Lateral Release Recovery: Do We Know this Knee Surgery Actually Works?
POSTED ON 6/27/2013 IN Knee BY Christopher Centeno
Why undergo lateral release recovery at all? If I had to create a list of bad knee surgeries just based on the hundreds of patients I've seen with failed knee surgeries, lateral release for knee cap tracking problems would be near the top of that list. Based on that experience, it's another knee surgery with a prolonged recovery and little scientific evidence to support that it's effective. First to review, when the knee cap begins to track too far laterally in it's groove (to the outside) and physical therapy fails, patients are often offered a lateral release surgery. The concept is simple: since the knee is pulling too far to the outside, the surgeon will cut the fascia on that side to try and reduce the pulling. Sometimes the medial side will be tightened as well. So what evidence is there that cutting this tissue and permanently altering the bio mechanics of the knee is a good idea? Turns out, not much, The existing scientific reviews show that the research is only level 3-4 (level 1 is the highest). This means that we have no solid evidence that lateral release works. Why do I see so many patients in the clinic that fail this surgery? As discussed in our practice's e-book (Orthopedics 2.0), a healthy body is tuned to sub millimeter precision. Surgical healing occurs a few millimeters this way or that way. So the likelihood that cutting the outside knee cap fascia will result in perfect seating of the knee cap in it's groove is small, as it's more likely that the cut won't loosen it enough or will leave the knee cap still too tight in the lateral direction. Even more importantly, the cause of the problem isn't in the knee cap. The reason the knee cap doesn't track well in it's groove can be due to problems in the low back, hip, quadriceps, or foot/ankle. So not addressing these other issues causing knee cap pain and focusing on surgery for the knee cap when the cause isn't there doesn't make common sense.
Let me give you a cautionary tale from a patient I saw yesterday in clinic. He had a lateral release surgery several years ago for patellar tendon pain (the theory being that his knee cap wasn't tracking right and this caused one side of the patellar tendon to be pulled on more than the other). At first he seemed to do well, then the problem came back so he doubled down for a second surgery, this time an arthroscopic debridement. He ended up with arthrofibrosis (joint scarring), so he "tripled down" and went for a third surgery to fix the damage the second had caused. The third surgery broke up the adhesions and scarring, but either the second or third surgery (or maybe even the first?) created a huge tumor like mass in his patellar tendon. So he had a fourth surgery to remove that mass. Now he still has the same pain he's always had, but now what's left of his lateral patellar tendon is a mess. He's investigating whether stem cells will help fill the huge gaps now left in the tendon.
The upshot? I've seen very few patients through the years that have had good outcomes from and that were happy with their lateral release surgery. The reasons are pretty simple: surgical healing isn't exact enough to create the kind of tiny adjustments that would make the surgery successful and the cause of knee cap problems is usually elsewhere. Take a few hours to read our e-book and find someone to take the time to figure out why your knee cap is messed up in the first place rather than trying to fix it with aggressive surgery.
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