Hey Dr, great video. Thanks.. I just had my lateral release done on my right knee in 9 weeks ago.. I am doing great in Physical Therapy, but the only place Im not seeing any improvement is in leg extensions.. it causes severe pain, and a little bit of locking. My Dr says to give it some time.. the cause was a work related injury in March of 2010... I can't wait to return to work, my job is very high labor intense, I assemble wimdtowers. About how long b4 one can return to work. A lot of climbin
@WhatHavU --- Thank You- Light jobs may return usually in six weeks but heavy work takes a lot longer. see the comment for SCSoccer and TOGCT.com or my book "the shoulder and knee handbook for all of us" on LULU.com
I believe that my doctor has made the mistake of giving me a lateral synovectomy vs a chondromalacia patellae surgery. There's a grizzly crunchy feeling when my knee is extended and I feel it interferes with my mobility(feeling like something's in the way). I believe mechanically when the cartilage rubs against whatever's there that's the problem. Because the crunch is still there post op and it's been 6 weeks. I was promised it would be alleviated. I'm a 21 year old soccer player on the road t
@SCSoccer911 So it seems you need a to work on your quads, inflammation and patella superior glide. Please talk to you therapist about getting you back on track. A course of a NSAID will help. Kenisiotapping may also help. G-C may also be worth trying. 6 weeks is too soon to get back to competitive sports. Function may have improved- but sports specific retraining, strength, and endurance is required. This takes much longer!
Sorry to hear your outcome was not great. Pending on your exam you may need a fulkerson realignment (also known a's a tibial tubercle transfer) or a MPFL reconstruction (medial patella femoral ligament) to correct he patella. It also depends on your age, body weight, leg alignment and status of the cartilage in your knee. There is more info in my book the knee and shoulder handbook for all of us go to LULU.com to find it.
I had this done on my lft knee mayyybe 2 years ago, and my knee is still killing me. The knee cap is still over to the left side. It creeks when I move my leg, and gives out almost weekly. My doctor did not want to do another surgery on my knee because the last one he did (he did 3 in total, 2 for plica) he messed up my nerve and I dont have feeling in part of my leg. Should I see another doctor and see if there is another surgry that can be done to correct whatever is wrong, or am I done for?
Rob4lb Different parts of the knee recover at different rates. Muscle and tendon recover faster than bone. In your case the bone(52 years old) was weakened my lake od loading and now you have increase the loads. I would stick to 3 miles for a while adding non impact first to your current exercises and when 3 miles is pain free than slowly increases your milage. A multiple-vit
@DrAReznik I had this surgery in feb2009, & I have to admit some buyers remorse. For about a year after surgery I could not err mechanically run, by that I mean even jog across a street. My knee would also give out daily. It still hurts to jump down from a height but all in all it is finally recovering. Thank you doctor for the helpful video.
Dr. - i had LR surgery 14 wks ago. After 8 wks of PT, my quad strength was the same in both knees and told I could start some running. I'm 52 yo marathon runner. Since then, i have run up to 4-5 miles. My knee usually starts to hurt a little after about three miles. It's hard for me to tell if this is normal part of healing or if I still have a problem and am doing damage by continuing to run. Is this typical of LR healing? Any suggestions on how I should structure my runs?
Would you say that this surgery is a good or bad idea for a 15 year old girl who has had about 5 dislocations? She has tried phyiscal therapy twice and all was well for 6 months until it dislocated once again. The dr. suggested physical therapy again. What would be your input? Thanks so much.
Patella dislocations an be caused by an number of factors. Mal-alignment, congenital abnormalities, a torn MPFL, lateral tibial tubercle position (increase TT-TG distance). These all need to be sorted out before considering surgery. Only a good exam and other studies can help clear the picture. See my web site for more details "togct."
@DrAReznik Thank you for the website. She has poor lateral tibial tubercle position. Is this really something she could grow out of? The problem as of now is she can't run, jump, or squat and walking is painful. It's been 4 weeks since re-injury. We are really looking for a way to fix this. Thank you so much for your time.
I have had a few patients like this. Pending a good examination that confirms mal-tracking, lateral tightness and/or medial laxity and if she has mature bone (no longer growing) then she may need a TT transfer- Fulkerson realignment with lateral release and possible a MPFL reconstruction to solve this problem. There is no harm in doing more PT. There are a lot of ifs here and again only the examining surgeon can make this call. Please remember, no one can make this decision over the internet.
