Lateral Release efficiency

[AlexisB2007]

Hi!

I have a torn medial meniscus and a tracking problem in my left knee, specifically a tilt. Doctor wants to do a lateral release but I’m reading nothing but bad things about it. Anyone have good success with this?

[Vickster]

Maybe get a second opinion. Is your surgeon a patella expert?
Have you been doing physio to try to address the Maltracking?
When did you tear the meniscus, have you rehabbed and given it time to heal? How big is the tear? Where is it? How old are you? Is the surgeon proposing to stitch or trim?

There are some articles around lateral release in the learning portfolio. The indications where you might get a successful outcome are quite limited so be very sure you fulfil the criteria.

E.g. https://www.kneeguru.co.uk/KNEEnotes/articles/expert-views/2019/lateral-release-why-bad-reputation

[AlexisB2007]

I’m 35 and have had the tracking issue since childhood. I’ve rehabbed it several times. Rehab was successful as a kid but now doesn’t help. The pain is just getting worse. I do also have arthritis.

I’m not sure when I tore the meniscus. No specific injury so more than likely it’s degenerative. It is small and doesn’t cause pain. It’s an oblique year in the posterior horn. He is planning on trimming it and cleaning it up.

The meniscus isn’t his concern, it’s the tracking and patella tilt. I do trust him and I’m gonna do research and see if there’s a better option.

[Lee1984]

Once they start cutting the retinaculum etc you get scarring etc and sometimes that can be worse then the arthritus as you constantly feel it as you walk.

I would look at the link Vickster gave you as Dr Blond seems to understand this and lengthens these structures rather than just slice them to release pressure..

[kineticrev]

I’m 35 and have had the tracking issue since childhood. I’ve rehabbed it several times. Rehab was successful as a kid but now doesn’t help. The pain is just getting worse. I do also have arthritis.

What kind of rehab exercises have/had you been working on?

[AlexisB2007]

The PT has me working on my inner thigh muscles and rolling the IT BAND. Doing a lot of resistance band glute bridges. I really don’t think I have a muscle imbalance though. As a child, I did, but not now as I have been working out for 3 years. I am wearing a Donjoy J brace now though. Not sure if it’s helping.

[stillwaiting]

Lateral release is RARELY indicated.  And when it is indicated, the surgeon is still making a subjective cut.  If he drinks too much coffee and gets scalpel happy, you're screwed.  Some patella specialists say to never do it.  Some patella specialists do a lengthening procedure.  The lengthening procedure requires a bunch more effort (as opposed to just cutting through the structure) but it allows the knee to maintain the critical check-rein function of the lateral side.


Very few of these guys have any clue about the patella and lateral release is a super simple procedure and they get paid good money whether you get better or not.  They even get paid if you're made exponentially worse.  Before you have the procedure, I would ask him how many Lateral Release reversal procedures he has done (it's called an LPFL reconstruction).  Ask him if he has done any lengthening procedures.  If he hasn't done any (and it's possible he hasn't heard of either), I'd stay far away. Seek out the opinion of a true patella specialist, and there are very few but you'll find some names in the forums who can do a skype consult and MRI review. 

Just my 2 cents, take it for what it's worth.

[frustrated101]

I had the equivalent of 4 lateral releases done to my knees (all without my consent).  I went from running and kiteboarding to not being able to walk down stairs and becoming a couch potato. My left quad shriveled up and died and my right knee is much worse than before.  On the bright side, I'm 3 months removed from having my left LPFL and MPFL reconstructed and can see a few positive changes and will hopefully get back to 90% of what I was before the surgical injury known as release of the kneecap.  My life has been a nightmare since the releases and I know you are suffering but I hope you don't go that route. 

[AlexisB2007]

I had the equivalent of 4 lateral releases done to my knees (all without my consent).  I went from running and kiteboarding to not being able to walk down stairs and becoming a couch potato. My left quad shriveled up and died and my right knee is much worse than before.  On the bright side, I'm 3 months removed from having my left LPFL and MPFL reconstructed and can see a few positive changes and will hopefully get back to 90% of what I was before the surgical injury known as release of the kneecap.  My life has been a nightmare since the releases and I know you are suffering but I hope you don't go that route.

When were your LRs done?

[frustrated101]

The place I went to is considered one of the best in the world and the surgeon I had had a lot of articles on pubmed which is why I chose him, he was the worst decision of my life.  The forum has rules tho, cannot mention names or clinics so I won't this time around.  I had my left LPFL and MPFL (the ligaments that connect the kneecap to the thighbone) reconstructed in January after my guy illegally cut them to show off for his "fellow" all the things he could do.  He was only supposed to do anterior interval release but he made the decision to detach my kneecaps from the thighbone after I was under the gas and did it to both of my knees.  Genius.  Perhaps he thought I was a cadaver, maybe he drank the night before and was hungover, perhaps he was paid extra by insurance for doing additional things.  I don't know.  My left knee lost 88% of it's strength post releases(cutting of important structures) and my right knee about 20%.  My right knee is functional but much worse than before what he did.  I've been able to improve my pain-free quad strength left knee from 5lbs to 20lbs terminal knee extensions  post recon (I've quadrupled my pain free strength!!)but I need to get it up to 50lbs to get back to where I was pre-surgical crippling.  A long ways to go.  I haven't been able to walk down stairs in 15 months and I take NSAIDS more or less every day now.

