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Author Topic: Lateral Release...Is it worth it??  (Read 5802 times)

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Offline CountryGirl

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Lateral Release...Is it worth it??
« on: May 09, 2012, 06:41:59 AM »
I cant decide rather to go thru with the surgery or look for a second oppinon. iv been having awful knee pains for the past 2 years since i fell down the stairs, i did physio twice and the last time they referred me to a ortho they said they had tried everything and nothing had helped. i had asked my physio to refer me to the best ortho around no matter the distance. because for 2 years iv been made to look like a fool about my knee problems by my doctor. had x rays and mri's an nothing was foound so i was determined to find a solution. so i went to the ortho. and he said that i needed to have a lateral release on my left knee (the one injured) and eventually i would need it on my right knee. turns out i was born with tilted knee caps. im only 19 yrs old and i didnt know if this surgery was common in teenagers or not? if i were to get this surgery what would my estimated time off work be? i work at sheetz so im on my feet the whole time. also im looking into being a police officer and i dont want this to ruin that dream. Help?
« Last Edit: May 09, 2012, 06:44:08 AM by CountryGirl »

Offline daveg72x

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Re: Lateral Release...Is it worth it??
« Reply #1 on: May 09, 2012, 12:27:22 PM »
Hi,
My daughter has a similar problem to the extent where if she puts her knees straight, both feet are pointing outwards and if she puts her feet straight her knees are ponting inwards. We never really saw it as a problem or even noticed it until she was about 14/15, whe she started doing more sports etc created pain in her knees, legs and hips. She went for x-ray and MRI and the surgeon said that there was no particular damage, but the twisting is unfortunately just the way she is built.  He recomended extensive Physio.

The physio was really good and explained that because she has this twist, she is not using all of the right muscles in her legs, and in her core and the muscles she is using are in a poor state. And that is what is causing the pain in her joints and because of her poor muscle tone it is exagerating the twist even more.
After 3 months of very disciplined Physio routine, she is really seeing the benefits. The pains are almost gone and she is a lot fitter and her muscle structure in her core and legs are much stronger and healthier. The surgeon said that surgery in this case is a very last resort and he was right.

What i am saying is, Try a good physio first. Really stick to it and put in a lot of hard work and effort. Do anything to avoid the surgery. Then if it really is not showing any improvement then and only then look into the Lateral release.
 
Dave.

Offline aaa

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Re: Lateral Release...Is it worth it??
« Reply #2 on: May 09, 2012, 02:15:32 PM »
Lateral release is a crapshoot, it almost never works.

Suggest you see someone specializing in patellofemoral issues, there is a list of surgeons somewhere on this site. 

Offline vickster

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Re: Lateral Release...Is it worth it??
« Reply #3 on: May 09, 2012, 03:26:36 PM »
What country are you in?
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline kneepaincure

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Re: Lateral Release...Is it worth it??
« Reply #4 on: May 10, 2012, 02:10:25 AM »
Hi CountryGirl,

I have the same problem as you do, and I would say that it's not necessary that the tilt is the cause of the pain. I had pain on and off for 2 years and finally one doctor suggested a lateral release which I refused to get done. After that I found a great physio and it's helped immensely. Diagnosing tilt as the cause of pain is not always right - other things could be causing it too. Maybe you didn't do the right physical therapy, and it could really help you if you target the right muscles. Surgery, especially the lateral release should always be a last resort especially considering that you want to be a police officer.
Have had tilted kneecaps for many years, and occasional patellar tendinitis.

Offline lululocket

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Re: Lateral Release...Is it worth it??
« Reply #5 on: May 10, 2012, 10:23:36 AM »
If your kneecaps are tilting outwards *assuming that is causing the pain*, you need the muscles pulling in to be stronger, and the muscles which pull outwards to be longer and stretchier. Think of your kneecap as a puppet being held up by strings - if they get out of balance then your kneecap can tilt and go the 'wrong' way, which hurts.

The LR will cut through a bit of the muscle structure that is pulling outwards. This will make them 'longer' in a way, but also much looser and weaker, which can cause problems if 'tilted kneecaps' is not the only problem. I would encourage you to think of surgery as the absolute last resort. It is traumatic, will weaken you further, and pretty hard to undo. You also need to be certain that you understand what the problem is and how surgery is the only thing that will fix it. Do everything you can to work on the muscles. After your injury, you probably avoided exercise for a while, your muscles got weaker and the imbalance between them got worse. This may be causing the pain, and clean xrays/MRIs suggest that you can fix this without drastic measures.