Hello Dr, sorry I bother you again, it seems no one would answer my questions. Its been 5 weeks since my lateral release surgery, with plica excision and scope on both my knees. My ROM is about 90 or 100 now, though when I do bend my knee it hurts like hell and seems to turn it more swollen and painful each time, making it harder for me to bend it. The dr applied growth factors, does this accelerate scar tissue development? I`m scared
Please see my comment after your first note. You have arthrofibrosis and it needs to be treated as such. Some people have a genetic predisposition for this. They make too much scar tissue. It is difficult to treat and one must be very patient. Medications like NSAIDs, injected or oral steroids, aggressive therapy and possibly a manipulation in the operating room may be needed. Talk to your doctor.
Hello Dr. My name is Paola and I am 24 years old. About a month ago I had a lateral release on both my knees, together with plica excision and patella scope. Today I went to the doctor for a revision and he told me that if by the 2nd month I dont bend my knees to 120, he would have to do surgery on my again. Currently, my ROM of the left knee (second surgery and less swollen) is about 100 and of the right knee (first surgery and much swollen) is about 80 or 90. Is this true? :'( Thnx
Fibrosis after knee surgery is always a concern. Some people are genitically predisposed to having this happen. It can be difficult to correct. In general, we try therapy, NSAIDs, injection with cortisone or oral steroids before a second surgery providing there are no contraindications to these treatments. The second surgery is often a manipulation, but many times non operative measures do work.
i had this surgery done two months ago also they reconstructed a ligament im healing ok walking ok my concern is im in pain when i sit down and when i walk for a while and i cant bend more than 90 degreees is this normal?????
In some cases the medial ligament (MPFL) is also loose as well as the lateral side being tight. Some surgeons even feel the MPFL is th eprimary problem in some cases and it needs to be reconstructed. It seems like this is the case here. It can be stiffer than just a release alone. At 2 months I would like to see my pts get passed 90 degrees and I would check with my surgeon about this.
I am booked for a lateral release Nov 25 /09 but this solution is not unanimous. The cause of my patella tracking is my tight iliotibial band but this procedure cuts the lateral retinaculum. I will speak to the surgeon but I think the biggest problem with these things is misdiagnosis. As a side note, I managed to locate the tender strands of the iliotibial band that are connected to the patella using acupuncture needles. Due to knee pain, I can't sleep through the night and I've tried stretch...
Patella femoral pain is a difficult area in general. As a rule we try therapy, nsaids, taping, orthotics, VMO strengthening, patella mobilization, rest and ice. We like to look at leg alignment, patella size and shape, the grove (with a patella view on Xray) and then even an MRI. It is important to see if there is a TT-TG difference see my web site about this under tibial tubricle transfer. Only then do we talk about surgery. In you case I would want more info than acupuncture causes pain.
I looked at your Patella Realignment page, thanks. I have also tried many of those therapies. I believe I am different from many other patients. Pain is at night (or driving for long periods) where the leg is at least 3/4 extended and immobile. I believe the patella is lightly pressing against the fat pad. I am certain the iliotibial band is the cause as I get relief from direct deep massage (my home-made peg solution). MRI: "Mild chondrosis of the patellar lateral facet." I emailed you more.
This is not unusual. In my experience mayny pateint have used deep friction massage and other painful modalities to distract from the problem. The problem here is that over time you cannot tell if this is continuing or worsening the problem. I recommend you stop all treatement that cause a increase pressure or local trauma to "reduce" the pain. In the long run these are of no benifit and may cause harm.
I don't understand "TT-TG difference". I read "Patello-Femoral Problems - Lateral Release". I do understand that I should ask my surgeon about evidence to show subluxation. If the patella is just resting against the groove perhaps I should continue iliotibial stretching and VMO strengthening. I have just jacked up the frequency and intensity. I hate to miss hockey! Thanks for your help. I feel very fortunate to have had this exchange.
This is something you will have to ask your surgeon. It is way to early to say anything has happened other that normal post op swelling. You need to respect for the fact that you have had surgery and the knee should be protected for at least for 4 to 6 weeks after. This means crutches while walking and advancing weight bearing over the first week.
