Lateral release is a surgical procedure that involves releasing (ie. cutting) of the lateral retinaculum. This is done arthroscopically and can be performed in knees that have patellofemoral arthritis with a tight retinaculum and laterally tilted patella. Recovery time from a simple arthroscopic debridement is around 4 – 6 weeks. Following surgery, the recovery time is significantly slower and is likely to take 8 – 12 weeks with continued improvement over 6 months following surgery. This longer recovery time is due primarily to the increased knee swelling seen following this procedure.
Post op exercises (0 – 2 weeks)
- You will usually stay overnight in hospital and are allowed to go home the following morning once mobilising safely
- A Richards (straight leg) splint is used for the first 3 post-operative days and patients use crutches (25-50% partial weight bearing) for 7 – 10 days. This is to help reduce the risk of developing a haemarthrosis which can occur with excessive loading or activity.
- Patients are instructed to “take it easy”, use a compression bandage and ice the knee regularly (up to 6x/day, 20 minutes) to assist with swelling control.
- Circulation drills – foot pumping, static quads and glutes.
- Static quads with small roll behind knee. Get VMO to fire.
- Active assisted range of motion 0-30 degrees for the first 3 days.
- After 3 days the splint is removed and you can perform simple quads drills like straight leg raise (SLR). You can also start to gently bend the knee (active-assisted foot slides) as swelling allows. Do not push the range too hard as there is a risk of haemarthrosis – generally as the swelling reduces the knee will start to “loosen up”.
- Gait re-education- instruct good gait pattern (PWB 25-50% until 7-10 days post op).
Review by Dr Gallagher and Robert Godbolt at 2 weeks
- Exercises are usually fairly conservative until swelling starts to settle.
- Quads drill – static quad (sitting, standing, lying w small rolled towel). If VMO is sluggish, then some NMS (neuromuscular stimulator) may be of benefit
- Straight leg raise / inner range quads
- Side leg and reverse leg raise
- Calf raise
- Clams (if 90° flexion)
- Active assisted flexion drills
- Gait re-education
- Single leg balance drills
Post op exercises (4 – 6 weeks)
As swelling settles and range improves, the following exercises may be appropriate:
- Bridging- doubles and progressing to singles
- Squat- with good technique. Activate glutes and avoid quads dominant squat and valgus collapse
- Band Walks- tall/lateral, low lateral and reverse skater
- Proprioception drills
- Strengthening of glutes , hip abductors / external rotators and core may assist in controlling patellofemoral pain.
Ongoing Management and Education
- Weight loss (if appropriate)
- Orthotic prescription (if appropriate)
- Activity modification – avoidance of high load and/ or repetitive patellofemoral loading – eg. heavy squats / lunges, pump classes.
- Give alternative exercises that don’t excessively load patellofemoral joint- walk, swim, cycle with good set up and higher cadence
The following physiotherapy interventions may be useful in restoring the joint:
- Patellofemoral mobilisation
- Release / soft tissue massage lateral thigh and ITB
- Massage of arthroscopy portals – care with depth until 4 weeks and portals healed
- The use of NMS (neuromuscular stimulators) for VMO activation
- Patellofemoral taping