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Patellofemoral Lateral Release Surgery

post #1 of 13
Thread Starter 

Hi All,

 

While I know this isn't a medical board, I just wanted to see if anyone has come across this type of surgery post-ski injury.  My wife and I were in Colorado this past winter, and my wife ended up taking a bad fall - she partially tore her MCL, fractured the fibular crown, and some other spraining and such, possibly a meniscus tear as well.  Doctor had her to PT for about 3 months as the damage should have been able to be healed without surgery, and now we're almost 6 months in with pain still in the knee.

 

New doctor comes in, recommends a specific type of PT with McConnell taping of the knee cap as it appeared to be off-center, and this helps relieve 5 out of 6 pain areas.  From this information and another MRI being completed, doctor is recommending Patellofemoral Lateral Release Surgery, as he believes that there is a buildup of tissue near the knee cap and wants to clean that up to get the kneecap back to normal, and also look at the meniscus when he's in there.

 

Does that make sense, to go from a torn MCL to this type of surgery?  Again, I know we're not doctors here, but just curious if anyone has ever come across this type of path before.

 

Thanks!

post #2 of 13

yes, of course, i am not a dr and only providing the dangerous and useless practice form of internet medicine :D  So here's what I have been told by a OS recently regarding this.  The procedure has a bad rep for being ineffective however, there are different approaches to the procedure and it really comes down to the experience of the OS and his/her methodology. Some do a limited release that is done while moving the knee through its range of motion and then only releasing the lateral release band to the extent necessary to achieve the desired alignment.   I would caution anyone about this procedure though given the rehab ahead and what (in my non-medical opinion) seem rather reliant on the OS's skill and specific technique.  

 

 

Ahh, I see you are in NJ?  Are you going to Lamb in Princeton or who?  I am really not a fan of anything OS related on the NY/NJ area. CAUTION.   


Edited by Finndog - 8/27/15 at 9:20am
post #3 of 13
Thread Starter 

Dr Gecha at Princeton - Same practice as Dr Lamb, but Gecha specializes in knees and this particular surgery. He did mention that he would be doing the limited release, as this worked better than a full release, and that generally he feels this is a 50/50 type surgery, but based on my wife's profile and what she can/can't, he really thinks this is the path to go seeing as we've done everything else he wanted to try - he really didn't want to do surgery to start.  I'm just concerned that this will provide a 100% fix, and that my wife can get back to skiing and other athletic activities (running, weight training, etc).  But I don't see many other options, considering the fact that PT hasn't fixed the problem after 6 months.

post #4 of 13
Quote:
Originally Posted by marlin29311 View Post
 

Dr Gecha at Princeton - Same practice as Dr Lamb, but Gecha specializes in knees and this particular surgery. He did mention that he would be doing the limited release, as this worked better than a full release, and that generally he feels this is a 50/50 type surgery, but based on my wife's profile and what she can/can't, he really thinks this is the path to go seeing as we've done everything else he wanted to try - he really didn't want to do surgery to start.  I'm just concerned that this will provide a 100% fix, and that my wife can get back to skiing and other athletic activities (running, weight training, etc).  But I don't see many other options, considering the fact that PT hasn't fixed the problem after 6 months.

Understand completely, very frustrating.  Did you consider going to Hospital for Special Surgery in NYC?  I would also discuss the healing time on that, from what I recall it was 6-8 weeks and yes, the odds weren't so good. I would suggest getting to another 1-2 OS's who deal with Sports and athletes.  I would also look into a new Physical therapist as well.  Sometimes getting a fresh look and approach can work wonders.  

post #5 of 13
Quote:
Originally Posted by marlin29311 View Post
 

Dr Gecha at Princeton - Same practice as Dr Lamb, but Gecha specializes in knees and this particular surgery. He did mention that he would be doing the limited release, as this worked better than a full release, and that generally he feels this is a 50/50 type surgery, but based on my wife's profile and what she can/can't, he really thinks this is the path to go seeing as we've done everything else he wanted to try - he really didn't want to do surgery to start.  I'm just concerned that this will provide a 100% fix, and that my wife can get back to skiing and other athletic activities (running, weight training, etc).  But I don't see many other options, considering the fact that PT hasn't fixed the problem after 6 months.

