Well, I posted a thread about 2 months ago about knee issues that I was having and an MRI report. Well, I saw another doc and today I got fitted for a knee brace that helps with patellar alignment. This thing is so fucking uncomfortable. I’m thinking about it and I’ve been dealing with these issues for over 10 years and I’m thinking at this point, what kind of conservative treatment options are there that will fix this permanently? So, I’ve been told by at least 3 different doctors over the years about lateral patellar retinaculum release surgery and how it might be an option for me. I was wondering if anyone else has considered it and why or why not did you go with it? If you had the surgery, what was the recovery like and what were the side effects?
Also, and to show you how bad my alignment issues are:
Don’t do it…I had a lateral release in '95 and it has been nothing but trouble ever since.
I am heading out the door, so don’t have time for a full run down, but I was told by Andy Pruitt afterwards that it is “the worst possible surgery for a cyclist.”
I had it done in 1990 as a last resort and the lit at that time was not clear as to whether if it was good or bad. I had done every possible type of strengthening, taping and bracing possible for over a year with no help. I finally got a lead into one of the pro team surgeons at the time to look at my knee and see what he said, and his recommendation was with all the failed outcomes of every possible alternative was to do the surgery. We thoroughly talked about my outcomes for the sports I was in at the time (which was running and hockey) and were given some time to make the decision. I had some options, find alternative sports where my condition would not be exacerbated, attempt failed treatments again, wait until new therapies option are discovered or have surgery. Given the experience of the surgeon and how much I had already been through I opted for the surgery, and my outcome had been great…but my story is by far in the minority! Ask 100 people who have had the surgery and you will find only 1 or 2 people like me is my guess. I chose surgery because at the time it was my last and only option and it was from a surgeon who knew what he was doing, had a very outstanding reputation. Had it been a different surgeon I probably would have waited or looked elsewhere because once its cut you can’t go back and correct it. If you feel you need to do this make sure you have exhausted every possible solution first, and then find your surgeon. I have never had a problem with running, hockey or cycling since and I am glad I had it done, but I am also glad I had a very trusted and experienced PT help and guide me along the process.
RUN AWAY or hobble away from the Ortho that is suggesting the lateral release! The incidence of success with that procedure is extremely low. At a minimum, get a second (maybe third) opinion with an Ortho that is focused on athletes (runners, bikers, tri-geeks). Many patellar tracking issues are related to pelvic instability - able to be fixed through hard work with a skilled physical therapist.
As the saying goes, there is more that one way to skin a cat - so take this reference as that - but there is a good discussion on the biomechanics of patellar tracking dysfunction here: http://posturalrestoration.com/ - full disclosure I used to sell this device many moons ago and saw a lot of relief provided from it but it is not the only path to relief - go see a good PT.
Agreed with what brewerbry said…look into hip / pelvic strengthening, etc. as one possible solution.
My lateral release was done in conjunction with cleaning up some cartilage damage. I did not know they were going to do the procedure, but had checked the box giving them permission to do additional procedures during the process. Massive mistake.
My initial rehab was horrific and was what finally led my to Andy Pruitt, paying out of my own pocket in desperation. That was when he told me (in conjunction with the doc he was practicing with at the time) that they had not done a lateral release on a cyclist in 12 years…and this was in 95!
As part of the procedure, they detached part of my lateral quad muscle. I therefore have a permamnent 10-15% strength imbalance that I can never correct. Until now, it had never been an issue, since I was a roadie. Once I started trying to run for triathlons, it has been I believe the root cause of injuries on my left side. First it was Achilles Tendinosis and now ITBS. I believe both of these are issues are related to the strength imbalance on my left side.
I honestly cannot emphasize enough the need to proceed very slowly. AS noted above, finding an ortho who is intimately familiar with the needs / mindset of an endurance athlete is critical. A “paint by the numbers” ortho is not gonna be able to make the correct decision, not give your proper guidance on how you should proceed. A lateral release may be a viable option for the general public, but should be approached with extreme caution by an endurance athlete.
Thanks, everyone. In addition to having a tight retinaculum, the grove that the patella sits in in the femur is also shallow which causes tracking issues. I’ve actually dislocated my left patella twice because of this. I am trying to proceed with conservative treatment plans first but I’m also thinking about other potential options as well.
I had my right knee done in 1996, and my left knee done in 1997. They detached my quads on both sides. As of this point, my only issue is that I’m now a bit of a fatty (which has more to do with having 4 kids and gone back to university), and that I still have pins in both knees, which kinda hurts when I kneel down.
When I had the surgery done, I opted to work on my own strength and conditioning with my doctor supervising what I did, and with input from physio. The end result was that I was playing squash again at about 4 months (only later did I find out how rare that was) out from my surgery each time. Both my legs are a lot weaker than they were, but that doesn’t matter as much to me as the decrease in pain and discomfort did. Pre-surgery my legs were in great shape, as I had been a very competitive swimmer, which probably helped a lot.