Lengthening the outside
How is your ITB (the band down the outside of your leg) - google illiotibial band to see which one I mean. If it is tight, you can have a huge impact on the tilt using a foam roller to stretch it (hurts a lot, but very effective - you lie on your side with the foam roller underneath and then roll up and down it, best £20 I spent in ages for pain relief).

Strengthening the inside
You need to make the VMO stronger.
http://www.sportsinjuryclinic.net/rehabilitation-exercises/knee-hamstring-thigh-exercises/vmo-rehab
2003 RK dislocation
multiple sublaxations (10+), both knees
2007 LK dislocation
03/2010 TTT on RK
03/2012 TTT on LK

Offline captainruss

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Re: Lateral Release...Is it worth it??
« Reply #6 on: May 10, 2012, 05:10:47 PM »
Countrygirl,

I would urge you to get multiple opinions before any surgery and especially before a Lateral Release.  Here is why:

My 15 year old daughter Kiani fractured her growth plate in her knee about six years ago.  OS put a cast on it and one side grew and the other did not.  She has had pain in her knee and another common problem in young women is her knee cap dislocates (sublux) as she has a shallow groove (also common in young women).  If you can move your knee cap (patella) laterally to the left or right more than half the length of the knee cap, you might also experience problems with a dislocating knee cap.  In my daughter, a Lateral Release would loosen her knee cap, not tighten it up or keep it in the groove.

I took Kiani to my OS and he recommended a LR after X-rays and MRI's.  He diagnosed her with Chondromalecia and a Plica.  He also recommended we see another OS at All Children's Hospital (Johns Hopkins) for a second opinion.  OS #2 examined Kiani and the films.  He recommended a LR and diagnosed Chondromalecia and a Plica.  I would normally have agreed to the procedure at this point...two great doctors....minimally invasive procedure...small scar with a scope. 

I decided to see one more OS at the same clinic (All Childrens) because neither OS #1 and OS #2 displayed any concern or interest in treating her knock kneed or bow legged condition.  Because of the growth plate, Kiani's knee bends outward.  So, I take her to OS #3 just 15 feet down the hall from OS #2  and he examines her.  He states that a LR would ruin her knee and would have had devastating complications.  He orders a rotational CT scan to check Kiani from her hip to her toes.  This CT had to be rescheduled twice because All Childrens did not have a radiologist who could do it.  We see OS #3 tomorrow and get the results, but we already know she has rotational problems as well as problems with her knee cap and cartilage.

A second point....I had eight (8) TKR's (Total Knee Replacements) in a two year period.  I had opinions from six different doctors (3 OS and 3 infectious disease).  I was told the TKR had to come out because my knee was infected causing swelling, hot to the touch, red..etc.  All the tests (50 different in 3 years) came back negative for infection.  I have endured the last seven surgeries because supposedly the knee was infected and to cure the infection it had to be removed, cleaned out, 6-8 weeks of I.V. antibiotics, and then put the joint back in. 

I went to see my OS yesterday and my knee (entire leg) is so swollen that I cannot walk.  They removed the joint seven (7) times to cure the infection which never showed up on the tests for infection and here I am three years later in worse condition than I was prior to the first TKR with both of my legs swollen (no idea why the good one is swelling) with no cure.  I am having ten different tests done in the next two weeks for everything from blood clots to auto immune deficiency.  I now have bone growing in the scar tissue that is growing in the knee because of my bodies response to the eight major procedures.

Please, understand I am in the 1/10th of 1 percent of all TKR patients who have major complications.  The odds of having my problems are like a hundred thousand to one......I am not trying to scare you in any way as your condition is sooooooo much less severe.....You do have a very painful knee that needs medical attention, but you will get the right treatment and live the rest of your life happily. 

All I am saying is I had six (6) different opinions from great doctors and they still don't know what is wrong with me other than eight major surgeries were not the cure (not needed) and I am worse off now than I was before the surgery. 

I am taking my daughter to see OS #3 on Friday.  A week from Monday we are going to Emory College in Atlanta to see Dr. X for another opinion.  On June 12th we are going to Ann Arbor Michigan to see Dr. T for another opinion.  Some here call me psycho dad, but from what I have learned is a LR can be the perfect cure to a diagnosis and it can also cause long term complications. 

Don't be nervous or hesitate to get all of the answers you need or until you are confident you have the right plan of action.

Keep us informed on how you do and what you do.  Again, I am not trying to scare you...just to illustrate that even six opinions was not enough in my very rare condition.