The McConnell taping etc has helped 5 of the 6 pain areas, though? How long has that been done? 

 

Short history: I had a lateral release maaaaany years ago, after 8 patellar dislocations between ages 13 and 16. It worked, in that I had no more dislocations. The damage was done, though, and I have pretty significant arthritis, ie no cartilage under that kneecap anymore. So this is a bit of a different issue.

 

Where I'm going: I do tape my knee, and first started McConnell taping about 20 years ago; mostly I use kinesiotape now. Every time I am rigorous about taping over a period of time (a few weeks?months?), my knee always starts to feel better. I am not sure why, but I think it has something to do with the better alignment allowing my muscles to work properly, whereas they don't fire correctly when there is pain and inflammation. I even went a month or so this ski season with almost no knee pain, which was really strange.  Even on really crappy refrozen snow, the stuff that usually just kills me.

 

Now, I am not a doctor, and I just made all this up in my head, but it happens a lot: tape for a long time, and then feel pretty darn good without tape (so of course I stop taping, and then the cycle repeats). So depending on how long she's been taping, she might find some relief upcoming. Or not. The problem with surgery is that doctors always fiddle around in there, and sometimes do more than you really wanted. So I am all for continuing non-surgical options as long as possible. 

post #6 of 13

The other consideration is to look a little closer at all that damage and whether or not it has healed properly.  She sustained a good amount of damage and its very possible all has not healed or has not healed correctly.  I would suggest that you push for another MRI. 

post #7 of 13
Thread Starter 
Quote:
Originally Posted by Finndog View Post
 

The other consideration is to look a little closer at all that damage and whether or not it has healed properly.  She sustained a good amount of damage and its very possible all has not healed or has not healed correctly.  I would suggest that you push for another MRI.

Just had one done last night actually.  The damaged areas all look good from what the doctor and radiologist said.

 

We did switch PT's and doctors as well - this doctor is the 2nd that we've seen since under the prior doctor and PT we weren't getting results really.  New PT and new doctor suggested the taping, which when the knee cap is properly taped, the knee feels pretty good, though there is still pain in the back of the knee, which may or may not be associated with a slight change in walking gait from the injury and pain, or possibly referred pain radiating from the knee cap.  Doctor said that the taping helped him identify the issue, which he then confirmed with the MRI from last night that he believes this is the issue.  Might still be a slight tear of the meniscus he said, but the real pain is coming from this tissue buildup around the kneecap.

 

I actually have a benefit at work that allows me to refer medical cases to a network of specialists for free (well, free to me anyway) for review and treatment recommendations.  I'm definitely going to pursue a second opinion on the surgery.  At first, we both felt that surgery was the only way to get back to 100%, but when the doctor said it's normally a 50/50, I got kind of freaked by that.  But still, after months of PT and stretching and rehabbing it non-surgically, there has to be something out there to fix the knee.

post #8 of 13
Quote:
Originally Posted by marlin29311 View Post
 

Just had one done last night actually.  The damaged areas all look good from what the doctor and radiologist said.

 

We did switch PT's and doctors as well - this doctor is the 2nd that we've seen since under the prior doctor and PT we weren't getting results really.  New PT and new doctor suggested the taping, which when the knee cap is properly taped, the knee feels pretty good, though there is still pain in the back of the knee, which may or may not be associated with a slight change in walking gait from the injury and pain, or possibly referred pain radiating from the knee cap.  Doctor said that the taping helped him identify the issue, which he then confirmed with the MRI from last night that he believes this is the issue.  Might still be a slight tear of the meniscus he said, but the real pain is coming from this tissue buildup around the kneecap.

