Do you suffer from knee pain that goes beyond just a sore knee? If so, you may need lateral release surgery. If you're thinking about the surgery (also known as a lateral retinacular procedure), read on to find out what you can expect. I successfully had a lateral release performed which helped postpone further surgery.
If you're considering the surgery, you're part of a very large group of people dealing with knee pain, as the numbers of Americans who suffer from severe joint pain is rising. In 2002, the CDC reported about 10.5 million people with serious joint pain. But in 2014, CDC reports cited 14.6 million people with the same kind of pain.
According to the CDC, those rising numbers are directly tied to rising arthritis rates. No matter what the explanation is, the pain remains the same for the people who suffer from it.
However, you don't have to live with joint pain for the rest of your life. There are many treatment options out there for different kinds of pain. For people with knee pain, lateral release surgery may be a good choice and may allow you to postpone even more invasive surgery like a total knee replacement.
Wondering what to expect from a lateral release or lateral retinacular procedure? Hopefully I can help clear up some of your questions based on my own experience with the surgery. In the end, only you can decide if lateral release knee surgery is a good solution for your pain.
What is Lateral Release Surgery?
This type of surgery involves the kneecap (called the "patella" in medical terms).
Your kneecap may be small, but it's important -- and complicated. It needs to sit in the right place on top of your thigh bone in order to do its job correctly. Since the kneecap isn't actually attached to the thigh bone, it relies on tissues to stay in place.
Two tissues on each side of the kneecap keep it there. One is called the medial retinaculum, and the other is called the lateral retinaculum. Sometimes, the lateral retinaculum starts to pull too much, straining the medial side. Lateral release surgery releases the pull from the lateral side to reduce pain.
The Lateral Release Procedure
What's the process of getting this procedure like? Below was my experience from start to finish.
First, your doctor needs to be sure that your problem comes from the medial and lateral retinacula. If you have knee pain, they'll probably start you out with other types of treatment. You might try pain relieving or anti-inflammatory medications, as well as physical therapy and knee exercises.
Your doctor might also recommend that you give up some activities, or try icing your knee to find relief. However, if these tactics don't work, surgery will be the next choice. Surgery can also help you get more out of the other strategies, like exercises.
Once you've decided on surgery, you'll need to get ready for it.
Before surgery, you might need to buy some tools for your recovery. Your doctor might recommend ice packs, crutches, a knee brace, or other things. I had all of these things. The knee brace came from a medical supply company and was fit specifically for my knee.
Sometimes, you might even need to get a continuous passive motion (CPM) machine. These machines automatically move your knee in gentle motions. Some orthopedic doctors use them, some don’t. This is something you’d get as a prescription from your doctor for after the surgery. I didn’t have one for after my surgery.
Your orthopedic surgeon should make sure you have all of these tools before the surgery, because you'll need them right away. If any of them are new to you, get some practice with using them first. Most doctors will want you to visit a physical therapist before surgery to teach you how to walk with crutches, or set up your CPM machine before surgery.
Another important part of the prep work is making sure you let your doctor know about your complete medical history, especially any problems. Let them know if you're currently on any medications, and if you have any ongoing health issues. This is a biggie, don’t leave anything out. Herbal supplements, vitamins, etc. Tell them everything you take, even if some of it isn’t on a daily basis. Surgery is serious and what you have in your body can affect the outcome.
Don't forget to ask your doctor or surgeon any questions you have. They need to give you the information that you need to feel comfortable about the process.
As part of getting ready for lateral release surgery, don't forget to make sure that you have insurance coverage. Most doctors’ offices handle this, but for your own peace of mind and to avoid unpleasant surprises like big deductibles, you may want to contact your insurance provider to find out their requirements for reimbursing a surgical procedure. You might need to see a certain provider, or get a second opinion.
Now, the day of your surgery has arrived. It is almost always done as an outpatient surgery unless you have special medical needs. I didn't, so my lateral release was outpatient.
Your knee area will likely get shaved, and you'll probably be put under general anesthesia for the process. The procedure itself can be either arthroscopic or open. With the open technique, your surgeon will make an incision. This allows more options for repairing the connective tissue, if you need major changes. Mine was arthroscopic. Even so, my surgeon was able to do serious work on my knee.
However, the incision-free method is less invasive, and also won't leave a scar. If you just need a standard lateral retinacular procedure, you may want this method.
The surgeon will carefully expose the lateral retinaculum. Then, they'll adjust it so it's longer and the extra pressure gets released. If you have the non-invasive type of procedure, you'll probably be done in under an hour. Even with an incision, this is a fairly quick procedure.
Lateral Release Surgery Recovery
After a bit of time to let the anesthesia wear off, you should be ready to head home. I’m not going to sugar coat this...I was in a LOT of pain. Then the nurse told me to stand. Ummm…what??? I was crying in pain! They took pity on me since every last bit of anesthesia had worn off (or the pain just came right on through). I did get a narcotic pain reliever before I had to stand and head home. You absolutely will need someone to take you to and home from your procedure. In my case, we made a beeline for the pharmacy because I was not having any more of the pain relief wearing off.
Once you’re at home, you need to rest. However, don’t stay in bed all day. It’ll make your lateral release recovery much worse because scar tissue will form. You do not want to have to get newly forming scar tissue snapped during your physical therapy. I did, and it isn’t fun. At all.
You'll probably need to wear a knee brace so the knee stays at the proper angle for recovery. Your doctor will recommend that you use the knee a little bit to keep the swelling down, but it will be some time before you can walk without assistance.
Finally, exercises and physical therapy will help you finish recovering. Go to every single physical therapy appointment. They will feel like torture at first, but an excellent outcome depends on physical therapy after surgery.
From the day of my lateral release surgery to the end of physical therapy and being able to walk normally took me about 4 weeks. Within a day or two after surgery I had a bruise from my ankle to my upper thigh that was almost black. It was huge and it hurt. It was not an easy surgery for me due to the amount of work the surgeon did on my knee. The small incision scars faded very quickly and at this point I have to look for them to notice where they are.
Was it worth it? YES. I didn’t have to have a knee replacement until 18 years later. You can’t get total knee replacements every few years, and you’re limited to how often you can have them in your lifetime. Putting off that surgery for as long as possible was worth the initial pain to me.
Is a Lateral Release Right for You?
The kneecap can play a role in people's knee pain. Knee pain often involves a patella that's tilted to the outside, or lateral, side of the knee. This tilt comes from your thigh muscles, which create a powerful pull on the kneecap over time. The medial retinaculum on the other side of the kneecap then becomes strained. This strain gradually translates to pain.
Of course, there are many different sources of knee pain, such as arthritis and injury. But if a physician determines that strain on the medial retinaculum causes your pain, they might decide this release procedure is best. Doing nothing so you can avoid the pain of surgery and its aftermath will only make your life exponentially more miserable. Surgery pain does get better. An injured and degenerating knee mechanism doesn’t get better.
Lateral release surgery isn't right for everyone. But if you never talk to a doctor, you'll struggle to find a solution for your ongoing knee pain. My recommendation is that you visit your physician as soon as possible. You may not need surgery at all, but having a good doctor as a partner in improving your health can help you find ways to reduce your pain in the long term, which could include a lateral release.