This is just my experience, and from what I have subsequently read, I was VERY lucky!
As a Physiotherapist in Australia who deals with this problem daily, I would agree with the others on this thread, in that the lateral release by itself is unlikely to help, and is quite difficult to recover from. It is a controversial procedure and rarely done these days. Your xrays shown here are only part of a big picture…starting all the way from your feet…all the way to your hips and pelvis. The rehab is complex and needs a very good assessment as a starting point. Is there a role for surgery? In some cases yes. With 2 previous dislocations and extremely poor tracking and instability on a daily basis surgery may be required…but its major with a capital M. It involves a lateral release plus a reconstruction of the medial patello-femoral ligament plus a medial tibial tubercle transfer (and a bloody good surgeon!) and a very long rehab.(with a very good Physio).
I’d actually be surprised that one can stretch those fibers enough to allow your knee to track better w/out surgery but I’m no doctor or therapist.
I underwent a scope that resulted in a lateral release + micro fracture surgery 2 years ago. My knee cap was tilted in a very similar manner as yours and as a result the cartilage underneath had been damaged. Prior to the scoping my ortho wasn’t sure what he’d find so it was a bit of a shock to wake up and find out what had been done. As others have noted recovering from the release was pretty rough, it swelled and hurt like a mo-fo. The video of the surgery showed the knee drop into the proper position after it was released. I was able to limp around after only a few days and was rehabbing myself on an exercise bike starting 2 weeks post op (starting with 1 minute a day and then 1 minute or 10% a week based on my progression). For me the surgery was a great success and I am running pain free (well except for unrelated ‘feet’ issues). I was hitting the elliptical 3 months post-op and jogging 4 month’s post-op. My right leg is still much “looser” than my left - in a good way though. I don’t feel any sort of instability or anything. In fact I’ve had more problems with my left leg (PF, AT) than my right since my surgery.
I’m really glad I didn’t read the sort of responses you have gotten so far else I would have been pretty depressed post-op. Anyhow maybe I was lucky because I have heard terrible stories about the micro fracture surgery as well.
I’m so-so about surgery at this point and the one thing that is keeping me positive is that all of the complaints are from people that had surgery 15+ years ago. I’m sure techniques have improved over the last 15 years and more information is known about the issues and procedures. I’m still looking at conservative options first though.
Well as far as techniques go, I’m not sure it has progressed much. When I asked my Ortho to describe what the lateral release was (because I had never heard of it at the time) he basically told me to picture a machete hacking through muscle and cord. I’m not sure that was the image I was looking for but I got lucky and had no clotting issues or problems with scar tissue and this w/out any PT, just self-rehab. knock on wood.
I’m so-so about surgery at this point and the one thing that is keeping me positive is that all of the complaints are from people that had surgery 15+ years ago. I’m sure techniques have improved over the last 15 years and more information is known about the issues and procedures. I’m still looking at conservative options first though.
…or it is that the medical community has realized the dire implications of the lateral release on endurance athletes and so it is rarely performed anymore.
steer far far away from a lateral release or any doc who considers it an option. I’m not sure what was discussed in the other thread about your knee, but what have you tried besides the patellar brace so far in terms of rehab etc.? the lateral release is sadly a mortgage payment surgery…very very few people actually need it and of those, not many will have a good outcome. Its a quick and easy procedure for an ortho surgeon that is of little value to the pt. Have you tried ART/graston in conjunction with rehab done by someone who knows what they’re doing? Also the brace will not fix the problem if that was your goal, it may slightly decrease the risk of a patellar dislocation but will more likely create other issues that you didn’t have before.
I am concerned that this brace may cause other issues because I can tell that I am favoring my right leg even when it is off. Besides no more athletic activity, I just don’t know what else to do to relieve the knee pain that I have.
I have not had it, but I am 90% sure that the Arpwave can help you. They have a track record of helping athletes with knee problems that need surgery, etc.
Nah, never went through with the surgery. I’ve decided that my knees are just always going to hurt and they’re just going to hurt in different ways. My right knee was bothering my for the first half of this year and now my left knee is starting to bother me. Actually, everything on my left side from my left SI joint down is bothering me at the moment, but it is improving. I just work on more medial quad strength and if anything comes up, I get to my physical therapist ASAP to get it fixed quickly. I had some plantar fasciitis creeping up for about 6 weeks or so. Hit it hard and 3 weeks later and it’s gone. I had it for over a year and a half at one point. I’m not one of those idiots that won’t go see a doctor until I’m dead. If something is wrong, I’ll go to a doc because I want to run!
