Following an MRI scan I’ve been told my knees are arthritic, have no cartlidge, and my knee cap is tilted to the side. They advise a lateral release to cut the tissue from the side if my knee cap to make it more central to relieve the pain.
Seen mixed reviews on this, what are peoples experience?
Oh jeez…DON’T DO IT.
Had a lateral release in '95 and I have a permanent 10-15% strength deficit that can never be corrected. IMO, it has been the root cause of all my running issues since I started tri’s (Achilles, ITBS, now plantar fasciitis).
Recovery from the initial surgery was also a struggle, but that was more due to the idiots that were doing my PT. I finally gave up on them and paid out of my pocket to see Andy Pruitt and Dr. Holmes (whom he was working with at the time). Holmes said that a lateral release was “the worst possible surgery” for a cyclist and they had not performed one in a dozen years (remember, this was '95).
I would find a sports oriented Ortho doc who understands cycling and triathlon and get a second opinion. Only consent to a lateral release as a last ditch effort.
I’d definitely get a second opinion from a sports oriented orthopedist.
My wife had a lateral release about 10 years ago and after talking to her current ortho last year, he couldn’t believe that a doctor had even suggested it as the thinking had changed to its effectiveness further back than that.
It wound up doing nothing but weakening her knee further. I’m not an ortho so there may have been a switch back, and there may be instances where they’d be called for, but I’d make sure you knew what you were getting into.
Twomarks
First, get an opinion on whether medial soft-tissue realignment (such as medial patellofemoral ligament reconstruction) is an option.
Surgery should be considered only after physical therapy has failed to restore adequate patellofemoral tracking.
Don’t do it until and unless you find an orthopedist who is experienced in doing a simultaneous lateral release and tibial tubercle osteotomy. I had a lateral release on my right knee in 1998. Big mistake. Lost a lot of strength in that quad, had knee instability, and the kneecap didnt move a millimeter. Fast forward to 2011. Major left knee pain and swelling, which was unresponsive to PT, activity modification (slang for not running), Synvisc, and cortisone. I was offered a partial knee replacement by one ortho (patellofemoral compartment only) and a combo lateral release/TTO by another ortho. After thoroughly researching both options and re-interviewing both surgeons, I went for the lateral release/TTO combo. I can’t tell you if it was successful, because I am only 6 weeks post-surgery. No walking for exercise til 12 weeks post-surgery. No running for six months. But i am riding a ton (inside only) and swimming some (no kicking with the operative leg, no flip turns). The kneecap is definitely more centered, but whether I will be able to get back to competing in tris is still a question mark. Do NOT have a lateral release done without also having another procedure done at the same time to get the knee joint properly realigned. You will regret it.
Don’t do it until you have explored all non surgical options.
I had one in 2001 - big mistake
I was diligent with physio regime post op and it took years to recover/regain strength and am still not convinced that I have.
I would seek second/third opinion before proceeding and also seek opinion re non surgical options from none surgeons
When I had a lateral meniscus tear trimmed off, along with general cartilage cleanup, my surgeon decided to do a lateral release without consulting with me prior - it took me years to recover strength in my lower quad and full stability in my knee, and the three months post-surgery were brutal. All that for my kneecap to end up right back where it was before the procedure.
I finally got my knee back to 100% with kettle bell swings and Turkish get ups, then transitioned to tri five years ago and have maintained decent knees since, with help from a joint supplement. I’d definitely try single-leg extensions from full extension back to half-way down, and maybe some low-weight ballistic routines before letting a surgeon try to do a release.
Lateral releases are not really all that common anymore–except as a solution when nothing else is working.
The statement “knees are arthritic and have no cartilage” is pretty broad–did they tell you WHERE the arthrtis was, and which portions of the knee are damaged? DId they suggest alternatives?
I would definitely get a few opinions.
When I had a lateral meniscus tear trimmed off, along with general cartilage cleanup, my surgeon decided to do a lateral release without consulting with me prior - it took me years to recover strength in my lower quad and full stability in my knee, and the three months post-surgery were brutal. All that for my kneecap to end up right back where it was before the procedure.
Exactly what happened to me…guy went in to clean up some cartilage damage and did a lateral release why he was there.
I likely rode for 15 years with a significant imbalance that continued to compound itself. When I started running for tri’s, it started an ongoing cycle of running injuries (see above). Always on my left side, which is the side where my lateral release was performed.
