Pros & Cons of Lateral Release

[jodie14]

Hi Everyone

I hope you all are well, or at least as well as can be expected. Once again I am after some advice, I went to see a joint assessment clinic on Friday who says I have Patello-femoral maltracking and CMP. She recommends surgery as I have tried everything else and nothing has seemed to work. She also said my knee-caps tilt. She has told me about three different operations I can have:

1. Lateral release
2. Shaving the back of my knee-cap
3. Shaving the back of my knee-cap and the putting a metal plate on. (this one is apparently quite new)

There is only one surgeon in our area who will carry out these operations and I am hoping to get an appointment to discuss the different solutions in the next 4-6 weeks, but before I go I would really appreciate hearing some views of people who have already had this done.

Thanks again, sorry to be a pest.

Jodie

[shadehawk]

Jodie,

LR - lateral release has a bad reputation. This seems to be because so many have had it done for the wrong reasons. I'll be getting one myself, but in conjunction with another procedure. My OS said that it will correct the tilt of the patella, but if everything that is loose inside the knee is not tightened at the same time then the LR will likely fail.

The second procedure Scraping the back of the kneecap is called a debridgement (I believe) and lots of times this is done with an LR surgery. They try to make the patella glide better.

The third procedure I am not sure about.

Jodie, you are not a pest. Hey, the more you understand about all the different procedures the better off you will be. There are many people on this site that can explain all these procedures and will help you.

Good luck to you and let us know how everything goes.

Shade

[mike_bknee]

From my understanding, they usually do a shaving if necessary at the same time as a lateral release. Arthroscopy is also the best way to get an accurate diagnosis of a stubborn knee problem. If they do arthroscopy, ask for scope photos for your own file. My LRs and shaving weren't the total solution, but they helped with about 50% of the pain. I would get a second opinion before putting a plate in.

[Leta_MT]

First of all...Nice graphic Mike! Was this before or after your marriage to Demi? Either way, you're looking good! LOL!

Jodie,

Shade is right. LR alone is usually not a happy ending! It's quite common and more effective when combined with another procedure. Contrary to the opinion of those who have never had it, it is NOT an "easy little arthoscopic procedure"! Sure, it's easy for the OS, but not for the patient! Don't take it lightly just because it's not an open surgery.

Have you had a CT yet? I highly recommend having a CT scan before you let anybody invade your knee for any reason. I don't believe in diagnostic arthoscopy until all of the non-invasive diagnostics have been performed. In my case, the arthoscopy didn't reveal the true problem. The CT did. No matter how invasive a procedure (arthoscopy or open), you are still opened up to all types of infection and potential complications as a result. Try to have one surgery. The right one, that gives you the best shot at not having to have another. You are smart to inquire and learn all you can before you make a decision as to the right path for you! Be comfortable in the decisions you make about your health.

Take care, study up and be an active participant in your treatment. I bounce around the board, so if you have more questions on "new" procedures, don't hesitate to IM me. It appears that I am one of the few who made a leap of faith with my treatment and ended up with two major surgeries done at once, so I completely understand what it takes to lay down for a surgery that has little data to comfort you! My outcome has been good so far and I consider myself a success story.

Leta

[mike_bknee]

First of all...Nice graphic Mike! Was this before or after your marriage to Demi? Either way, you're looking good! LOL!

Leta

Enough already. It was the only picture I could find of an old guy with a receding hairline

I agree you should get all the non-surgical tests your doctor will agree to before you proceed with any surgery. If when you are talking about a "metal plate", make sure you know exactly what device your doctor is talking about, research said device thoroughly (the internet is a good place to start), and then be comfortable with the device before you allow your doctor to operate. There are many PFRs that have had a high failure rate in the past. The Avon device Leta had implanted is a much more promising device than many in the past.

