Overview
Lateral release surgery is used to treat patella femoral syndrome and other tracking problems with the patella. It is performed as an arthroscopic procedure and the decision to have this surgery should come only after failed conservative rehabilitation.
In some patients, the kneecap is abnormally pulled towards the outside of its groove. When the kneecap does not slide well within the groove, cartilage irritation and pain can result. There are several causes of patellar maltracking (the name given to the kneecap being pulled to the outside), and the most common is tight tissue attached to the outside of the kneecap (the lateral retinaculum).
When your doctor assesses your kneecap problems, he or she will look for several underlying problems with the mechanics of the kneecap. Patellar tilt is the angle of the kneecap, and whether or not it is being excessively tilted by a tight retinaculum. The other is patellar subluxation, which is when the kneecap is being pulled outside of the groove due to malalignment.
Lateral release is best for patient with excessive patellar tilt. When the lateral retinaculum is too tight, it can act as a tether to the kneecap. A lateral release is a procedure performed to cut through this tight retinaculum, and allow the kneecap to sit properly within its groove.
Does a lateral release help with knee pain?
A lateral release is successful when performed in the right patient. For many years, doctors were performing this procedure too commonly, and some patients did not find relief. As we have gained experience with this problem, surgeons have become better at selecting which patients are likely to benefit from a lateral release.
What are the side effects of a lateral release?
The most common side effect of a lateral release is bleeding into the knee; this can lead to pain and swelling. Other complications include infection, and scar tissue formation.
Surgical Procedure
A lateral release is most effective in treating either lateral tilt or a lateral riding patella. If you have either of these problems you should have good results after your surgery.
Lateral Release
The lateral release begins with an arthroscopic evaluation. Your surgeon will make 2-3 small portal incisions in order to look inside the knee joint.
They will evaluate all of the structures including the ligaments, meniscus, joint surfaces, and the retinaculum.
Once they determine the best treatment, a release of the lateral retinaculum will be performed.
They will cut through the lateral retinaculum in order to release the tension on the tissue. This will allow your patella to return to a normal position.
Once the release is performed, they will close your incisions with sutures or staples. Most surgeons will also place a small pad with an elastic bandage on the outside of your knee to help keep the patella from returning to its lateral position.
Recovery
Full recovery from this knee surgery can take anywhere from 3-5 months. Most people will be able to return to normal activities in a few weeks, and then return to sports once their strength and balance are restored. You may be on crutches for a few days or one to two weeks depending on your pain levels and surgeons preference.
Rehabilitation after a lateral release is essential for a full recovery. Because patella femoral problems are caused by many different factors, you need to go through a good rehab program to address any flexibility or strength issues.
After Surgery
Many surgeons will have their patients take part in formal physical therapy after knee surgery for patellofemoral problems. Patients undergoing a patellar shaving usually begin rehabilitation right away. More involved surgeries for patellar realignment or restorative procedures for the articular cartilage require a delay before going to therapy. And rehabilitation may be slower to allow the bone or cartilage to heal before too much strain can be put on the knee.
The first few physical therapy treatments are designed to help control the pain and swelling from the surgery. The physical therapist will choose exercises to help improve knee motion and to get the quadriceps muscles toned and active again. Muscle stimulation, using electrodes over the quadriceps muscle, may be needed at first to get the muscle moving again.
As the program evolves, more challenging exercises are chosen to safely advance the knee's strength and function. The key is to get the soft tissues in balance through safe stretching and gradual strengthening.
The physical therapist's goal is to help you keep your pain under control, ensure you place only a safe amount of weight on the healing knee, and improve your strength and range of motion. When you are well under way, regular visits to the therapist's office will end. The therapist will continue to be a resource, but you will be in charge of doing your exercises as part of an ongoing home program.
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