Russ
80 Shattered patella 5 surg
09† TKR†
09† MUA
09† MUA
09† Knee infected??
10† TKR† Scar Tissue
10† 2nd OS† Diagnosis Infection
10† TKR with antibiotic spacer, no joint
4/11† TKR
11† TKR PT
11† TKR
11† TKR† AF diagosis
12/11† HO diagnosed
2012† Intractable Pain
2012† OS split
amputation possible?

Offline captainruss

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Re: Lateral Release...Is it worth it??
« Reply #7 on: May 10, 2012, 05:13:34 PM »
I apologize for the length of my previous post. 

I know it bothers some people on this forum and that when I tell my story of my condition it also bothers some people.

This young lady is considering having surgery without a second opinion....or third or fourth.   I find that tragic and very scary.

So, please accept my humble apology for the length and content of the previous post.

Russ
80 Shattered patella 5 surg
09† TKR†
09† MUA
09† MUA
09† Knee infected??
10† TKR† Scar Tissue
10† 2nd OS† Diagnosis Infection
10† TKR with antibiotic spacer, no joint
4/11† TKR
11† TKR PT
11† TKR
11† TKR† AF diagosis
12/11† HO diagnosed
2012† Intractable Pain
2012† OS split
amputation possible?

Offline The KNEEguru

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Re: Lateral Release...Is it worth it??
« Reply #8 on: May 10, 2012, 07:47:18 PM »
Here is an article that may be of interest - http://www.healio.com/Orthopedics/Knee/news/print/orthopedics-today/%7B069F44D9-E426-48ED-AFD1-A4570DD12019%7D/Interview-What-are-the-current-indications-for-lateral-retinacular-release

You say that the knee problem started after you fell down the stairs? Can you tell us more about that injury - how it happened, what part of the knee (or knees) was injured, what the symptoms were at the time, etcetera. It seems unlikely that tilted kneecaps would suddenly become symptomatic after falling down the stairs.
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Offline Tinkerbell11

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Re: Lateral Release...Is it worth it??
« Reply #9 on: May 14, 2012, 03:02:16 AM »
Hey I would deffo stick with pt like everyone says lr has so many risks ! And I would get another opinion I went through with the lr was young like yourself 20 I have tilt to both knees but right was always more painful ! I had 2 os saying I should go ahead with it and one saying he wouldn't touch me and was asking for trouble. Its been 5 months still early days but knee feels brilliant so much more I can do cause pains improved so much ! So I have no regrets the tilt caused so much damage to my knee joint and scuffed cartilage so would of got worse if didn't go ahead ! Doesn't help everyone so deffo stick with pt which helps my other knee :) and make sure if u do decide get all the tests and people u want to see cause its ur knee and have to live with it ! Have u tried the Tapping for ur knee can't remember proper name but I found that helped me ? Lr is a tough and long recovery so wouldn't tell anyone to jump into it all the best and good luck xx
Right Knee Lateral Release

Offline CountryGirl

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Re: Lateral Release...Is it worth it??
« Reply #10 on: May 16, 2012, 04:49:56 AM »
I go back to the orthopedic tomorrow afternoon i wanna talk to him about this surgery. i wanna know every bit of info that is possible to know. he made it seem like it was NO BIG DEAL that i would be fine then i get on here and i feel like my dream of being a cop is crushed like im in a no win situation. when i feel 2 yrs ago on my left knee it wasnt down the steps it was up. i tripped an landed right on my knee right on the edge of the step not only once but twice in the same staircase. it was very bruised and i thought then that i really messed it up. everyone made me look like a fool. like i was faking this pain to get outta everything but i really wasnt. i went to my regular physician an she claimed it was just bruised. and i accepted that. but then the pain got WORSE to the point i didnt wanna get outta bed to do anything. thats wen they did the first xray an said nothing looked messed up. an they decided i should do physio so i did an i stuck to it i was there 3 or 4 days a week by then i was gettin sick of the pain. it was about 3 months into the physio when they claimed i was "cured" an released me. i didnt know wat to say or do so i left it go for a few months and then decided it was really getting outta hand the pain was NOT getting better and i wasnt helping letting it go an expecting it to be better wen i woke up so back to the doctor i went. thats when they said i needed an mri and once again nothing was wrong so i did another couple months of physio...not at the same place...i didnt feel they did their job an maybe that was the cause. so i decided id go to the better place an that was Drayers i had to pay bcuz my insurance didnt cover all of it but im determined to get better. couple months there and i start to notice a differance i was litterly there every other day things were looking just alittle bit better not much but a start...but then it all fell thru the pain became unbarable after physio so bad id go home an cry...Drayers did everything they could...and could tell i was just gettin frustrated that nothin was helpin me so they sent me to the OS outta town i was determined to have the BEST doctor around no matter wat. at my first appointment he did a check an had me do some stuff an worked with my knee an had xrays done an decided i had 2 choices steriod shots or the LR but he wanted to see this mri i had done so i got the release from the hospital and went back to the OS when he seen the MRI the shots were outta question..it was the surgery was the fix. said something about their both this way but my injury made this one worse. that probbly when im older ill need a LR on the other knee as well. im scared to DEATH i read so many bad things about LR idk wat to think. but now that im more educated on this LR i wanna discuss it with him an see how things play out. ill keep everyone updated. thanks SOOOO much for all of your feed back

