella & Grade III MCL Tear
06/10 RK - Re-Dislocation Patella
09/11 RK - MPFLr + Lateral Lengthening

Offline Tinkerbell11

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Re: Waiting on lateral release knees started clicking !
« Reply #8 on: October 18, 2011, 04:18:38 PM »
Will keep my fingers and toes crossed for u it worked stay positive :) yeah that's exactly how a feel I I fix it now hopefully won't end up with more damage I have been lucky and don't have any instability just pain round the top of my knee and running down the side and now the clicking :( hope it all works out for u with ur knees !
Right Knee Lateral Release

Offline aaa

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Re: Waiting on lateral release knees started clicking !
« Reply #9 on: October 18, 2011, 04:50:08 PM »
Tinkerbell11, I take it you are  going ahead with the lateral release.

If thats the case, I think its still a good idea to a Physiotherapist to keep the pain and maltracking under control, and try to have the knee stronger before the surgery - without doing anything unsafe of course.  It helps to be strong before the surgery as the recovery can go better.

I've been through a ton of Physiotherapy.  The most effective stuff for me was hip strengthening, especially hip abductors and external rotators .  A good stretching routine and mobility exercises can help.  Hip mobility and gastrocnemius/calf stretching I found was helpful.  I found bridging exercises helpful too.

Some people have had a reduction of symptoms by using braces, or mcconnell taping.  Again, the prone quad stretch can be really helpful, and even mobilizing the lateral retinaculum might help.

Above is just my experience, again a good PT will be able to help more.  But .... its hard to find a PT who really knows about patella maltracking.  If the PT is focusing more on quads strength than hip-centric work, I would take that as a clear sign that you need to find another PT.
« Last Edit: October 18, 2011, 04:53:10 PM by yb »

Offline Tinkerbell11

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Re: Waiting on lateral release knees started clicking !
« Reply #10 on: October 18, 2011, 05:02:30 PM »
Thanks yb I am on the waiting list hopefully going to try and get me in in 9 weeks I am still sort of undecided and researching it ... But just keep been told am a good candidate with my knee caps just been tilted and if I put effort in at physio after yeah thing is the nhs physio is rather busy and can't keep going forever with it been very busy the physiotherapist I had was brilliant and included hip strengthening but found it all very difficult with my pain :( was going to the gym and keeping it all up myself but giving up with the pain :( I  have tried taping and braces the taping worked brilliantly and made my knee feel really nice and relaxed the brace helps but is a nightmare with my active job to keep moving about all day also notice that my knees getting worse with cold weather coming in whole things just a nightmare just want to do what's best for me with been so young !
Right Knee Lateral Release

Offline runnergal

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Re: Waiting on lateral release knees started clicking !
« Reply #11 on: October 18, 2011, 08:29:21 PM »
The clicking could very well be from cartilage damage between the patella and the femur (lateral femoral chondyle).  I'm suffering from it too.  Like you, my OS is recommending a LR.  I'm 44 and don't have a history of knee problems, no instability, and no giving out:  just an isolated injury.  My MRI shows a thickened retinaculum, patellar tilt, and full thickness cartilage loss on my lateral femoral chondyle and lateral aspect of the trochlea (likely from my patella 'kissing' my femur during the twist & fall).  The tibial tubercle to the troclear groove distance is normal.  I did over 6 months of PT, and my leg muscles are well-developed (including the VMO).  I'm doing my best to keep my muscles strong prior to surgery (including upper body -- for crutching!)   Good luck to you!

Offline Lottiefox

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Re: Waiting on lateral release knees started clicking !
« Reply #12 on: October 18, 2011, 09:01:50 PM »
I don't think anyone on here can tell you exactly what the clicking is....but my kneecaps are tilted laterally and they click. Do you mean one single click (almost like the analogy someone else used of a train jumping back onto its tracks) or is there a continual clicking/grinding noise and sensation as you straighten the leg/knee? Does it still happen if you put your foot on the floor with your knee bent and slide the leg outwards to straighten it but with the floor taking the weight of the leg?

It is interesting that the taping helped you. I think the problem with physio is that it takes a LONG time and you may not end up "pain free". Not sure when you have shonky knees that pain free ever really happens - but our goal has to be functional, free of serious pain that stops us doing normal things..... I guess the thing for me is that you manage your expectations from the surgery. If you feel comfortable with the concept of a LR and have decided to go for it, be realistic in what you expect afterwards. It isn't a painfree fix. You will need the right physio and dedicated time to get your leg back to strength afterwards. yb is spot on with the comment on physios. My first one was useless - quad focus and made all my symptoms worse. My second one - she stopped me having a LR two days before surgery and I haven't looked back.

Good luck. I'd be perhaps asking to see your GP if you're really worried about the new clicking and pain.

Lottie x
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 Tinkerbell11

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Re: Waiting on lateral release knees started clicking !
« Reply #13 on: October 18, 2011, 09:45:55 PM »
Thanks lottie and heinselrunner they thought I had cartilage damage before my 2 MRI scans which there's not I no the scans are not 100 percent but for two to show it all fine would seem strange according to my physio I actually have a very healthy knee part from the tilt good luck with ur surgery and let me no how it goes :) lottie it tends to click when I am in a seated position and it feels all sore and that it needs to click if u no what a mean and then a straighten it it clicks and it goes away sometimes a see myself sitting and have to constantly bend it and straighten It to get it to click to make the horrible sensation go away yeah it's a single click what I want out of surgery is just for it to feel a little better used to be very active and struggle with anything ! Is it a good thing the tapping help ? A thought it was meant to help u seem suprised it helped me ! Thanks for the help lottie x
Right Knee Lateral Release

Offline Lottiefox

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Re: Waiting on lateral release knees started clicking !
« Reply #14 on: October 18, 2011, 10:08:08 PM »
Hi Tinkerbell

I *think* from your description that it sounds like the kneecap is kind of slipping out of the groove it is meant to run in and you're having to "click" it back in. Imagine a train running on some tracks and it should run smoothly along the two lines. Then suddenly it hits a bit where the lines deviate and the train goes off track....sort of like our kneecaps do. That can be painful. The taping kind of tries to pull the kneecap back into the right groove; the reason i was surprised is that for many people it doesn't help (because the taping isn't quite right or because the issue isn't actually the slippage/angle). It never did anything for me apart from actually make my knee more sore! The MRI scans are not perfect - even on repeat scans they can miss cartilage damage but you need to know that once your doctor is inside your knee and checking out what is happening that if he thinks you DO have damage then he considers whether the release is still the best thing. Just make sure that after your op you get the right physio. SO many NHS physios do not understand about patella problems or knee rehab. They churn out the same useless exercises and don't look at what YOU need. If you can afford it, I might even see a private sports physio prior to your op who understands the knee joint They can make sure you do the right things after the release. There is NO point going through the surgery unless you do the right things afterwards.

I hope you get some relief soon. It is NO fun being in pain all the time.

Lottie xx
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....