Lateral release knee surgery

Just understand that no matter how skilled the surgeon, the successful the surgery and how successful the recovery, you may never regain 100% mobility and use.

Don't expect a miracle because you will be sorely disappointed.

Don't, don't, don't, don't, don't don't don't have a lateral release. It was actually done without me knowing about it (during a meniscus repair). I'm so piss.ed off. My knee has never been the same. And they aren't reversible.

DON'T DO IT.

missh1967 wrote: »

Don't, don't, don't, don't, don't don't don't have a lateral release. It was actually done without me knowing about it (during a meniscus repair). I'm so piss.ed off. My knee has never been the same. And they aren't reversible.

That sounds like medical malpractice and something worth reporting to whatever boards your surgeon is on as well as the hospital you had it at.

I had one done January 2017 - took a full year until I was "normal" (recovered from the surgery) again and have noticed no improvements whatsoever to knee tracking, pain, etc. I did a lot of reading into it prior to the surgery and was willing to try anything that had a chance of helping, but most of what I read said it is not a surgery that is done often anymore due to poor outcomes. Also, it hurt like a *kitten* - way worse pain in the hours/days afterwards compared to the Microfracture surgery I had the year before (another one I wouldn't recommend!)

fitcrt wrote: »

Thanks for your feedback guys! The more I read on the subject the more leery I am growing about having this done... now I need to come up with some alternative options...

If you need to lose weight, that's the place to start. Extra weight is very hard on the knees.

My knees have improved significantly since I started doing these religiously:



https://www.youtube.com/watch?v=yLoMA7I7HOQ&feature=youtu.be

Additionally:

1. I wear good shoes the vast majority of time.
2. When I walk, it's on trails in the woods rather than roads.
3. I sit with legs crossed as little as possible.

Muscleflex79 wrote: »

aokoye wrote: »

fitcrt wrote: »

Thanks for your feedback guys! The more I read on the subject the more leery I am growing about having this done... now I need to come up with some alternative options...

Honestly I would get a second or third opinion. The reason why I ended up with my current orthopedic surgeon is because i sought a second opinion. While a lateral release was never on the table, I couldn't be happier with both my surgeon and my progress thus far.

aokoye - if you don't mind me asking, what alternatives did your surgeon provide? did you do another surgery instead of the lateral release? as I noted above, I've had microfracture and lateral release and neither have helped whatsoever. seen a slew of surgeons and all tell me there really aren't any options left!

So in short I've had four tibial tubercle osteotomies, two on each side and then one MPFL repair on each knee. If you have issues involving patellar tracking I would ask about, at the very least, an MPFL repair, which is a significantly less invasive surgery than the TTO. Now on to my wall of text

In reality this all started when I dislocated my knee when I was 18 or 19 and, for whatever reason, my GP didn't prescribe PT and I wasn't knowledgable enough to know I needed it. Had I gotten PT it would have likely prolonged the inevitable on my right knee and totally eliminated the need for it on my left knee. About three years after the dislocation I was doing base training on the bike because I wanted to race that upcoming season and realized that my knees were both in a lot of pain. I went to a sports med doctor, was prescribed PT, had x-rays MRIs on both knees and it was eventually decided that I needed the TTOs on both knees (they were spaced four or five months apart). Note that in addition to the pain they also subluxed a lot. Only once was there a full dislocation, but they tracked really poorly. While the orthopedic surgeon who did them did a good job, apparently shortly after the second one was done a bunch of research came out on how best to perform that surgery on people who have similar anatomical issues to mine. Note that I also don't have a trochlear groove (the grove that your patella glides in).

After that I had a load of PT, once at the PT gym that our local professional soccer teams use (my then ortho is the their team doctor) and the second from a PT who specializes in working with cyclists which was pretty amazing. I healed pretty well, was able to do everything other than run for probably four and a half years before the pain came back. The maltracking also reoccured, especially on the right. I went back to the same ortho who didn't really know what to do with me. PT wasn't really doing much, we tried injections of synovial fluid (or an analogue of it), and I don't remember if we tried cortisone shots.

