A lateral release is an orthopedic surgical procedure for the knee designed to correct issues with the kneecap, or patella, which is not tracking properly in its groove on the thigh bone (femur). This common intervention aims to relieve pressure and pain that develop when the patella is pulled too far toward the outside of the knee joint. The procedure specifically targets and cuts a tight band of tissue to restore the kneecap’s alignment, allowing it to glide more smoothly during movement. It is typically considered when non-surgical treatments have failed to alleviate persistent anterior knee pain.
The Underlying Problem: When the Patella Tracks Improperly
The kneecap, or patella, sits in a groove at the end of the femur, known as the patellofemoral joint. For the knee to bend and straighten without pain, the patella must glide centrally within this groove, a motion referred to as patellar tracking. The stability and alignment of the patella are maintained by a balance of forces from the surrounding soft tissues, including muscles and ligaments.
A common source of anterior knee pain and maltracking is an imbalance of these soft tissue forces, often resulting from tightness on the lateral, or outer, side of the knee. The lateral retinaculum is a fibrous expansion that provides lateral support and resists medial displacement of the patella. When this lateral retinaculum becomes overly tight, it exerts an excessive pulling force, causing the patella to tilt or shift out of its normal track toward the outside of the knee.
This lateral maltracking increases pressure and friction on the cartilage surfaces of the patella and the femoral groove, which can lead to significant discomfort and irritation. The resulting condition is often diagnosed as patellofemoral pain syndrome. The goal of surgical intervention is to release this excessive tension to allow the patella to recenter itself and reduce the abnormal stress on the joint.
How the Lateral Release Procedure Works
The lateral release procedure is most frequently performed using an arthroscope, making it a minimally invasive surgery. The surgeon makes two or three small incisions, typically about half an inch long, around the knee joint to insert a tiny camera and specialized surgical instruments. The arthroscope projects images onto a monitor, providing the surgeon with a clear view of the knee’s interior structures.
The procedure’s mechanism is straightforward: the surgeon carefully cuts or incises the tight lateral retinaculum. Releasing this fibrous band of tissue alleviates the tension that was pulling the kneecap laterally. This action allows the patella to shift back toward the center of the femoral groove, improving its side-to-side mobility and overall alignment.
The surgery is typically done under general or regional anesthesia, and the duration is often relatively short, sometimes taking only 20 to 30 minutes. Once the surgeon confirms the improved patellar mobility, the small incisions are closed with sutures or staples. Patients are usually able to return home shortly after waking up from the anesthesia.
The Post-Operative Rehabilitation Process
The success of a lateral release procedure relies heavily on a dedicated post-operative rehabilitation program. Immediately following the surgery, managing pain and swelling is paramount, often involving medication, ice application, and elevating the leg. Patients are typically encouraged to begin range-of-motion exercises as soon as possible, sometimes starting the day after surgery.
Early mobilization is a focus, with initial exercises including gentle patella mobilizations, quadriceps sets, and straight leg raises to maintain muscle activation and prevent stiffness. A knee brace or crutches may be used for the first few weeks to allow partial weight bearing, but the goal is to progress to a pain-free, normal gait. Discontinuing crutches often occurs around two to three weeks post-surgery, depending on the individual’s comfort and confidence.
Physical therapy continues beyond the initial recovery, transitioning to strengthening exercises for the quadriceps, hamstrings, and hip muscles. This phase is designed to build the muscular support needed to keep the patella centered in its new, corrected position. Following the prescribed rehabilitation protocol diligently is considered more important than the surgery itself for achieving a positive long-term outcome.
Expected Functional Improvement
The primary goal of a lateral release is to achieve a substantial reduction in the anterior knee pain caused by patellar maltracking. By balancing the tension across the kneecap, the procedure aims to improve patellar alignment, which decreases the excessive friction and pressure within the patellofemoral joint. This improved stability allows patients to engage in daily activities with greater confidence and less discomfort.
Patients can expect a gradual return to normal activities, with most of the improvement occurring within the first three months following the procedure. However, full recovery, including the return to high-level sports or demanding physical activities, can take between three to six months or even up to a year.
Long-term studies suggest that the majority of patients who undergo this procedure report satisfaction and demonstrate well-functioning knees several years later. The successful realignment allows patients to perform strengthening exercises more effectively, which is essential for maintaining the knee’s stability and function over time. The overall expectation is a significant improvement in the quality of life due to the alleviation of chronic knee pain.