So is the only cure stretching?
I have a sports massage each week, what should I target during these sessions?
Would Kenisis tape help, or whatever its called?
Me, too. I specifically asked him NOT to do the lateral release, and he did it anyway.
So is the only cure stretching?
I have a sports massage each week, what should I target during these sessions?
Would Kenisis tape help, or whatever its called?
Dunno…find a good sports-oriented ortho and a good PT and see what they say. In all honesty, given your description, I don’t know what a lateral release would achieve anyway…it won’t grow cartilage back or cure arthritis.
Definitely look into leg extensions to help strengthen the VMO and provide more central tracking for your knee cap.
So is the only cure stretching?
I have a sports massage each week, what should I target during these sessions?
Would Kenisis tape help, or whatever its called?
Dunno…find a good sports-oriented ortho and a good PT and see what they say. In all honesty, given your description, I don’t know what a lateral release would achieve anyway…it won’t grow cartilage back or cure arthritis.
Definitely look into leg extensions to help strengthen the VMO and provide more central tracking for your knee cap.
If the OP has significant patellofemoral OA (not sure this was specified), leg extensions are the last thing he/she should be doing. Supine straight leg raises to strengthen the VMO are the way to go. If they are too easy, add ankle weights.
To the OP: I don’t think anyone coming out of residency in the last 15 years is doing lateral releases. I’ve first assisted on dozens of MPFL reconstructions, but I’ve never been in the OR for a lateral release. I’ve only seen the aftermath, and it has never been good. Surgeons just don’t do them anymore because they don’t work based on what I’ve seen/read.
Well I had one about 21 years ago. Had significant problems running before the surgery. Had significant problems after the surgery. Eventually it got better (years). Maybe 12 years after the surgery it actually became better than before the surgery. Now I run without a brace and most would say I am pretty fast (ok maybe only some). I used the brace to keep my patella in place.
I have Patellofemoral OA. Severe at this point (bone on bone) for the last 2 yrs, I’ll be 39 by the end of the year. My Ortho doc wants to do a Fulkerson Osteotomy. I’m going to have it done next spring. I’ve done a year and half worth of PT with limited positive results. Napproxn helps a lot and I’ve stopped all running. I’m still able to swim & bike pain free. Consecutive hard bike days causes some extra aching.
I had both of my knees done 4 years ago and I have been fine ever since. I started triathlon 1 year after my surgeries and have done all distances up to a half ironman with no issues. Like others have said make sure you go to a good doc. Mine made me do 3 months of intensive pt before he would consider the surgery. I had about 3 weeks of recovery for both and I was back to normal. I know a lot of people have been saying don’t do it but I’m glad I had mine done and I know I wouldn’t be the same without it. If you feel like you don’t want to I would get a second opinion. If you are in central Wisconsin I can get you the name of the physician who did mine.
99.9% chance you can fix this with GOOD physical therapy. Finding good is another question.
To post a positive view, I had a lateral release done just 2 days ago on my right knee. I previously had therapy, exercises to strengthen the quads. I did this for about 6mths before realising my only possible option was surgery!! An mri scan showed patella tilt and cartilage damage under the Patella itself, and everywhere else was intact. I had suffered with knee pain, particularly going upstairs and being a keen runner (3-4) half marathons a yr wasn’t helping. My gp was very against surgery but I felt that unless I did something now my knee would only ever get worse. Well here I am 2 days post op and I feel great, I was fully weightbearing the day after and able to do exercises straight after surgery!! I haven’t needed painkillers once. I am totally convinced this was the best thing I could have done. I’m sure the fact that I was fit going into the surgery helped and also all the strengthening exercises beforehand helped too!! I believe this surgery air 
s if you are the right candidate, I also realise I have a long way to go but I’m recovering better than I could of imagined and I feel very positive that I’ll be running again in the future even if it is cross country from now on.
Good luck
Lisa
I also have had a very positive experience with a lateral release. My surgery was in Dec 2008 (after 1 year of unsuccessful PT) and was back running 4-5 months later but my PT was pretty conservative. I did have some minor residual knee pain through all of 2009 and into early 2010 that finally went after a series of ART sessions. Since then I’ve done 3 IMs and had no issues as long as I stay on top of basic hip strengthening exercises and foam rolling.
If I was to do it all over again, I would probably try active release for a period of time before giving in to the surgery.
Good luck!