Offline The KNEEguru

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Re: Lateral Release...Is it worth it??
« Reply #11 on: May 16, 2012, 10:12:30 AM »
I don't think you need to be scared 'to death', but you need to be informed so that you can make proper value judgements.

Firstly, let's consider your injury, which appears to have been a direct sharp blow to the front of the knee with the whole force of your body weight behind it, and bruising to follow plus the onset of pain that was not there before. So it was a significant injury. You say it was 'right on your knee', so I assume it was onto the middle of the patella, but you do not specify.

When you smack a patella hard in an impact injury, of course the patella may fracture (which yours appears not to have), but more common is that the cartilage surface behind the patella may burst in a star-shape from the impact. That would not have shown on X-ray, although it might have been evident in the later MRI. There may have been some bone bruising of the patella, which is often not evident on X-ray, but again it should have shown up on MRI.

Another thing that may have happened is that a synovial plica may have been traumatised (http://www.kneeguru.co.uk/KNEEnotes/node/1797). Clearly something was traumatised or you would not have had bruising. A bang on a medial or suprapatellar plica can cause it to bleed, and thicken and scar up, and subsequently it can catch between the femur and tibia in incidents of acute pain, or it can snap or the knee can give way.

Another thing that may have happened, depending on where exactly you banged the knee, is damage to the fat pad or to the patellar tendon and structures behind it.

I am not minimising the fact that your surgeon has found that you have two tilted patellae, and that tilted patella is a recognised indication for a LR, but your problem seems to have stemmed from this incident so that is what seems to require further elucidation.

What part of the knee exactly was banged with the initial injury? How long was it before you did physiotherapy. How did you manage the knee for the first 6 weeks or so after the injury?
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Offline aaa

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Re: Lateral Release...Is it worth it??
« Reply #12 on: May 16, 2012, 11:22:40 AM »
Hi CountryGirl,

I also had a really hard impact on my kneecap.  But instead of it fracturing or the cartilage getting damaged, it ended up dislocating / subluxing laterally.  My impact was on the medial border of the patella.

I had a lot of swelling, and some pain around the inside of the kneecap.  After that my kneecap became unstable as the ligaments became damaged.  I recently had my MPFL reconstructed and that seems to be curing the problem, but I'm still in the middle of rehab.

Offline rob43

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Re: Lateral Release...Is it worth it??
« Reply #13 on: May 16, 2012, 11:57:48 AM »
ive had it done on both knees!!!
if thats all thats causing the problem then id say have it done

Offline CountryGirl

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Re: Lateral Release...Is it worth it??
« Reply #14 on: May 17, 2012, 04:57:14 AM »
Okay went back to the OS today told him that i wasnt so sure about the surgery that iv read ALOT of very bad reviews on it. told him maybe we should look further into the mri maybe he missed something that would be causing this issue without needing this LR. he is a great doctor...and being 20 he took me serious about being scared of what the outcome might be. i was there for 2 hrs discussing this with him...he showed me the mri so i could see for myself that the knee cap was tilted showed me how it should be an how it is. its a very bad tilt. still my nerves were still going...i have dreams i dont want them wrecked. and he point blank told me. he wouldnt be suggesting this surgery if it wasnt the last resort and that its not the greatest surgery but at the point i am in theirs no other solutions. he also said i have arthritis in my knee. we talked about every detail. and iv decided to go thru with the lateral release. scheduled June 14th. some thing in my head is telling me to do it. im still very anxious and scared but im doing better now that i have had this discussion with my OS so wish me luck if you will and ill keep every one updated. thanks so much for all the great answers.