A lateral release is a common orthopedic surgery addressing issues with kneecap movement, medically known as the patella. The procedure is typically performed using an arthroscope, a minimally invasive technique involving small incisions and a camera. The primary goal is to relieve excessive tension on the outer, or lateral, side of the kneecap. Reducing this tension helps the patella track more correctly within the groove of the thigh bone, or femur. This realignment reduces pain and improves the overall function of the knee joint.
Why the Procedure is Necessary
The formal name for this operation is a Lateral Retinacular Release. It is indicated when tight structures on the outside of the knee pull the kneecap out of its central alignment. This malalignment can lead to conditions such as chronic patellar instability or Patellofemoral Pain Syndrome (PFPS).
When the kneecap is pulled laterally, it can cause a condition sometimes referred to as “excessive lateral pressure syndrome” (ELPS). This chronic lateral pull places uneven stress on the joint, leading to pain and potential wear on the cartilage.
The tight band of tissue responsible for this lateral force is the lateral retinaculum. Releasing this tight structure allows the patella to shift slightly toward the inner side of the knee, helping it move more smoothly in the femoral groove.
The surgical option is not usually the first step in treatment. The procedure is generally considered only after conservative treatments have been exhausted. These non-surgical methods typically include physical therapy, specialized bracing, anti-inflammatory medications, and activity modification, often over several months. If symptoms persist, a surgical release may be recommended.
Surgical Technique Explained
The Lateral Retinacular Release is most often performed arthroscopically, meaning the surgeon uses specialized instruments inserted through small incisions around the knee. This minimally invasive approach allows the surgeon to visualize the inside of the joint without needing a large open incision.
The camera, or arthroscope, guides the surgeon to the specific location of the tight tissue. The targeted structure is the lateral retinaculum, the fibrous tissue that connects the kneecap to the outer side of the knee.
The surgeon carefully cuts or incises this tight band of tissue. This action releases the restricting force that was causing the kneecap to track improperly.
The extent of the release is carefully controlled to ensure the kneecap is not over-released, which could cause instability in the opposite direction. Releasing the tension on the lateral side restores the balance of forces around the kneecap. This allows the patella to center itself more effectively, reducing the painful pressure against the outer wall of the femoral groove.
Immediate Post-Operative Expectations
In the first few weeks after a lateral release, managing pain and swelling is the immediate focus of recovery. Swelling and bruising are common reactions to the surgery and can be significantly reduced by elevating the leg above heart level and applying ice regularly. Patients are typically prescribed strong oral pain medication for the initial days, which should be used judiciously and supplemented with over-the-counter medication as pain subsides.
Many surgeons recommend the use of crutches for partial weight-bearing for the first couple of weeks, though in some cases, full weight-bearing may be permitted immediately with the aid of a brace. A temporary brace is often used to stabilize the knee, sometimes locked at a slight bend, and its use is guided by the surgeon’s specific protocol.
Wound care involves keeping the small incisions clean and dry. Showering is usually permitted after about 48 hours, but avoiding baths or soaking the knee until the incisions are fully healed.
Early, gentle range-of-motion exercises are essential. Patients are often instructed to begin simple exercises on the first day, such as quad sets and straight-leg raises, to maintain muscle tone and prevent stiffness. These exercises are frequently supervised by a physical therapist, who also guides the progression of knee bending to prevent scar tissue formation. The goal is to regain full knee extension as soon as safely possible.
Long-Term Rehabilitation and Outcomes
The path to full recovery requires a structured physical therapy (PT) program and typically spans three to six months. Structured PT is necessary to ensure the long-term success of the surgery. The therapy focuses on strengthening the muscles that support the kneecap, particularly the vastus medialis obliquus (VMO) muscle, which is located on the inner side of the thigh.
The exercises progress from simple range-of-motion and isometric movements to advanced strengthening and proprioceptive training. Strengthening the VMO helps counteract any residual pull from the lateral structures and improves overall leg alignment and kneecap stability.
While most individuals can resume the majority of their daily activities within three months, maximal recovery can take up to a year.
Success rates for pain reduction following a lateral release are generally high for carefully selected patients. Potential long-term complications are uncommon. Risks include recurrence of instability or medial patellar instability, which occurs if the lateral retinaculum is over-released.