The patella, commonly known as the kneecap, is one of three bones that make up the knee joint and serves to increase leverage. Pain in the patella can be a result of overuse or injury. One of the most common sources of knee pain is patellar tracking disorder, which involves a shifting of the kneecap that occurs when the leg bends or straightens, as a result of misalignment caused by cartilage damage or a shallow groove track. The kneecap is often pulled laterally, to the outside of the knee, because of overly tight tissue in that area. Patients with this condition may experience pain when bending the knee for sitting, walking downstairs or squatting. There may also be a popping, grinding or catching sensation with the knee bends or straightens.
Another disorder of the kneecap is patella femoral syndrome (PFS). This occurs when the patella is pushed against the side of the groove in the thighbone in which it rests. The pressure on the patella may also cause its underside to roughen or become inflamed. Discomfort is usually felt in the front of the knee, although it can also present on the inside, outside or throughout the joint. Pain may be sharp or dull and may be accompanied by clicking or grinding noises when the knee bends. Squatting and walking down stairs often make the pain worse. Sitting for long periods may produce an urge to straighten and "crack" the knee.
PFS is one of the most common sources of knee pain in runners, and in fact is often called "runner's knee." Skiers, bicyclists and soccer players also frequently experience patello-femoral pain. In addition to these sports, knee injuries, muscle tightness, muscle weakness, exercise that involves large amounts of hill- or stair-climbing or long distance walking/running, an uneven patello-femoral groove and abnormalities such as overpronation and "knock knees" all increase the likelihood of a person developing PFS.
Dr. Williams will perform a physical examination of the knee, performing a thorough assessment of its mechanics. The angle at which the kneecap sits and whether it is out of alignment can provide proof of a patellar tracking disorder or PFS causing poor positioning. Imaging tests such as an X-ray or MRI may also be necessary to visualize the tissue within the knee and rule out structural damage as the cause of the pain.
Treatment for many of these knee disorders can often be successfully achieved by resting and icing the knee or taking pain medication. Physical therapy may also be useful. However, in some cases, lateral release surgery, in which the lateral retinaculum ligament complex is surgically cut, may be necessary.
Lateral release surgery is useful in realigning the kneecap and re-establishing normal patellar tracking. It may be performed in your doctor’s office using local or general anesthesia. This arthroscopic procedure employs a minimally invasive technique. Lateral release surgery entails the formation of two to three small incisions in the knee area to provide access to the knee joint. A narrow device with a tiny camera on one end is inserted into one of the incisions, allowing your surgeon a comprehensive view on a monitor of all of the ligaments and other structures of the knee.
Other surgical instruments are next placed in the knee through the additional incisions that were made. The lateral retinaculum can then be cut, which will release the pulling on the tissue and return the patella to the correct position in which it belongs. The incisions can then be closed using either sutures or staples. Sometimes, a support bandage with padding will be positioned on the outer knee to hold the patella in its new, correct alignment.
After lateral release surgery, you can expect to make a full recovery in three to five months. Most patients can resume normal daily activities within a few weeks. Participation in sports and activities that are high-impact should not be attempted until recovery is complete. Some patients require crutches for up to two weeks post-surgery to keep weight-bearing on the knee to a minimum.
Physical therapy is generally necessary after lateral release surgery. Not only can it help promote healing, but these exercises are designed to strengthen the muscles surrounding the knee and promote flexibility, both of which can serve to prevent the causes of the knee issues from resurfacing.
Questions? If you would like more information about Lateral Release or to schedule an appointment, feel free to fill out our convenient contact form or call our office at (212) 606-1855.