Patello-Femoral Problems

Lateral Release

The patella or kneecap is the moveable bone on the front of the knee. The patella is wrapped inside a large tendon that connects the large muscles on the front of the thigh, the quadriceps, to the lower leg bone. The underside of the patella is covered with articular cartilage, the smooth covering of joint surfaces. This slippery surface helps the patella glide in a special groove of the thigh bone or femur. Together the patella and the groove in the femur are called the patello-femoral mechanism.

Problems commonly develop when the patella suffers wear and tear and underlying cartilage begins to degenerate.
Degeneration may occur as part of the aging process or because of the way the patella moves through the groove in the femur. Remember, the quadriceps muscle controls the movement of the patella and if this muscle becomes weak for any reason an imbalance can occur which causes the patella to pull to one side more than the other. This places more pressure on one side of the underlying cartilage and can cause damage over time.

Patella Malalignment/Dislocation

The normal patella should track in the groove of the femur in a relatively straight manner, but sometimes the patella can slip out of place due to injury or congenital abnormalities in the shape of the knee. This slippage may be very minor, or you may actually see that the patella is in the wrong position. If it slips all the way out of position this is called dislocation. If it only partially slips this is called subluxation.

Sometimes the bands of tissue that hold your kneecap in place can become too tight on one side and pull the patella out of the groove in the femur. If this occurs your physician may prescribe physical therapy and exercises to correct the problem. If conservative measures fail to help you may require surgery. The surgery is called Lateral Release. This procedure is done to allow the patella to shift back to a more normal position and relieve the pressure on the articular cartilage. In this operation, the tight ligaments on the outside of the patella are cut or released to allow the patella to slide more towards the femoral groove.

Pain Control:  Take pain medication as prescribed by Dr. Reznik.  Please call our office with any questions regarding your medication Use ice as needed and elevate leg above heart level. This will decrease swelling and help with a common complaint of “throbbing” pain associated with a lateral release procedure.

Dressing and Bleeding:  After a lateral release procedure, a moderate – large amount of blood tinged drainage post-op is not unusual.   You may need to reinforce the dressing during the first 24 – 48 hours.  Applying pressure to area will help reduce this drainage.

Crutches:  Patients are to use two crutches for the first week, putting light weight on the operative leg with each step.  Remember to put your foot flat on the ground even when lightly weight bearing.  Increase the weight as tolerated.  Advance to one crutch a few days and then a cane if needed. Most patients can be full weight bearing by the end of the first week.

Return to Work:  People with light work (desk work with no squatting, lifting or kneeling) can return to work within a week.  The exception is for people who may have long commutes. By staying still with the leg down for long periods, THEY ARE AT RISK FOR BLOOD CLOTS. Patients with active office work or very light labor with variable tasks can sometimes go back to work at two or three weeks, depending on lifting requirements.  Heavy work, (lifting or unprotected heights) cannot usually return before 6 weeks.  Most will need to be cleared by their physical therapist.

Driving: Right knee patients and left knee patients with a standard transmission car cannot drive until out of the knee immobilizer, off all pain meds and can fully weight bear without pain.

Airplane Flights:  You may fly 2-3 weeks after surgery on short flights (under 2 hours), 6-8 weeks for longer flights.  You should also take an aspirin per day unless allergic. Call our office with any questions.

Blood Clots:  Those at high risk of blood clots include patients who have long car or train commutes, may be overweight, have a history of cancer, women on birth control pills or males over the age of 40.  These patients should be taking an aspirin per day unless allergic to aspirin.  Doing the exercises Dr. Reznik prescribed will also reduce the risk of blood clots.

Post-Operative Exercises

You will start these exercises while still in the recovery room. Then, while resting after the surgery, do the following: 

	•  Ankle Pumps: Pump your ankle up and down for 1 minute (like pressing on the gas pedal). This will increase circulation and reduce the risk of developing a blood clot.  If watching TV, do this during every commercial.
	•  Straight Leg Raise: Tighten your quads (muscle in the front of your thigh) with the knee immobilizer on and raise your leg 8 to 12 inches off the bed.  Do at least three times a day.