patella knee syndrome (surgery or not)

My doctor said I am probably looking at a lateral release procedure for my knee problem. He said it isn't urgent and to think about it. What if I don't have this done? I do have pain in daily and sports activities. I am not too keen on surgery.

My doctor gave me a patella brace for now while doing any kind of activity. I also have strengthening exercises to do. I am a 55-year-old female who wishes to stay active forever.

If I have to live through some pain without any further injury or damage to my knee, that is fine. If surgery will prevent further damage, then so be it too. I just need to know.

Thank you.

Diane

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patella knee syndrome (surgery or not)

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Nov 03, 2008
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patella femoral syndrome surgery
by: Bart - SII

Making a decision to have surgery for PFS is one that needs lots of consideration. I can't comment specifically on your situation, so let me give you some background information regarding a lateral release and its success with PFS.

Lateral release surgery is best used to treat lateral tilt of the patella. This is caused by excessive tightness of the lateral patellar retinaculum. If lateral tilt is not present, then the success rate of a lateral release decreases.

Lateral tilt is only one factor that contributes to patella femoral syndrome. It is one very common contributing factor, but it isn't always present.

Many times, a lateral release is used as the last option for treating PFS, after conservative rehabilitation fails. The biggest problem is that many times the rehabilitation focuses on the quadriceps, and strengthening of the VMO. This is usually not the primary problem of PFS. And since the primary problem (hip strength and control) is not addressed, rehab fails. Then, unfortunately, after the surgery, the rehab continues to focus on the quads and VMO and the real problem isn't ever addressed, leading to continued knee pain.

So, before considering a lateral release, make sure that you think about these things:

Do you have true lateral tilt of the patella?
Have you gone through a comprehensive rehabilitation program for patella femoral syndrome that focuses on strengthening of the hips and core, improving mobility of the hips and lumbar spine, and improving balance and muscle control?
Have you had your gait evaluated and corrected for any overpronation at the feet?

If you answer yes to all of these things, then a lateral release is likely your next choice. If you answered no to any of them, I would explore those options first before surgery.

Again, these are just my opinions, but they are based on many patients that I have seen with PFS.

Bart

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Nov 03, 2008
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Submitted by: Bart - SII

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Making a decision to have surgery for PFS is one that needs lots of consideration. I can't comment specifically on your situation, so let me give you some background information regarding a lateral release and its success with PFS. Lateral release surgery is best used to treat lateral tilt of the patella. This is caused by excessive tightness of the lateral patellar retinaculum. If lateral tilt is not present, then the success rate of a lateral release decreases. Lateral tilt is only one factor that contributes to patella femoral syndrome. It is one very common contributing factor, but it isn't always present. Many times, a lateral release is used as the last option for treating PFS, after conservative rehabilitation fails. The biggest problem is that many times the rehabilitation focuses on the quadriceps, and strengthening of the VMO. This is usually not the primary problem of PFS. And since the primary problem (hip strength and control) is not addressed, rehab fails. Then, unfortunately, after the surgery, the rehab continues to focus on the quads and VMO and the real problem isn't ever addressed, leading to continued knee pain. So, before considering a lateral release, make sure that you think about these things: Do you have true lateral tilt of the patella? Have you gone through a comprehensive rehabilitation program for patella femoral syndrome that focuses on strengthening of the hips and core, improving mobility of the hips and lumbar spine, and improving balance and muscle control? Have you had your gait evaluated and corrected for any overpronation at the feet? If you answer yes to all of these things, then a lateral release is likely your next choice. If you answered no to any of them, I would explore those options first before surgery. Again, these are just my opinions, but they are based on many patients that I have seen with PFS. Bart