Hello. I had this surgery on the 2nd of October. I am in alot of pain, and I am unable to walk. The doctor said that I could be able to walk the actual day of the surgery, but everytime that I even move my leg, it feels like I can feel where the muscles were cut. My whole leg is still very swollen, and so far, the pain has not gone down at all. I am really hoping you can tell me if this is normal or not. Also, when can I take the bandages of? Please let me know. Thank you!!!
Swelling after a lateral release is very common. The number one issue after a lateral release is blood collecting in the knee. As on the video there are blood vessels that are cut as part of the procedure and even if cauterized they can bleed afterward. It is equally important to be sure you do not have an infection (increasing swelling, pain, redness and fever) or a blood clot (calf pain or tenderness).
It is possible that what you are feeling is a direct result of blood and perhaps pressure inside the knee. If this is not what your doctor told you to expect you need to call him and ask to have it checked
shortly. (See the precautions for lateral release at my web site). If you have a fever or calf pain you should be seen today.
i had this surgery dec. 2004. i still have a few issues. knee seems to constently ach or feel inflammed and ihave gained like 35 pounds the only enjoy or relief i get is swimming or if put ice on my knee. i wander if i need another surgery. I am 30 now, i first hurt in football, in 96, and re injured in 2000, but by 2004 it so painful, that sitting and driving hurt so had to do it, . any insight would be great DrAReznik
Sorry to hear of your poor outcome. There are many considerations when preforming a Lateral release. The pain needs to be mostly lateral, the patella is tilted and the tibial tubricle needs to be within a distance of the grove (the TT-TG distance). If other conditions are present, the TT-TG distance is high, or there is advanced cartilage changes on the knee cap, a lateral release may not work. The technique has improved since 1999 hence better outcomes now. A new exam and Xrays may be helpful.
grade 1-2-3 on the lateral surface of the patella is the most commonly treated by arthroscopic LR- grade 4 is significant arthritis and often requires other approaches.
Dr. Reznik: i have had CMP in the left knee for 9 years now. i have this Sugary scheduled for 2 weeks from now. My question is will lateral release help with CMP caused by pronation(SP?) errors (I have prescription orthotics)?
The problem here is after 9 years the damage may be significant and may be irreversable.
The Lateral Release is to reduce load on the lateral patella and works well in those patients with pain laterally, lateral tilt and tracking with CMP, but not advanced arthritis. When I treat runners with this problem I am concerned if they like to run hills and are not willing to give hills up. Running hills makes this problem far worse. Other factors for returning to running come into play as well.
I stopped running in2000 because of the knee and I have been seeing a sports medicine physician for two years now on the graduated approach, and the surgery is what we are up tohe did comment that I have tracking problems and arthritis but my knee is not debilitating yet I just cant run. Its ironic that you mention running hills you see doctor I do not have much of a choice other than running hills, I live in Hillsdale County, if I road run there will be hills.
Hello Dr. I had my surgery February 26. The physician said that besides the lateral release and some plica that he removed everything else look good, and the arthritis from my 9 year bout with CMP was minimal. I will be starting a runners program at my PT as soon as the remedial PT is taken care of.
Hey Dr, great video. Thanks.. I just had my lateral release done on my right knee in 9 weeks ago.. I am doing great in Physical Therapy, but the only place Im not seeing any improvement is in leg extensions.. it causes severe pain, and a little bit of locking. My Dr says to give it some time.. the cause was a work related injury in March of 2010... I can't wait to return to work, my job is very high labor intense, I assemble wimdtowers. About how long b4 one can return to work. A lot of climbin
WhatHavU 1 month ago
@WhatHavU --- Thank You- Light jobs may return usually in six weeks but heavy work takes a lot longer. see the comment for SCSoccer and TOGCT.com or my book "the shoulder and knee handbook for all of us" on LULU.com
DrAReznik 1 month ago
I believe that my doctor has made the mistake of giving me a lateral synovectomy vs a chondromalacia patellae surgery. There's a grizzly crunchy feeling when my knee is extended and I feel it interferes with my mobility(feeling like something's in the way). I believe mechanically when the cartilage rubs against whatever's there that's the problem. Because the crunch is still there post op and it's been 6 weeks. I was promised it would be alleviated. I'm a 21 year old soccer player on the road t
SCSoccer911 2 months ago
@SCSoccer911 So it seems you need a to work on your quads, inflammation and patella superior glide. Please talk to you therapist about getting you back on track. A course of a NSAID will help. Kenisiotapping may also help. G-C may also be worth trying. 6 weeks is too soon to get back to competitive sports. Function may have improved- but sports specific retraining, strength, and endurance is required. This takes much longer!