 

I actually have a benefit at work that allows me to refer medical cases to a network of specialists for free (well, free to me anyway) for review and treatment recommendations.  I'm definitely going to pursue a second opinion on the surgery.  At first, we both felt that surgery was the only way to get back to 100%, but when the doctor said it's normally a 50/50, I got kind of freaked by that.  But still, after months of PT and stretching and rehabbing it non-surgically, there has to be something out there to fix the knee.

hmmmmmmm,,,,,  ok, Pt should be working on correcting any issues with gait!  Curious why the Dr said, "might still be a tear"  they don't generally heal on their own; especially in a non-blood flow area. MCL tear, what grade? It could easily take more than 6 months to really feel healed depending. How much is she using it now? Is she running? Riding? Plyo?  Sounds like I would def' keep the knee taped for now but I would keep diggin' here

post #9 of 13

I had a lateral release done 12 years ago after dislocating my patella in a wrestling match in college.  Similar situation in that I did a 5+ months of rehab before they recommended surgery.  The surgery was a success, I was able to get back to wrestling the next year, although I subluxed the same patella later, that can't be blamed on the surgery.  Today, the joint is strong.  I played rugby after college, lift weights regularly including heavy squats, still run a few miles a week, and generally have no limitations.

 

Now, I'll expand on the "generally".  There is a loose body of calcium build up that sometimes (couple times a year) gets caught in the joint and won't let me bend my knee more than 50% or so.  Eventually it will work itself out with time and light walking, usually in 5-10 minutes, rarely as long as a day.  I've also found that my knee is very sensitive to the shoes I wear, specifically if they get old and the cushioning becomes worn out.  I've seen a few orthos over the past dozen years about the scar tissue build up and loose body in the joint, including an MRI just 18 months ago.  Their advice basically came down to, sure we can go in there and clean it up, but are you sure you want to go through surgery if it's only a few times a year, with no guarantee that it wouldn't happen again?  I've decided against it, and have instead focused on keeping the joint capsule strong.

 

Not really sure if it's answering your question, but I can say the procedure worked for me, I didn't have any tracking issues afterwards.  I don't know if the scar tissue and loose body is common or not, I've never asked since it's not really going to change anything.  I'm going to assume it's a by-product of staying active after surgery (lifting, wrestling, rugby, and now skiing), which I'll gladly take over the alternative.

post #10 of 13
Quote:
Originally Posted by St Bear View Post
 

I had a lateral release done 12 years ago after dislocating my patella in a wrestling match in college.  Similar situation in that I did a 5+ months of rehab before they recommended surgery.  The surgery was a success, I was able to get back to wrestling the next year, although I subluxed the same patella later, that can't be blamed on the surgery.  Today, the joint is strong.  I played rugby after college, lift weights regularly including heavy squats, still run a few miles a week, and generally have no limitations.

 

Now, I'll expand on the "generally".  There is a loose body of calcium build up that sometimes (couple times a year) gets caught in the joint and won't let me bend my knee more than 50% or so.  Eventually it will work itself out with time and light walking, usually in 5-10 minutes, rarely as long as a day.  I've also found that my knee is very sensitive to the shoes I wear, specifically if they get old and the cushioning becomes worn out.  I've seen a few orthos over the past dozen years about the scar tissue build up and loose body in the joint, including an MRI just 18 months ago.  Their advice basically came down to, sure we can go in there and clean it up, but are you sure you want to go through surgery if it's only a few times a year, with no guarantee that it wouldn't happen again?  I've decided against it, and have instead focused on keeping the joint capsule strong.

 

Not really sure if it's answering your question, but I can say the procedure worked for me, I didn't have any tracking issues afterwards.  I don't know if the scar tissue and loose body is common or not, I've never asked since it's not really going to change anything.  I'm going to assume it's a by-product of staying active after surgery (lifting, wrestling, rugby, and now skiing), which I'll gladly take over the alternative.

