Lateral release?

[vwoude]

I did competitive gymnastics for over 11 years, and I always had some kind of knee pain. I never adressed it, because I figured that it was just from overuse. Now I am a rower in college, and I am having a lot of trouble with my knees. It started in January, so i went to see the athletic trainer at my college. After doing pt and stim and ice with her for over a month, i did not see any results. I made an appointment with the team doctor who saw me for 5 minutes and said that the fat pad under my kneecap was inflamed and gave me a cortisone shot. I didn't feel right about this, so I made an appointment with my orthopedic who told me that he could see a slight patellar tilt on the xrays and we decided to do an mri after I went on our training trip for spring break. It felt slightly better for a couple days and then resumed to the same pain as before. After my mri, at my follow up my doctor said that i had plica syndrome and that i should try taking some time off and see if that helps. He mentioned surgery but wanted me to take time off first. I took it easy, and rowed only twice for 1 month. I did not experience any relief with the pain, and it even got worse. I went back after a month and he said that surgery was probably the best option for my problem, because it affects my everyday activities such as walking and doing stairs. I have an ppointment with the surgeon next week, so i have continued rowing because the season is almost over. I experienced a sublaxation of my kneecap in the uninjured knee the other day and now it also is very painful. It has been giving out on me just like how the other knee started. In my injured knee i cant even starighten it all the way anymore and i have started to get sharp pains randomly. Do you think this is the best way to go?

[sscheurich]

My daughter just had a lateral release done on March 19th, 2009.  She is 13 years old and is an avid softball player with a very high pain tolerance.  Her pain started back in the fall of 2008 (end of October).  She finally asked me to get her to a doctor due to the pain.  She began physical therapy 3 times a week to build her quad muscle in that leg. She's was told that she had patellar tracking which is very common in girls her age.  We finally went to our 2nd specialist after 12 weeks of therapy as her strength in that leg kept decreasing.  (the 1st specialist after MRIs and x-rays told us it was tendonitis and if worse came to worse- give up your sport.)  Which wasn't an option to this 13 year old athlete or us - her parents!!  Her softball coach recommended her orthopedic surgeon who works with several professional sports teams in Chicago.  After meeting with him and discussing the length of this injury - he gave her 1/2 of a cortizone shot (which normally is not given to kids).  3 weeks to the date the shot was worn off.  I called the dr and we set up a date for the surgery.  During the surgery, he did the lateral release, found a crack in her cartlidge and a blister under the kneecap from the kneecap rocking in and out all the time.  He said her knees were like a 18-20 year olds.  She had the surgery at 9:15 am and we were on our way home by 12:20 pm the same day.  She had a nerve block so she couldn't feel the leg for about 2 days.  We stopped at Cracker Barrel on the way home for lunch and she acted like she never even had surgery.  The 3rd day (once she could feel the leg again) she was outside walking with her crutches putting a little weight on the leg and said that her knee hadn't felt that good for a long time.  Her surgery was 7 weeks ago and she had a softball tournament over the weekend and pitched a great game.  So I'd just like to say that our experience with a lateral release has been such an answer to prayer and she had made the comment that she would have that surgery any time over her tonsillectomy!!!!  She basically had NO pain with it.  Good luck with what you decide.

[vwoude]

I was put on two different NSAIDs, neither of which really made any difference. I also have been wearing a brace when i row. I am now going on my 5th month of trying to deal with this, and nothing seems to be working. I have been reading up on this online, and I have heard so many horror stories about this sugery and I just wanted to know basically what to expect.

[Michael L Gross, MD]

Problems with the patellofemoral articulation, the joint between the kneecap and the thigh, frequently present with pain going up and down stairs, and craqcking and popping in the knee.  The cause is usually a combination of malalignment of the patellofemoral joint, quadriceps weakness or imbalance, and wear of the cartilage behind the kneecap. These problems often are referred to by a variety of names:  runner's knee, chondromalacia patella, anterior knee pain syndrome, patella femoral syndrome.  Certainly, Ehlers-Danlos syndrome, generalized ligamentous laxity, could be a contributing factor.
In general, treatment for patellafemoral problems begins conservatively, and only progresses to surgical options if nonoperative treatment is unsuccessful.  Treatment usually starts with physical therapy aimed at strengthening the quadriceps, and stretching contacted soft tissue structures. Braces to control patella alignment and inserts to correct flat feet are often helpful as well.  Judicious use of non-steroidal anti-inflammatories is also an important adjunct to therapy.
Surgical options include arthroscopic lateral release, various open patella realignment procedures, and even replacement of the patella femoral joint.