Lateral Release of the Knee

Surgery to realign the kneecap

lateral release
A lateral release is typically performed by arthroscopic surgery. Javier Larrea / Getty Images

A lateral release is a surgical procedure on the knee used to realign the kneecap (also called the 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 that of a dislocating or subluxing kneecap that is causing pain.

Patellar Movement

The kneecap moves up and down in a groove on the end of the thigh bone as the knee bends. In some patients, 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 causes of patellar maltracking (the name given to the kneecap being pulled to the outside), and the most common are tight tissue attached to the outside of the kneecap (the lateral retinaculum).

When your doctor assesses your kneecap problems, he or she will look for several underlying problems with the mechanics of the kneecap. Patellar tilt is the angle of the kneecap, and whether or not it is being excessively tilted by a tight retinaculum. The other is patellar subluxation, which is when the kneecap is being pulled outside of the groove due to malalignment.

Lateral release is best for a patient with excessive patellar tilt. When the lateral retinaculum is too tight, it can act as a tether to the kneecap. A lateral release is a procedure performed to cut through this tight retinaculum, and allow the kneecap to sit properly within its groove.

When to Perform a Lateral Release

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.

The good news for patients is that in most cases, a tight lateral retinaculum can be successfully treated with nonsurgical stretching and rehabilitation. For this reason, a lateral release should only be considered when patients have failed extensive efforts to address this problem through formal physical therapy. 

In addition, patients who have a kneecap dislocation often require a more extensive surgical procedure to address their condition. There are a number of different surgical procedures to address kneecap dislocations including ligament reconstruction, bone realignment, and others. The critical piece to finding success with treatment is to perform the right surgical procedure for each individual situation.


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 surgery is ensuring the ligaments are released sufficiently to address the alignment issue, but not loosening the ligaments so much that the kneecap becomes unstable and pulled to the inside of the knee (medial subluxation).

The other common problem of this surgical procedure is lack of relief of the original symptoms of pain. 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 decade, surgeons have become much more selective with patients having this procedure, and it seems to help more commonly. However, doing a lateral release surgery is not a guarantee of relief of knee pain. Anyone considering this surgery should discuss with their surgeon how likely the procedure will be at relieving their symptoms, and if the surgeon feels there may be the effective nonsurgical treatment of the problem.

The kneecap is a common source of pain within the knee joint, and can cause symptoms of discomfort with many activities including walking, climbing up and down stairs, kneeling, squatting, and sports activities. Doctors have identified a number of problems that can occur with the kneecap, the cartilage surface underneath the kneecap, the tracking of the kneecap as the knee bends, they can all contribute to the source of this discomfort. However, a lateral release will not necessarily improve all of these different potential causes of kneecap pain. This is why the surgical procedure of a lateral release has a reputation as being an unpredictable surgery. The reality is that a lateral release is not so much of an unpredictable surgical procedure in terms of effectiveness, rather the surgery requires a careful selection of patient's to ensure its being performed for the right reason.

A Word From Verywell

A lateral release is a surgical procedure use to address specific problems of kneecap function. The lateral release is generally performed for people who have a kneecap that is not positioned properly in the groove on the end of the thigh bone. Furthermore, lateral release should only be performed when people have done an appropriate workup with physical therapy, and other treatment modalities.

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