what is a lateral release?

[Aubz87]

I know it isn't an abbreviation or anything. And I'm not going to get one, Im just REALLY curious as to what it is, i've never heard of it before...

thanks!
Aubz

[jennwren]

If you go to www.webmd.com and type in Lateral release.. it has some info there.

I know it's a surgery to fix a pateller tracking problem.. but I don't totally understand it yet.. and I just had this done 9 days ago LOL.. I should know..  I hope you find the info there.



jenn

[Heather M.]

You both should check out the 'general info' link at the top of this page--go to step 5 on patellae and read away!  It's good information, and very easy to understand. 

http://www.kneeguru.co.uk/KNEEnotes/primers/patella/surgical-procedures-correct-patellar-alignment
http://www.kneeguru.co.uk/KNEEnotes/primers/patella/lateral-retinaculum-and-lateral-release
http://www.kneeguru.co.uk/KNEEnotes/courses/patellofemoral-pain/conditions-interfering-patellofemoral-mechanics

Lateral release is a surgery to cut through the lateral retinaculum, a bit of tough, gristly tissue that goes down the outside of the knee--from the base of the quads all the way down to a bit below the knee on the outside.  It, along with other structures, is attached to the kneecap and helps keep it in position in the trochlear groove.  If you have a tight lateral retinaculum, then it can actually pull your kneecap out of place to the outside (called lateral mal-tracking) and/or can actually tilt your kneecap so that the outer side is lower than the inner side.  Take a look at the pictures to see this demonstrated in the link--it's great.

Anyway, lateral release is a bit of a controversial surgery.  The best knee specialists out there believe it is massively over-done--it's so easy to do it (arthroscopic) and doctors seem to have this idea that it's no big deal.  It is a big deal and it changes the mechanics of your knee.  If it's done correctly and for the right reasons, it can really improve a patient's quality of life.  Done for the wrong reasons or overly-aggressively, it can lead to serious issues and even disability.  It's complications are not to be taken lightly, and I'm probably not the best person to tell you about them, because I had the three worst ones you can get--hemarthrosis or joint bleed, arthrofibrosis or excessive scar tissue formation, and patella baja or kneecap that dropped down too low in the joint and is now leading to bone on bone contact.

But I'm a worst case scenario.  I suggest if you are considering this surgery, do lots of reading on it.  And find a doctor who specializes in knees and PFS.  Most orthopedic surgeons do lateral release--it's a 'simple' arthroscopic procedure.  But very few OS's do any of the bigger realignment procedures.  So I'd rather see a doctor who does a bunch of patella realignment procedures and see which one he feels is best for me--instead of seeing a doctor who recommends lateral release because that's the ONLY knee realignment procedure he does.

Once you've read the patella information on this page, check out a couple of other really good resources on PFS (patello-femoral syndrome).

http://www.steadman-hawkins.com/pate/overview.asp
http://www.kneehippain.com
Both of these are fantastic resources to add to the information you get on the kneeguru's general info section.

Also, go down the the patello-femoral joint section.  There are probably hundreds of posts relating to lateral release and patellar realignment.

Heather

[jennwren]

wow thanks for that info. I wish my OS had told me exactly what he was doing before I went to surgery. I honestly thought I was just having a simple arthroscopic surgery.. I had two before and i recovered really quickly from both of them..

then I spoke to him last week and he told me that the pain i was in was from him doing a lateral release.. so then I started doing research... but your explaination was the best I've seen.

Thanks I will keep reading

jenn

[Aubz87]

AWESOME,

thanks much for all the information, it's really informative, and I'm glad to FINALLY start to understand the whole concept of the pateller tracking problems...

Jennwren, good  luck with the recovery, seems like that was an intense surgery, hope all's going well!

xoxo
aubz

[jennwren]

AWESOME,

thanks much for all the information, it's really informative, and I'm glad to FINALLY start to understand the whole concept of the pateller tracking problems...

Jennwren, good  luck with the recovery, seems like that was an intense surgery, hope all's going well!

xoxo
aubz

Thank you Aubz, I'm actually doing really really well. I'm healing up wonderfully Thank you for your well wishes.

Jenn

[imnotpunk]

Wow Heather, it's so crazy to read someone else who's struggled that much after a LR -- I thought I was the only one. I know you mentioned it in the other thread, but I felt like commenting on it here; it seems so rare to find a person who had dealt with a LOT of scar tissue after a seemingly 'simple' LR. Before I had it done I figured that it WAS a simple procedure because that's the impression I got from my OS. And of course, as you are well aware now, I've since switched doctors (I am now seeing a knee specialist). He also told me how complex this type of procedure could be, which really made me second-guess getting the LR in the first place.