DrAReznik 1 month ago
Sorry to hear your outcome was not great. Pending on your exam you may need a fulkerson realignment (also known a's a tibial tubercle transfer) or a MPFL reconstruction (medial patella femoral ligament) to correct he patella. It also depends on your age, body weight, leg alignment and status of the cartilage in your knee. There is more info in my book the knee and shoulder handbook for all of us go to LULU.com to find it.
DrAReznik 3 months ago
I had this done on my lft knee mayyybe 2 years ago, and my knee is still killing me. The knee cap is still over to the left side. It creeks when I move my leg, and gives out almost weekly. My doctor did not want to do another surgery on my knee because the last one he did (he did 3 in total, 2 for plica) he messed up my nerve and I dont have feeling in part of my leg. Should I see another doctor and see if there is another surgry that can be done to correct whatever is wrong, or am I done for?
AbsolutRachel 4 months ago
Rob4lb Different parts of the knee recover at different rates. Muscle and tendon recover faster than bone. In your case the bone(52 years old) was weakened my lake od loading and now you have increase the loads. I would stick to 3 miles for a while adding non impact first to your current exercises and when 3 miles is pain free than slowly increases your milage. A multiple-vit
, extra vit c nad calcium could help as well.
DrAReznik 1 year ago
@DrAReznik I had this surgery in feb2009, & I have to admit some buyers remorse. For about a year after surgery I could not err mechanically run, by that I mean even jog across a street. My knee would also give out daily. It still hurts to jump down from a height but all in all it is finally recovering. Thank you doctor for the helpful video.
badgerattoadhall 1 year ago
Dr. - i had LR surgery 14 wks ago. After 8 wks of PT, my quad strength was the same in both knees and told I could start some running. I'm 52 yo marathon runner. Since then, i have run up to 4-5 miles. My knee usually starts to hurt a little after about three miles. It's hard for me to tell if this is normal part of healing or if I still have a problem and am doing damage by continuing to run. Is this typical of LR healing? Any suggestions on how I should structure my runs?
rob4lb 1 year ago
Would you say that this surgery is a good or bad idea for a 15 year old girl who has had about 5 dislocations? She has tried phyiscal therapy twice and all was well for 6 months until it dislocated once again. The dr. suggested physical therapy again. What would be your input? Thanks so much.
Ashleee2299 1 year ago
Patella dislocations an be caused by an number of factors. Mal-alignment, congenital abnormalities, a torn MPFL, lateral tibial tubercle position (increase TT-TG distance). These all need to be sorted out before considering surgery. Only a good exam and other studies can help clear the picture. See my web site for more details "togct."
DrAReznik 1 year ago
@DrAReznik Thank you for the website. She has poor lateral tibial tubercle position. Is this really something she could grow out of? The problem as of now is she can't run, jump, or squat and walking is painful. It's been 4 weeks since re-injury. We are really looking for a way to fix this. Thank you so much for your time.
Ashleee2299 1 year ago
I have had a few patients like this. Pending a good examination that confirms mal-tracking, lateral tightness and/or medial laxity and if she has mature bone (no longer growing) then she may need a TT transfer- Fulkerson realignment with lateral release and possible a MPFL reconstruction to solve this problem. There is no harm in doing more PT. There are a lot of ifs here and again only the examining surgeon can make this call. Please remember, no one can make this decision over the internet.
DrAReznik 1 year ago
Hello Dr, sorry I bother you again, it seems no one would answer my questions. Its been 5 weeks since my lateral release surgery, with plica excision and scope on both my knees. My ROM is about 90 or 100 now, though when I do bend my knee it hurts like hell and seems to turn it more swollen and painful each time, making it harder for me to bend it. The dr applied growth factors, does this accelerate scar tissue development? I`m scared
HighWMusic 1 year ago
Please see my comment after your first note. You have arthrofibrosis and it needs to be treated as such. Some people have a genetic predisposition for this. They make too much scar tissue. It is difficult to treat and one must be very patient. Medications like NSAIDs, injected or oral steroids, aggressive therapy and possibly a manipulation in the operating room may be needed. Talk to your doctor.