Eventually I got a second opinion and another set of MRIs from an ortho at the teaching hospital where I live who specializes in patellar femoral injures. She also has worked with elite athletes basically since her first residency which was a plus for me given that the goal was to get back to sports. She suggested that we do a second set of TTOs and noted that, as I mentioned above, the surgeries were done really well, but what I didn't benefit from was a lot of the more recent research. She was actually surprised that I had been able to last as long as I did without major issues. She also suggested that we do an MPFL repair (replacement) and was also the one who diagnosed the patella alta on my right side. It was very clear to me that she knew what she was talking about. She teaches at a major research hospital, had done fellowships in the US and Europe, really keeps up on current research, and in general is just really passionate about what she does and making sure that patients have as good an outcome as possible. Given that one of the reasons I got the second opinion was because the first ortho appeared to more or less throw up his hands, I was very pleased.

We spaced my surgeries about a year apart, primarily because of my schedule. With both of my most recent surgeries I've done a lot of physical therapy. What was nice this time is that I kept the same main PT. There are two others that I see - one who is certified to do blood flow restriction and the other who I see when neither of them are available and who is also certified in blood flow restriction. What has been really beneficial to me is that all of my PTs are very focused on getting me back to being able to do sports related things, they are also all in constant contact with my ortho. My priorities, sports wise, - in the order that I was cleared to do them are, swimming, cycling, and running. My ortho has a set of protocols that the PTs use that are more or less the same ones that the Center for Special Surgery came up with (my ortho did a residency there but I know other orthos and PTs use the same protocols) which I think is smart. We didn't follow them to the letter with my most recent surgery because I was progressing very quickly (like weeks ahead of schedule), but I think they helpful. There was also a very large gap between my being cleared to ride my bike and cleared to run. I was cleared to swim, save for doing breaststroke, six weeks out (so essentially once I was allowed to be weight bearing again) with not falling on the pool deck being everyone's primary concern. I was cleared to ride my bike inside once I had enough flexion to actually complete a full pedal stroke - they left the amount of resistance up to me, especially after the second one because they knew that I knew how not to push myself too hard. This came very quickly with the second one and much slower with the first. The key there was my having done a lot of scar mobilization and then I was allowed to go outside at I think 12 weeks. Of course the second time around I managed promptly fractured my shoulder on that first ride.

Running...The first surgery I just didn't get cleared at all. There was too big of a deficiency in strength between the two sides and then I spent the summer studying abroad in Berlin. As for my most recent surgery, I got cleared to start a running program about four weeks ago and that was after the second isokinetic test on the dynamometer (basically this but with a lot more verbal encouragement). I was allowed to run on the Alter-G at the PT gym about four weeks before I got cleared to run outside or on a regular treadmill - I mainly run on a track. The running plan I'm doing was designed by my hospital's PT department. It takes you from four 1x4 min run walk intervals to four 5min x no actual specified time run walk intervals. Right now I'm at 4x1 min interval level and once I'm done with this level I will go to 5x30 seconds, 6x30 seconds, and so on. Moving to C25K would be too fast given how major my surgery was.

So yeah - that's a lot, but I will end this by noting that TTOs are really major surgeries. Think knee replacement, major, except you are allowed to be weight bearing much sooner with knee replacements. Our goal, especially with the first two, was to maintain enough healthy cartridge so that I could hold on on getting a knee replacement for as long as possible. Arthroscopic views of my knees show mild amounts of cartilage damage, but it would have been worse had I not had surgery. Again, I think that both my team of doctors being extremely knowledgeable pared with my having worked very hard is the reason why I was so successful this time around.

edit: I will also note that I have had all of my surgeries while being over 200lbs, I'm 5' 8". No one hesitated because of my weight and I have always been treated as if I am an athlete (because, well, I am). Given my issues, weight played no issue here. The real issue was that I had dislocated the left knee and didn't have PT for it. That set in motion a chain reaction of my right knee overcompensating while it already had a few anatomical issues that made it significantly more susceptible to not tracking correctly.