Ugh, I've been doing a lot of second-guessing these past few days, it's definitely not a good feeling. *sigh*

Heather, I've been meaning to ask you though, how "long" did it take you to form the scar tissue in your knee? I mean, after your first LR did you make progress at first only to have many setbacks which led to the arthrofibrosis or did you have the frozen knee pretty much from the getgo? For me, I had very limited ROM from the start (which was already unusual for a LR, or so I was told by the infamous PT), but after my OS dropped my leg off the table during a post-op appointment my ROM just went to crap and I never was able to regain it, I guess causing the scar tissue to rapidly form. But you already know THAT story, so let's not open that can of worms again  

Patricia

[Heather M.]

Patricia,

Likely the scar tissue formed right away.  The thing is, when scar tissue is new it's very rubbery and pliable.  But as it ages, it begins to harden, shrink, become more fibrous, and put traction on whatever it is attached to...usually, the point to start really going south for me was 3 months or 12 weeks post op.  That was when the pain and heat and lack of function would start to grow, rather than shrinking.

I actually rehabbed pretty well after my LR which was on 8/31/01.  The day before Thanksgiving of that year, I went to PT and everything just seemed to really hurt.  I took a break over the holiday weekend, and things just got worse and worse from there.  In early December I had an MRI, which came out perfectly fine.  Over Christmas and again in January of 02 I did two rounds of prednisone (oral steroid) which knocked back the heat and swelling very well...but it always came back.

On 2/04/02 I had my second scope and my OS was horrified at the amount of scar tissue in my knee.  He said he'd never seen so much, not even after a knee replacement.  He scraped it all out and on the operative report noted that I had patella baja (in the days before I even knew what that was!).  I was given a cortisone shot after he closed, and put into PT the next day, encouraged not to use crutches, and so forth.  One week post op my lower incision popped open, and refused to close.  It drained for two weeks, and I was on antibiotics the whole time.  Despite that, I got a raging infection and on 2/25/02 I had my third scope--this time to clean out infection.  It was only 3 weeks after my scar tissue scope, and my knee was horribly traumatized.  I woke up in the recovery room in a CPM set at 45 degrees and I was crying from the pain.  I could only bend it to 30 degrees before the pain became unbearable.  So they checked me into the hospital for pain management and IV antibiotics.  When I got out, I went straight to PT and had a couple of scares with the incision not wanting to close.  Finally it did, and we worked on ROM after that.  By late March, I had managed to go from 55 degrees flexion to 85, and couldn't straighten the leg no matter what.  So on April Fool's day I had a manipulation.  It worked--I got to 135 degrees flexion, anyway.  But extension was still lacking, and I still had patella baja.  The pain was so bad I couldn't build up my quad at all--it shut down.  The stabbing scar tissue pain continued, and my incisions started to adhere down, the patella lost mobility, and the doctor was very concerned about the patella baja being permanent.  I begged him to do another scope because I was in so much pain.  He did, and found there were actual strands of scar tissue connecting each of my incisions under the skin, and a little scar-wrapped bit of nerve (neuroma) near the lateral release site.

Unfortunately, despite being on antibiotics, I again got an infection--this time I got nice red stripes on my thigh!  It was handled medically this time because I just couldn't take any more surgeries.  I was able to regain ROM to about 120, but was missing 3 crucial degrees of extension.  And the pain was unbelievable.  I entered pain management and went through a whole long course of diagnostic tests at the Mayo Clinic in Scottsdale.  One month later, the OS there told me to leave the knee alone and 'get used to pain.'  But my knee was getting worse, inflamed, red hot, stabbing pain, losing ROM...it got so bad that my kneecap would catch just about every step I took.  I had a terrible limp and the kneecap was really all over the place (not to mention in a severe baja situation).

My first OS said he couldn't help me anymore, that he didn't understand why my knee was so messed up, and that it looked like my problems were genetic and he couldn't help with surgery.  Great, huh?  I really liked him, though.  It might have been easier if he had been a jerk--but he was a wonderful, thoughtful surgeon who really wanted to help.

I finally went to see Dr. Steadman and in December of 02 had my fifth knee scope.  He found TONS of scar tissue.  It started to regrow in a couple of areas despite our best efforts with very careful PT.  So 2.5 weeks post-op, he did another procedure (insufflation) which ruptured most of the scar tissue.  The rest was liveable.  But the problems the scar tissue left in my knee are permanent, because the mechanics are altered completely.

All this because of a stinking lateral release.  I wish I'd said no, I really do!

So that's my story--feel better now, Patricia?  Maybe not, but sometimes it helps to know others have gone through total medical nightmares and came out alive on the other side....

Heather

PS Jenn I see that you're in Phoenix.  I used to live in Ahwatukee until 3/04, when I moved up to Sedona.  Where are you in the Valley?

[Decruz]

Dear Heather,
I read your story and I'm terrifed, I'm trying to contact you (http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=49872.0) but you're not active in this bullettin board from one year and I don't know how and if I can bother you.
Please let me know, with a personal message if you prefer - I post here hoping you've setted the automatic e-mail warning, so you can see this...
Thank you