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Nov 22, 2008
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lateral release
by: Anonymous

your comments are interesting - about 4 years ago while out shoveling snow - i slipped on the ice and seemingly dislocated the patella along with damaging the miniscus - had arthro surgery to repair the miniscus after which the knee felt unstable - like it was slipping around inside - i had several minor dislocations and one major which found me seeking a specialist - i had a lateral release done about 8 months ago - did extensive rehab after surgery - i have now had another major dislocation caused by a slip on a slippery hiking trail - went down like a ton of bricks - again heard and felt the "pop" - in my research i have read that once a dislocation happens it does become prone to more - the lateral release seemed to have worked - but given that it has again dislocated - well.........
so - now that the lateral release has been done, what else is there that can be done - would be nice to be able to walk around without the fear of having another dislocation -

Dec 10, 2008
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re: lateral release
by: Bart - SII

Your situation sounds all too familiar. A lateral release often will not correct for patellar dislocations. Once you dislocate, you have some instability, usually medially, with the patella. With the dislocation, the medial patellafemoral ligament is torn. It will heal and scar, but it will likely continue to be lax. A lateral release loosens up the lateral side of the patella - so after that procedure you have even more mobility of the kneecap.

Surgical intervention for dislocations include medial reefing (where they tighten the medial soft tissue to stabilize the patella) or a reconstruction of the medial patella femoral ligament (this one is not nearly as common as the medial reefing or medial realignment procedure.

Rehab focused on the hips and core may help. If you can keep the femur out of the "danger zone", then you are less likely to dislocate.

Hope this helps.

Bart

May 09, 2009
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lateral release
by: 1.5yrs

i had a lateral release done almost a year and a half ago. after therapy and everything i played a year of college soccer on it but i wasnt the same and quit the team. the only time i have pain now is when the weather is bad or i step on it wrong. but other than that it was a very successful surgery. hope this helps.

Jun 12, 2009
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Patellar Dislocation
by: Craig L

Hey everyone, this looks like a legit website for help. My kneecap dislocated for the first time last August, since then, it has dislocated approximately 8 times. Only 4 out of the 9 I would consider major dislocations. The most recent was yesterday, June 11 while at football practice. The thing that scares me the most now is that it doesn't hurt at all today. After every dislocation, minor or major, I was massively sore the next day. Today I got up at 6:30am, like everyday and went to morning workouts with very little apprehension. I am wearing a brace during every practice and workout. I even bought a $90 brace that has metal struts on the side for even better stability. The doc said my kneecap is getting pulled to the outside of my knee socket by a ligament. On the X-Rays I had taken about 9 months ago, I and the doctor saw that that track my kneecap slides in is abnormally far to the outside, so my kneecap actually has a head start on its way out. Any suggestions are much appreciated. Please ask if more info is needed.

Jun 16, 2009
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IT band: surgery of the patella?
by: Anonymous

Hello,

About 9 months ago I ran my first marathon. I am an experienced runner and had run 9 half marathons before the full marathon.

About two days after the marathon, I was teaching a group ex class, in which I did not actually teach but demonstrated movements from the floor. The next morning I woke up with extremem pain on the outside of the right knee and was diognosed with IT band syndrome. I went through two bouts of Physical therapy for it and I still cannot run beyond a 1/4 mile.

I was told today by an orthopedic surgeon that I should have a lateral release done becuase I have a slight tilt in the right knee cap. He thought this would help, since my MRI indicated no tears an no other IT problems. I am crunched for time, since I am supposed to be back in Chicago by the end of the week...I just don't know what to do. It seems that I should have patellar pain to have this surgery, which I don't have.

Any advice about whether or not to have this surgery because of IT pain would be very helpful. I am very hesitant, but is there anything else I can do other than surgery?

Aug 22, 2009
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Lateral Releases
by: Greg Blaney

My situation may be a bit different, but at around the age of 50, I had patella lateral tilt in both knees which caused significant pain. The pain was due to all the cartilage under the patella being worn away on one side resulting with bone-on-bone. I had a lateral release in 2004 on my right knee which helped a lot. I just had another lateral release on my left knee this August (2009). If you have lateral tilt, I would recommend the lateral release before all your cartilage is worn away / gone. Bone-on-bone under your patella hurts causing constant nagging pain. My doctor is trying to get me by with the lateral releases and joint fluid shoots until I decide to have patella replacements.