Lateral release surgery addresses patellofemoral pain, which involves the kneecap (patella) tracking improperly in the groove of the thigh bone. This misalignment occurs because the lateral retinaculum, a tight band of tissue on the outside of the knee, pulls the kneecap out of alignment. The surgery releases this tight tissue to allow the patella to sit properly and reduce pain. Because the integrity of the knee’s soft tissue is altered, bracing is a necessary part of the immediate post-operative protocol to protect the surgical site. The specific type of brace, how long it is worn, and the rehabilitation timeline are determined by the surgeon based on the extent of the procedure and the patient’s individual healing progress.
The Initial Requirement for Bracing
The immediate period following lateral release surgery is focused on protecting the surgical site and ensuring the released soft tissues heal in a lengthened position. A brace is applied immediately after the operation to provide stabilization to the knee joint. This external support is designed to limit excessive or uncontrolled range of motion (ROM) that could disrupt the healing of the lateral retinacular repair.
The brace helps manage the initial swelling and pain. During this maximum protection phase, the brace is often locked in a straight or near-straight position, such as full extension or a slight bend like 20 to 30 degrees of flexion. This restriction is crucial for the first one to two weeks, as it prevents the kneecap from being pulled laterally before the released tissues have had a chance to begin healing. The patient often uses crutches for ambulation during this time, with weight-bearing status varying while the brace remains locked.
Understanding Brace Function and Design
The type of brace used in this recovery phase is designed to manage the knee’s movement with precision. A common option is a simple knee immobilizer, which completely locks the knee in a straight position, providing maximum support and preventing any bending. This is often used for the first few days to a week for comfort and maximum protection.
A more advanced device is the hinged knee brace, also known as a post-operative range-of-motion (ROM) brace. This brace features mechanical hinges that can be adjusted to set specific limits on the allowed degrees of knee flexion and extension. The surgeon or physical therapist dictates these settings, ensuring controlled movement that protects the healing site while allowing for necessary early, gentle motion. The hinged mechanism allows the brace to be locked at full extension for safe ambulation, but then unlocked to a controlled range, such as 0 to 90 degrees of flexion, to permit therapeutic exercises.
Phased Transition to Mobility
The progression out of the brace is a gradual process determined by specific healing milestones, not a fixed date. The first follow-up appointment, typically around 10 to 14 days post-surgery, is when the surgeon assesses wound healing, pain control, and the patient’s ability to perform a straight leg raise without extensor lag. At this point, the brace may be discontinued entirely or the allowed range of motion may be increased.
Physical therapy plays a role in this phase, guiding the controlled return to function. If a hinged brace is still worn, the therapist will adjust the mechanical stops to permit greater degrees of flexion and extension over time, perhaps increasing the limit by 10 to 15 degrees per week. Exercises initially focus on reactivating the quadriceps muscle, such as quad sets and straight leg raises, which are vital for stabilizing the kneecap. The goal is to transition from the large hinged brace to unsupported mobility, or possibly a simple elastic sleeve, once sufficient strength and a pain-free, normal gait pattern are achieved. This gradual weaning process ensures the new alignment of the patella is maintained by the patient’s own musculature before the brace is fully discontinued.
Recognizing Post-Operative Concerns
While bracing and rehabilitation are guided by a structured protocol, patients must monitor for potential complications that require immediate medical attention.
Signs of Infection
Signs of infection at the surgical site include:
- Increasing redness that spreads beyond the incision.
- Warmth or a foul odor.
- Thick, white or greenish pus-like drainage.
- A persistent fever of 101 degrees Fahrenheit or higher.
Deep vein thrombosis (DVT), a blood clot in the leg, is a risk after any lower extremity surgery. Symptoms include disproportionate calf pain, tenderness, or swelling that does not improve with elevation.
Severe, unrelieved pain that does not respond to prescribed medication or any sudden loss of sensation, numbness, or tingling in the foot and toes could indicate a nerve issue and should be reported to the surgical team immediately.