Knee still maltracking four months after Lateral Release?!
Question: I had a lateral release on my knee in early October, and went through physical therapy until mid December. After going back to my orthopedic surgeon for another post op appointment January 2nd, he prescribed me with another month of therapy and told me to come back if I was still having problems.
My knee has never fully felt right after the surgery, even at my very strongest point during physical therapy. I'm back in PT now, but my knee is maltracking badly again, and the therapists told me this is because my quad is weak... though I've been having this same pain all along (just not to this extent) even when my quad was "stronger." Any exercises in therapy to make my quad stronger hurt my knee terribly (not just muscular soreness, it's joing soreness), and it's begun popping again (like before surgery) when i bend.
I realize everyone has different healing time, but as a 22 year-old, I thought I would be better/see vast improvement by now. Is this normal-ish? I'm kind of concerned.
Answers: I had a lateral release on my knee in early October, and went through physical therapy until mid December. After going back to my orthopedic surgeon for another post op appointment January 2nd, he prescribed me with another month of therapy and told me to come back if I was still having problems.
My knee has never fully felt right after the surgery, even at my very strongest point during physical therapy. I'm back in PT now, but my knee is maltracking badly again, and the therapists told me this is because my quad is weak... though I've been having this same pain all along (just not to this extent) even when my quad was "stronger." Any exercises in therapy to make my quad stronger hurt my knee terribly (not just muscular soreness, it's joing soreness), and it's begun popping again (like before surgery) when i bend.
I realize everyone has different healing time, but as a 22 year-old, I thought I would be better/see vast improvement by now. Is this normal-ish? I'm kind of concerned.
Yes, 4 months later, you should be feeling considerably better. Quad weakness and lateral component tightness are only two considerations when it comes to poor tracking problems.
Another consideration is the depth of your trochelar groove...the groove in which your patella tracks. If it is inadequate, a lateral release will probably be ineffective because the patella can still very easily fall out of the groove. Conservative options would be a patellar relocation brace that actually applies compression to the patella to help it sit in the groove. One such example is the Q-lock by bioskin. Surgical options could include troclear plasty or wedge osteotomy where they actually cut bone to make it deeper...yet, I've never seen anyone with this done.
Your structure is another consideration...if you have a large "Q" angle...the angle between your thigh and your leg, again lateral release will be ineffective because the quadriceps mechanism is ineffective because of the angle of the pull as well as the lateral component is put into a shortened position. This is where the tibial transposition may need to be considered as Whitney mentions above. Orthotic correction of the foot may also been needed.
You certainly shouldn't be fully recovered at this point, but you should defintely be feeling a lot better than what you describe.
Give it another couple months, and if it still isn't looking good and your doctor doesn't have the answers, go to a teaching hospital with a good orthopedic reputation.
Hi Leslie. I am sorry to hear about the difficulty you are having with your knee. Obviously, this continuing problem is very frustrating for you. Clearly, your therapist and surgeon do NOT have clear answers for you - they are basically just hoping time (and your body's own healing powers) will cure what they have not been able to heal.
Have you had an evaluation by your family Chiropractor? There are many bio-mechanical problems that can be present in you knee, foot, hip, pelvis, lumbar spine and even cervical spine that could be contributing to your knee condition and/or impairing your body's ability to heal. Such an evaluation may be time and money well spent.
You may also want to get a second opinion from another knee surgeon and another physical therapist.
Best wishes and good luck.
I had sort of the same thing happen to me because of a patellar dislocation. I have no clue what to you tell since my knee has never been even close to the same, after 2 surgeries and months of PT and rehab, I've just come to accept that things will never be the same again.
I so understand!!!!!!! I've had 4 knee surgeries including two lateral releases. I had a lateral release about 4 years ago (along with other procedures) and my knee kept mal-tracking. I went back to PT several times, but my quad, specifically my vastis medialis, would not get stronger. I eventually had to have another surgery , and come to find out, my lateral release had re-grown!! That happens in less than 1% of people!!:( Any way, they had to do a procedure called tibial tubercle transfer, where they moved my tibia 10 cm to the right to keep my patella from dislocating while also re-doing the lateral release. My patella still moves around alot but has not dislocated since. I still have trouble w/ my quad, so I have to wear a brace at all times. Just keep up the PT and if it doesn't help, ask your doctor about what can be done!! Good Luck!!!
ACL- go to another Doctor, one with a proven track record for sports medicine. May be only answer, how did you find this one? Does the term Malpractice mean anything to you? Was it ortho surgery? May still be salvagable if ACL good luck!!!!
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