An effective last resort for knee tracking problems.

I have had trouble with my knees for quite some time and have tried just about everything. A local doctor recently suggested a lateral release surgical procedure. What can you tell me about this procedure? How long will it take to recover, and what is the success rate? Are there any troublesome reports I should know about?

Frank Ostrov

Lexington, NY

Lateral release is a surgical treatment for a patellofemoral disorder in which the kneecap tracks to the outside of the knee during flexion and extension. It therefore sets laterally during some or all of the excursion of the patella through its groove. This is more common in females but many males have the condition.

Lateral release surgery should never be considered unless all other treatments have been exhausted. These would include NSAIDs, Tylenol, rehab exercises, patella centering braces, quad strengthening, and avoidance of inappropriate activities such as hill or stadium running and leg extension exercises. Some leg presses and squats are okay. You would need at least six months of rehab without success before I'd recommend surgery.

Lateral release can be done with arthroscopy, which I prefer to open surgery. If there is already considerable arthritis it is less likely to be successful. There are times, however, when the procedure helps even in that situation. It is an outpatient procedure.

The surgery would significantly limit your movement for at least six weeks. Count on another six weeks of diligent rehab before you can resume most activities. Some people are greatly helped, others less so. Only a small percentage do not note any improvement.

Complications are rare but they can include no improvement, infection, and (though very unlikely) excessive correction. There tends to be a moderate amount of bleeding into the joint post-surgery which results in pain and swelling. However, in my extensive knee practice I have been fortunate to see people improved by lateral release if there is strict adherence to the above principles.

Larry D. Hull, MD

Centralia, WA

When a physician does an arthroscopic examination of the knee it is usually done for a specific reason and if patellar pain seems to be the cause, a lateral release may be done in conjunction with a shaving or debridement of lesions beneath the patella. If the knee seems to have lateral subluxation or deviation of the kneecap to the outside, a lateral release is often done to improve normal tracking of the patella.

If very abnormal dislocations of the patella are occurring, another small incision is made during arthroscopy in order to perform a percutaneous lateral release under direct observation.

Healing time can be a few months for vigorous activity because if activity is increased too soon, bleeding into the knee joint may persist. If lateral displacement of the patella is causing pain or if rubbing of the patella in the knee occurs against the femur, a lateral release may provide significant relief. But this is not a procedure to be performed because one "might as well."

Paul Lunseth, MD

Tampa, FL