Why do a lateral release

The kneecap moves up and down in a groove on the end of the thigh bone as the knee bends. In some people, 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 reasons why this might occur, the most common of which is the tightening of tissue, called the lateral retinaculum, on the outside of the kneecap.

When this happens, the patella to begin to tilt laterally and place abnormal pressure on the joint. When your healthcare provider assesses your kneecap problems, he or she will look for several underlying problems with the mechanics of the kneecap. In addition to a tight retinaculum, patellar subluxation may occur, causing the kneecap to be pulled to the outside of the groove. Lateral release is a minimally invasive surgery used to correct an excessive patellar tilt.

It involves cutting through a tight retinaculum so that the kneecap can slip properly into its groove, thereby restoring its normal alignment. The surgery is usually performed arthroscopically with "keyhole" incisions to minimize complications and speed healing. A lateral release is successful when performed in the right patient.

For many years, healthcare providers 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.

For most people, a tight lateral retinaculum can be successfully treated with nonsurgical stretching and rehabilitation. For this reason, a lateral release should only be considered if extensive physical therapy has failed to provide relief. In addition, people who have had a kneecap dislocation as a result of a patellar tilt may require more extensive surgical procedures.

These may involve open surgical techniques such as ligament reconstruction, bone realignment, and others. 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. One of the most difficult aspects of the surgery is ensuring that the ligaments are released sufficiently to correct the misalignment but not so much that the kneecap becomes unstable and is pulled to the inside medial subluxation.

The other common problem is the lack of pain relief following surgery Historically, many healthcare providers have thought that a lateral release was performed much too frequently, without a good, careful selection of people who are most likely to benefit from the procedure.

Candidates for knee lateral release surgery Patients who experience pain and pressure from tightening in the lateral retinaculum tissue on the outside of the kneecap may be candidates for a lateral release surgery. Lateral release surgery on the knee is most successful on people who have tried nonsurgical therapies such as bracing, icing, medications, and modifying activity levels and extensive physical therapy without relief.

Risks associated with knee lateral release surgery Lateral release surgery is a complicated procedure. Risks associated with lateral release surgery in the knee include: Bleeding into the knee, which leads to pain. Unstable kneecap which leads to medial subluxation where the kneecap is pulled to inside the knee. No pain relief due to the procedure being performed on a less than ideal candidate.

Preparation for knee lateral release surgery Before deciding to get lateral release surgery, your doctor will recommend you try nonsurgical therapies such as braces, crutches, knee braces, ice packs, and physical therapy. What to expect during knee lateral release surgery Knee lateral release surgery is performed with a patient under general anesthesia, to that you will be asleep during the procedure.

Therefore, it was not surprising that 14 years after our preliminary report, Jack Hughston published his study of 54 cases of over-release leading to iatrogenic medial instability. To avoid iatrogenic medial patellar instability after a lateral release, see Sanchis-Alfonso and Merchant, As patellar instability has multiple causes, such as trochlear dysplasia of varying severity, increased standardized Q angle and increased TT-TG distance of different amounts, patella alta of differing ratios, variable level of triggering physical activity, etc.

Healio News Orthopedics Sports Medicine. By Alan C. Merchant, MD, MS. Disclosures: Merchant reports he received direct and indirect payment from patients in return for medical and surgical care, and has no other conflicts of interest to report.

Read next. November 19, Receive an email when new articles are posted on. Please provide your email address to receive an email when new articles are posted on. You've successfully added to your alerts. You will receive an email when new content is published. If these measures fail to relieve symptoms, surgically decreasing strain by releasing the lateral retinaculum may help.

In addition, this will allow the leg strengthening exercises to work better. From the inside of the knee the lateral retinaculum is incised, from the inside, allowing the kneecap to untilit itself. Releasing the tight lateral tissues takes the strain off the medial tissues which are causing pain. Postoperatively, the knee will initially be in a knee brace locked at 30 degrees of knee flexion.

Partial weightbearing, with crutches, is recommended to minimize pain and swelling. The first office visit after surgery is between 7 and 14 days after surgery.