Lateral Release after an ACL Reconstruction

by Shelley
(San Jose, CA)

Two years ago, I had an ACL Reconstruction (patellar tendon graft). It seemed to go pretty well... less pain than expected for the first several months after surgery. My knee popped (loud, heavy, deep pop) almost daily... It is quite painful going up stairs, especially if I am carrying any additional weight.


I recently went back for MRI's and assessments, and my kneecap is tracking to the outside with a tilt.

The surgeon is considering a lateral release if the month of PT doesn't correct the problem. Does this sound like a reasonable approach?

Should I expect any additional complications due to the fact that I had an ACL Reconstruction two years ago? (My quads in that leg are much weaker than they were prior to the ACL Reconstruction).

I should also add that I am a good patient when it comes to Physical Therapy. I am diligent in following the directions and "home work" they assign...

Thank you for the info!
Shelley

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Mar 25, 2008
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Sounds reasonable...
by: Bart - SII

Lateral release has the best outcome when it is used to treat a laterally tilted patella...so if you truly do have lateral tilt, it would be the surgery of choice...however...

At least a month of conservative treatment should be done to make sure that surgery is absolutely necessary. Because of your previous ACL reconstruction, two things come to mind that I would pay special attention to - your patella mobility and scar tissue formation from the previous surgery, and your quadriceps/hip/core strength.

Patellar tendon graft ACL reconstructions are notorious for causing restricted patellar mobility.

What I mean by this is how freely your patella moves. To check yours, straighten both of your knees out and relax your quads - move your kneecap around on your uninjured side and see how freely it moves - side to side and up and down.

You should have some motion in all directions. Now do the same thing to your injured side - it should be the same as the other side. If you have limited motion or if it doesn't move as freely, that is a problem that could very well be contributing to your knee pain. Patellar mobilizations can be done to improve this motion - you can have your PT do them, or you can do them at home by simply pushing your patella in different directions and "stretching" the tissue.

Patellar tendon graft ACL reconstructions also tend to have a lot of extraneous scar formation around the patellar tendon and patella. If you have fibrosis in this area, it could be causing some of the popping and pain you are having. Friction massage can help with this, but after 2 years, the results may be limited.

Quadriceps strength is not as important as hip and core strength when talking about patella-femoral problems, but if it is significantly weaker than the other side, that needs to be addressed. Also, a strong focus on your hip abductors and external rotators is important.

I would suggest talking with your PT about all of your concerns - ask about your patellar mobility and their opinions on the lateral release procedure.

I hope this helps - use the comment box if you have other questions - and keep me posted on your progress!


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