DrAReznik 1 year ago
Hello Dr. My name is Paola and I am 24 years old. About a month ago I had a lateral release on both my knees, together with plica excision and patella scope. Today I went to the doctor for a revision and he told me that if by the 2nd month I dont bend my knees to 120, he would have to do surgery on my again. Currently, my ROM of the left knee (second surgery and less swollen) is about 100 and of the right knee (first surgery and much swollen) is about 80 or 90. Is this true? :'( Thnx
HighWMusic 1 year ago
Fibrosis after knee surgery is always a concern. Some people are genitically predisposed to having this happen. It can be difficult to correct. In general, we try therapy, NSAIDs, injection with cortisone or oral steroids before a second surgery providing there are no contraindications to these treatments. The second surgery is often a manipulation, but many times non operative measures do work.
DrAReznik 1 year ago
Thx
impconfused 2 years ago
thanks dr. you have been helpful to me i appreciate your answer
2005chevyimpala 2 years ago
i had this surgery done two months ago also they reconstructed a ligament im healing ok walking ok my concern is im in pain when i sit down and when i walk for a while and i cant bend more than 90 degreees is this normal?????
2005chevyimpala 2 years ago
In some cases the medial ligament (MPFL) is also loose as well as the lateral side being tight. Some surgeons even feel the MPFL is th eprimary problem in some cases and it needs to be reconstructed. It seems like this is the case here. It can be stiffer than just a release alone. At 2 months I would like to see my pts get passed 90 degrees and I would check with my surgeon about this.
DrAReznik 2 years ago
i had a lateral release on each knee at once, as well as a VMO on my right knee.
darkwater2691 2 years ago
I am booked for a lateral release Nov 25 /09 but this solution is not unanimous. The cause of my patella tracking is my tight iliotibial band but this procedure cuts the lateral retinaculum. I will speak to the surgeon but I think the biggest problem with these things is misdiagnosis. As a side note, I managed to locate the tender strands of the iliotibial band that are connected to the patella using acupuncture needles. Due to knee pain, I can't sleep through the night and I've tried stretch...
openendedthinking 2 years ago
Patella femoral pain is a difficult area in general. As a rule we try therapy, nsaids, taping, orthotics, VMO strengthening, patella mobilization, rest and ice. We like to look at leg alignment, patella size and shape, the grove (with a patella view on Xray) and then even an MRI. It is important to see if there is a TT-TG difference see my web site about this under tibial tubricle transfer. Only then do we talk about surgery. In you case I would want more info than acupuncture causes pain.
DrAReznik 2 years ago
I looked at your Patella Realignment page, thanks. I have also tried many of those therapies. I believe I am different from many other patients. Pain is at night (or driving for long periods) where the leg is at least 3/4 extended and immobile. I believe the patella is lightly pressing against the fat pad. I am certain the iliotibial band is the cause as I get relief from direct deep massage (my home-made peg solution). MRI: "Mild chondrosis of the patellar lateral facet." I emailed you more.
openendedthinking 2 years ago
This is not unusual. In my experience mayny pateint have used deep friction massage and other painful modalities to distract from the problem. The problem here is that over time you cannot tell if this is continuing or worsening the problem. I recommend you stop all treatement that cause a increase pressure or local trauma to "reduce" the pain. In the long run these are of no benifit and may cause harm.
DrAReznik 2 years ago
I don't understand "TT-TG difference". I read "Patello-Femoral Problems - Lateral Release". I do understand that I should ask my surgeon about evidence to show subluxation. If the patella is just resting against the groove perhaps I should continue iliotibial stretching and VMO strengthening. I have just jacked up the frequency and intensity. I hate to miss hockey! Thanks for your help. I feel very fortunate to have had this exchange.
openendedthinking 2 years ago
You are welcome. Look at the page for Patella realignment/Tibial tubricle transfer that will help explain it.
Rehab is always the first choice
DrAReznik 2 years ago
This is something you will have to ask your surgeon. It is way to early to say anything has happened other that normal post op swelling. You need to respect for the fact that you have had surgery and the knee should be protected for at least for 4 to 6 weeks after. This means crutches while walking and advancing weight bearing over the first week.