[Linds]

Hmm.. Lateral Release as everyone else has said has a BAD reputation.
If you ONLY have LAteral tilt of the patella it can be quite effective but it will not correct LAteral Tracking. I've had a LR on both of my knees. They are wrose now than ever. .. My OS was quite confident that I only had latera tilt and I trusted his opinion, turns out that isn't how it is. Wish i'd never done it... in combonition with some of the other realignment surgeries I suppose it's quite effective but... alone I don't think it's all that effective. I hope they can come up with something to help get you sorted out... Knees are so frustrating.
Goodluck
Hugs
Linds

[jodie14]

Hi

Thanks for your replies, i am trying to get an MRI scan but because I had one 7 years ago they are under the impression that it would be very probable that nothing has changed. My PT has also said that they are not 100% accurate, but having said that I dont think there are many things in this world that are 100% accurate. My local hospital is not the best at being honest with you so I am trying to get every last bit of information so that I can question what he says because from past experiences they have always just tried to give you a diagnosis thinking you will go away happy, at least this way I can be prepared. I have also heard that if I leave it untreated it will lead to arthrits then eventually a knee cap replacement, is this true?

Thanks again

Jodie

[mike_bknee]

I assumed when you said "metal plate", you meant knee cap replacement (probably what the doctor meant) . Backing up, if you have inflammation and pain of the knee, you already have arthritis (arthritis=joint inflammation). The person probably meant osteo-arthritis which is the wearing out of the protective covering (cartilage) of the kneecap and/or femoral groove. Then you need a knee cap replacement(or metal plate in the femoral groove and a special plastic backing on your kneecap). A TTT might also be under consideration (re-alignment of kneecap in femoral groove). Bottom line, find a doctor you trust, and don't be afraid to get a second opinion. Good Luck!

[jodie14]

Hi

I think thats my problem, the PT or doctor will explain things but I dont know enough to know if Im asking enough questions or finding out everything I need to know. Then finding a doctor I trust is like finding a needle in a haystack so finding a second opinion would be even harder. I have an appointment at occupation health which is doctors employed by the company I work for. They can help you speed things up by getting in touch with an OS and also finding out everything and explaining it properly to me. I think I will feel a lot better once I have been to see them. Thanks again peeps.

Jodie

[Leta_MT]

Hey Jodie!

I hope you can get a CT scan instead of an MRI. MRI's show soft tissue, like ACL/MCL and stuff like that. Even with soft tissue, they aren't real accurate. The CT scan will show the bone issues and be a better diagnostic tool for what you are facing. I totally understand about finding an OS that you can trust and feel comfortable with. Number one, they have to listen to YOU! My current OS and I have had it out a time or two, but in the end, I feel like he has my best interests at heart. (Besides, I think he's a little scared of me... )

Now, on the patello-femoral replacement...There is lots of info out there now. When I was searching, there wasn't much, but now you can find stuff fairly easily. The two most widely used components are the Avon, which Mike mentioned and the DePuy. They are fairly similar and I left that decision up to the OS. I actually pushed him a little to try the newer "patient-matched" prosthetics, but he was a chicken and wanted data behind whatever he picked. (Can't blame him, but personally I think the patient-matched implants have promise!) Not that I am an expert, but I have never heard of replacing only the patellar button. The two components (patellar and femoral) have to mesh and if one is devoid of carilage, it's eventually going to damage the other. If you have a shallow femoral groove, the PFR will add some "ridge" to it and may allow you to skip the TTT to correct the lateral tracking. It adds to the ability of the groove to "catch" the patella and keep it in place. Some folks will tell you that you have to have "perfect alignment" in order to have a PFR. Well, if you had perfect alignment in the first place, you probably wouldn't need the PFR as malalignment is the most likely cause of the damage! To my knowledge, I am the only one on the board who had to have the TTT at the same time as the PFR, so that should tell you something.

Anyway, enough blah blah! Good luck, Jodie and keep in touch! BTW, are you in the UK? I think I looked at your profile once, but I forgot!

Hang in there!

Leta