If I were you I'd purchase some ankle weights.  https://www.amazon.com/All-Pro-Weight-Adjustable-Weights/dp/B001U0HJN0/ref=sr_1_3?crid=2XTE2CVT4OD9D&keywords=all+pro+ankle+weights&qid=1556820174&s=gateway&sprefix=all+pro%2Caps%2C366&sr=8-3   Sit on the edge of a table, put the weights on your ankle, and extend the leg.  It's the best exercise for building the quad.  Stay away from lateral release and the doctor who recommended it, especially if he has never done LPFL reconstruction.  Or maybe have him sign a contract with you and your lawyer whereby he has to refund all surgical fees he makes for the surgery plus an additional $20,000 if (and certainly when) you find yourself in a much worse situation because of his ineptitude.  You can then use that money to go to the guy who reconstructed my kneecap ligaments but your knee will never be the same after your guy injures you.

Listen to the people on the forum.  We are all here because of what we've been through.  Experience trumps book smarts and medical textbooks any day of the week.  I'd say a good bunch of us can give better opinions that most surgeons (at least those who have never had the injuries or the problems they attempt to treat) any day of the week.  You can PM me if you have any other questions.

-Bill

[AlexisB2007]

frustrated101 I got your message but it won’t let me reply.

I haven’t decided on the surgery yet. I’m still researching and talking to my doctor. I do trust him and I know he genuinely wants the best for me. He’s not one of those doctors who are in it for the money.

I workout at the gym a lot and have plenty of leg muscles so I know my issues aren’t from a muscle imbalance. Which is why physical therapy didn’t work for me this time around.

Doc did say if a LR doesn’t correct the issue, then a tibial tubercle transfer would be the next step.

[frustrated101]

No worries.  You have to have 20 messages to PM. 

This sounds like a bad idea.   The lateral release result can go 1 of 2 ways.  Your symptoms will resolve or you will get worse.  It's not a neutral or better procedure.  So if you do get worse, then the plan is to saw out your tibial tubercle and move it into another position?  And what if that then makes you even worse.  Then you'll have a damaged retinaculum and a misplaced tibial tubercle.  What then?  Reverse the tibial tubercle back to the original spot and reconstruct the lateral retinaculum?  3 surgeries, lots of unemployment and depression and pain, and now you are leagues worse than where you started?

My advice to you is this.  Do a consult with my guy Lars Blond.  An opinion is only as good as the person giving it.  It will cost you 175 dollars via SKYPE but that is a drop in the bucket if you proceed down a potentially nightmarish path.  If lateral release/ lenghtening/or TTO is indicated he will let you know.  If there is nothing that can surgically help you at this time he will let you know.  Do you really want just one opinion, this is your knee you are playing with.  He may seem like a nice guy and want the best for you, but the surgeon who injured me seemed like a nice guy but was a complete unethical moron in hindsight.

Very few out there are more skilled or knowledgeable with regard to the patella than him.  He invented arthrocopic trocheoplasty.  And he's a decent human being as well.  He told me last time we talked "maybe you'll be able to train harder once your left knee gets better and then you might be able to avoid surgery to your right knee (damaged LPFL/MPFL).  Please read https://www.kneeguru.co.uk/KNEEtalk/index.php?topic=75746.0  (specifically 2nd, 3rd, 4th)
That's the type of surgeon you want, someone like Lars Blond.  Not some POS who offers to do both knees at the same time and then does the wrong procedure to both of them.  Anyhow, hopefully you won't have to go through what I'm going thru and what many others before you have gone thru.  Should read through the diaries of smillie and greyliston when you get a chance. 
-Bill

[AlexisB2007]

No worries.  You have to have 20 messages to PM. 

This sounds like a bad idea.   The lateral release result can go 1 of 2 ways.  Your symptoms will resolve or you will get worse.  It's not a neutral or better procedure.  So if you do get worse, then the plan is to saw out your tibial tubercle and move it into another position?  And what if that then makes you even worse.  Then you'll have a damaged retinaculum and a misplaced tibial tubercle.  What then?  Reverse the tibial tubercle back to the original spot and reconstruct the lateral retinaculum?  3 surgeries, lots of unemployment and depression and pain, and now you are leagues worse than where you started?

My advice to you is this.  Do a consult with my guy Lars Blond.  An opinion is only as good as the person giving it.  It will cost you 175 dollars via SKYPE but that is a drop in the bucket if you proceed down a potentially nightmarish path.  If lateral release/ lenghtening/or TTO is indicated he will let you know.  If there is nothing that can surgically help you at this time he will let you know.  Do you really want just one opinion, this is your knee you are playing with.  He may seem like a nice guy and want the best for you, but the surgeon who injured me seemed like a nice guy but was a complete unethical moron in hindsight.

Very few out there are more skilled or knowledgeable with regard to the patella than him.  He invented arthrocopic trocheoplasty.  And he's a decent human being as well.  He told me last time we talked "maybe you'll be able to train harder once your left knee gets better and then you might be able to avoid surgery to your right knee (damaged LPFL/MPFL).  Please read https://www.kneeguru.co.uk/KNEEtalk/index.php?topic=75746.0  (specifically 2nd, 3rd, 4th)
That's the type of surgeon you want, someone like Lars Blond.  Not some POS who offers to do both knees at the same time and then does the wrong procedure to both of them.  Anyhow, hopefully you won't have to go through what I'm going thru and what many others before you have gone thru.  Should read through the diaries of smillie and greyliston when you get a chance. 
-Bill

Thank you so much for your help! I’m definitely going to do more research and talk to my doctor some more.

[frustrated101]

Yea no problem.  So you won't be taking my advice and contacting Lars?!?!?!  All good no worries.   Hope things work out and you graduate from kneeguru one day(graduation=getting back to life and spending less time on the forums-that's how I see it at least)

[AlexisB2007]

I may try to get another opinion locally. I can’t afford a $175 consult.