DrAReznik 2 years ago
Hello. I had this surgery on the 2nd of October. I am in alot of pain, and I am unable to walk. The doctor said that I could be able to walk the actual day of the surgery, but everytime that I even move my leg, it feels like I can feel where the muscles were cut. My whole leg is still very swollen, and so far, the pain has not gone down at all. I am really hoping you can tell me if this is normal or not. Also, when can I take the bandages of? Please let me know. Thank you!!!
AbsolutRachel 2 years ago
Swelling after a lateral release is very common. The number one issue after a lateral release is blood collecting in the knee. As on the video there are blood vessels that are cut as part of the procedure and even if cauterized they can bleed afterward. It is equally important to be sure you do not have an infection (increasing swelling, pain, redness and fever) or a blood clot (calf pain or tenderness).
DrAReznik 2 years ago
It is possible that what you are feeling is a direct result of blood and perhaps pressure inside the knee. If this is not what your doctor told you to expect you need to call him and ask to have it checked
shortly. (See the precautions for lateral release at my web site). If you have a fever or calf pain you should be seen today.
DrAReznik 2 years ago
i had this surgery dec. 2004. i still have a few issues. knee seems to constently ach or feel inflammed and ihave gained like 35 pounds the only enjoy or relief i get is swimming or if put ice on my knee. i wander if i need another surgery. I am 30 now, i first hurt in football, in 96, and re injured in 2000, but by 2004 it so painful, that sitting and driving hurt so had to do it, . any insight would be great DrAReznik
Riffe26 2 years ago
I had that operation in 1999. Worst thing i've ever done. My knee was much worse after the operation and 10 years later no relief.
johnnyu3 3 years ago
Sorry to hear of your poor outcome. There are many considerations when preforming a Lateral release. The pain needs to be mostly lateral, the patella is tilted and the tibial tubricle needs to be within a distance of the grove (the TT-TG distance). If other conditions are present, the TT-TG distance is high, or there is advanced cartilage changes on the knee cap, a lateral release may not work. The technique has improved since 1999 hence better outcomes now. A new exam and Xrays may be helpful.
DrAReznik 3 years ago
i just had this done today and im fine i was able to walk out of the hospital
braden006 3 years ago
Thanks for posting this video. I will be going in for this procedure in the near future.
motox1980 3 years ago
hi
whatever degrees have this chondromalacia?
thanks
markosxbcn 3 years ago
there are many ways to stage chondromalacia
0 - none to 4 loss of all cartilage
grade 1-2-3 on the lateral surface of the patella is the most commonly treated by arthroscopic LR- grade 4 is significant arthritis and often requires other approaches.
DrAReznik 3 years ago
Dr. Reznik: i have had CMP in the left knee for 9 years now. i have this Sugary scheduled for 2 weeks from now. My question is will lateral release help with CMP caused by pronation(SP?) errors (I have prescription orthotics)?
For the love of god I just want to run again.
badgerattoadhall 3 years ago
The problem here is after 9 years the damage may be significant and may be irreversable.
The Lateral Release is to reduce load on the lateral patella and works well in those patients with pain laterally, lateral tilt and tracking with CMP, but not advanced arthritis. When I treat runners with this problem I am concerned if they like to run hills and are not willing to give hills up. Running hills makes this problem far worse. Other factors for returning to running come into play as well.
DrAReznik 3 years ago
I stopped running in2000 because of the knee and I have been seeing a sports medicine physician for two years now on the graduated approach, and the surgery is what we are up tohe did comment that I have tracking problems and arthritis but my knee is not debilitating yet I just cant run. Its ironic that you mention running hills you see doctor I do not have much of a choice other than running hills, I live in Hillsdale County, if I road run there will be hills.
badgerattoadhall 3 years ago
Hello Dr. I had my surgery February 26. The physician said that besides the lateral release and some plica that he removed everything else look good, and the arthritis from my 9 year bout with CMP was minimal. I will be starting a runners program at my PT as soon as the remedial PT is taken care of.
badgerattoadhall 3 years ago
That's Good news- best of luck.
I would still caution all patients having CMP
with respect to hills and heavy impact activity.
AM Reznik, MD
DrAReznik 3 years ago