Lateral Release of the Knee

Surgery used to correct knee misalignment

A lateral release is a surgical procedure on the knee used to realign the kneecap (patella). The lateral release is performed as an arthroscopic knee surgery and can be performed as an outpatient. The usual reason to perform a lateral release is to correct a partially dislocated (subluxated) kneecap that is causing pain.

Conditions Treated

The kneecap moves up and down in a groove on the end of the thigh bone as the knee bends. In some people, the kneecap is abnormally pulled towards the outside of its groove. When the kneecap does not slide well within the groove, cartilage irritation and pain can result.

There are several reasons why this might occur, the most common of which is the tightening of tissue, called the lateral retinaculum, on the outside of the kneecap. When this happens, the patella to begin to tilt laterally and place abnormal pressure of the joint.

When your doctor assesses your kneecap problems, he or she will look for several underlying problems with the mechanics of the kneecap. In addition to a tight retinaculum, patellar subluxation may occur, causing the kneecap to be pulled to the outside of the groove.

Lateral release is a minimally invasive surgery used to correct an excessive patellar tilt. It involves cutting through a tight retinaculum so that the kneecap can slip properly into its groove, thereby restoring its normal alignment.

The surgery is usually performed arthroscopically (with "keyhole" incisions) to minimize complications and speed healing.

Indications

A lateral release is successful when performed in the right patient. For many years, doctors were performing this procedure too commonly, and some patients did not find relief. As we have gained experience with this problem, surgeons have become better at selecting which patients are likely to benefit from a lateral release.

For most people, a tight lateral retinaculum can be successfully treated with nonsurgical stretching and rehabilitation. For this reason, a lateral release should only be considered if extensive physical therapy has failed to provide relief.

In addition, people who have had a kneecap dislocation as a result of a patellar tilt may require more extensive surgical procedures. These may involve open surgical techniques such as ligament reconstruction, bone realignment, and others. 

Complications 

The most common side effect of a lateral release is bleeding into the knee; this can lead to pain and swelling. Other complications include infection and scar tissue formation. 

One of the most difficult aspects of the surgery is ensuring that the ligaments are released sufficiently to correct the misalignment but not so much that the kneecap becomes unstable and is pulled to the inside (medial subluxation).

The other common problem is the lack of pain relief following surgery Historically, many doctors have thought that a lateral release was performed much too frequently, without a good, careful selection of people who are most likely to benefit from the procedure.

Over the past decades, surgeons have become much more selective in choosing the people who would benefit from the procedure. Even then, a lateral release surgery is not a guarantee of pain relief. Anyone considering the surgery should only do so after consultation with an orthopedic surgeon. In many cases, conservative treatment is the more appropriate approach.

A Word From Verywell

A lateral release has the reputation of being an unpredictable surgery. However, the problem lies less with the surgery and more with the selection of the right patients.

As much as you may want a "quick fix" for your knee pain, it is important that you listen to your surgeon and understand both the potential benefits and shortcomings of the procedure.

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