 

Yeah, me too. A couple years ago I definitely had a bunch of crap floating in there so that I could barely bend the knee. By last year it was so much better, whatever was sticking moved. I asked my physio about surgery to clean "it" out, whatever "it" was, and he recommended I wait and see if it works itself out. It did.

post #11 of 13
Thread Starter 
Quote:
Originally Posted by Finndog View Post
 

hmmmmmmm,,,,,  ok, Pt should be working on correcting any issues with gait!  Curious why the Dr said, "might still be a tear"  they don't generally heal on their own; especially in a non-blood flow area. MCL tear, what grade? It could easily take more than 6 months to really feel healed depending. How much is she using it now? Is she running? Riding? Plyo?  Sounds like I would def' keep the knee taped for now but I would keep diggin' here

 

The 'might' comment was referring to the fact that he does not know if the meniscus was torn in the first place, as both MRI's do not conclusively show if it was or not.  He was simply commenting that some pain could be coming from that, but he's not sure since the visual evidence is not on the MRI's, but that's normal - depending on the tear of the meniscus, it might not show on the MRI.

 

Definitely going to keep the knee taped though moving forward, and my wife is really going to work had with her daily stretching and exercises, even up until surgery (which is scheduled for November, since we are going to Italy in October).  My wife is frustrated at the PT route, though I want to keep her on taping and PT with the tape because I want to go through that some more.  She's also just super frustrated that it's been 6 months and still constant pain.  She's gained a couple pounds because she can't run and workout her legs anymore too, so she's just getting very frustrated.  Trying to find the balance of what to do/what's right is tough right now.

post #12 of 13
Quote:
Originally Posted by marlin29311 View Post
 

 

The 'might' comment was referring to the fact that he does not know if the meniscus was torn in the first place, as both MRI's do not conclusively show if it was or not.  He was simply commenting that some pain could be coming from that, but he's not sure since the visual evidence is not on the MRI's, but that's normal - depending on the tear of the meniscus, it might not show on the MRI.

 

Definitely going to keep the knee taped though moving forward, and my wife is really going to work had with her daily stretching and exercises, even up until surgery (which is scheduled for November, since we are going to Italy in October).  My wife is frustrated at the PT route, though I want to keep her on taping and PT with the tape because I want to go through that some more.  She's also just super frustrated that it's been 6 months and still constant pain.  She's gained a couple pounds because she can't run and workout her legs anymore too, so she's just getting very frustrated.  Trying to find the balance of what to do/what's right is tough right now.

GOTCHA!  I understand as I just dealt with an extremely painful knee for the past 9 months with Orthovisc injections and PT.  Ended up that the root cause was a inflamed hip bursa sac. One injection and almost all knee pain was gone. I gained a few myself and more than anything, the frustration of not getting better really eats at you.  I truly wish you the best and I hope she can find some relief!  Hopefully, the injuries will continue to heal up and she can get back to her normal life.  

 

MRI's- You are right! They can be wrong and aren't as reliable as many think.  I had one show an extensive tear and meniscus de-lamination in my shoulder that was wrong (thankfully!) and another missed a meniscus delam in my hip that was found during surgery) 


Edited by Finndog - 8/28/15 at 10:13am
post #13 of 13
Thread Starter 
Quote:
Originally Posted by Finndog View Post
 

GOTCHA!  I understand as I just dealt with an extremely painful knee for the past 9 months with Orthovisc injections and PT.  Ended up that the root cause was a inflamed hip bursa sac. One injection and almost all knee pain was gone. I gained a few myself and more than anything, the frustration of not getting better really eats at you.  I truly wish you the best and I hope she can find some relief!  Hopefully, the injuries will continue to heal up and she can get back to her normal life.

 

MRI's- You are right! They can be wrong and aren't as reliable as many think.  I had one show an extensive tear and meniscus de-lamination in my shoulder that was wrong (thankfully!) and another missed a meniscus delam in my hip that was found during surgery)

 

Yea unfortunately sometimes the only way that the doctors can really ascertain what's going on is to go in and do surgery - then they know 100% what's wrong/not wrong.

 

We did get some good advice from the PT about some exercises that my wife can do that will work her legs without putting pressure on the knees, so hopefully that provides a little bit of relief.  It's not going to be the 135lb squats she was doing, but it will be something nonetheless.  I'm personally hoping that over the next 2 months it gets better and better and maybe the problem will sort itself out, but I know that can't always be the case with knees.

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