Arthroscopy?

[pll]

I hope Knotted will read your post, but without any expertise in the area, I wonder what causes the problem only on your left side, and if you can correct/compensate whatever asymmetry is the root cause, then the muscles will be better behaved.

[Possegal]

I've had a lateral release done. I am definitely much better off since my surgery. I had it done a year after I had a patella dislocation and prior to the surgery I couldn't comfortably walk up and down steps and I could only run 1/16th of a mile and even then it hurt. I had been in PT nearly that whole year.

I will say though, that the PT who had worked on me both post injury and then post surgery, said that I was the only successful lateral release she and the other PTs there had worked on. She said most others saw no real change after their surgery.

That is purely anecdotal though, but thought it worth mentioning. I'm glad that I didn't talk to her prior to the surgery, or I may not have had it. And I'm glad I did have it as it is really much better. The surgeon said my patella was textbook for a tracking abnormality.

That's a mixed bag of info and probably didn't help you much. I did have a friend from HS that had one and she was much better after it too. I remember doing some internet searching and finding all sorts of people with bad stories. Then I was reminded that the people with the good stories were out doing things on their new happy knees.

I woke up with the giant ice pack on the knee, but I never needed crutches after the surgery. I got around pretty well from the day after onward. My sister came with me and stayed for about 36 hrs, but then I was on my own and it was no problem. For me I compared it a lot to the original injury and the injury was so much worse. That may have given me a different perspective to it. PT after the injury was really rough, after the surgery it wasn't.

Pain - I didn't have much pain at all. I think I took the pain pills the first 24 hrs but then didn't bother. I went out to lunch with my niece and sister on Sunday afternoon (and the surgery was Friday morning). I'm trying to remember how long I was off work (this was a while ago) and I'm thinking I took a week off. Then the first week or so back at work, well I wasn't running down the hallways and I did wear sweats most of the time for ease of putting them on. But again, no crutches, at all. Did the Dr tell you that you'd need them? I remember asking mine if I should bring them (had a pair from the ER when I dislocated) and he was all - oh no, you won't need that. He told me to NOT immobilize it and to NOT stop from putting my weight on it. So like I said, I was very mobile very soon after the surgery.

Just my experience, but I did have the exact surgery you are talking about.

[soprano]

Get a second opinion from a doctor who does not have a financial stake in your potential surgery.

I would absolutely fly my mom out. (Well, not my mom specifically because we don't get along, but you get the picture.)

Untill you get good with crutches, to get up stairs, turn around, sit down and scoot yourself up. Does this surgery require general anesthesia? Three flights of stairs is going to suck. Would you consider staying with a friend that night? My husband had two orthopedic surgeries a few years ago, and both times getting him up 2 steps and as far as the couch was quite an ordeal. I can't lift him, so he almost spent a night on the kitchen floor!

[Sky King]

My lateral release was done in 1998 and I have never regretted it. I will say that my knee is really ugly though. I have a big dimple on the top outside of my knee where the ligament is attached. While he was at it the ortho "roughed" up areas of bone to stimulate the area.
I do not have regular pain
My knee still sounds horrible and it really "clunks" but it has be almost 12 years.
My knee does swell often, especially after long rides and long hikes or backpacking.
I am not as flexible as I should be
I avoid activity that involves side to side movements (soccer, volleyball)
I do not run, EVER
I do not jump, Ever
This is my left side, which is basically a mess but as PT isn't an option I do stretch and am bartering some yoga with a friend.

Good luck, I had stairs and did spend the first two nights on the couch but then was able to handle the stairs. See if your insurance will cover "home health" type stuff for the first couple days.
I was always able to put weight on my knee, just not full weight for the first week.

[ehirsch83]

I did about 4 years ago. I was able to get around on crutches starting the next day, granted I lived in an apartment building with an elevator though.

Stairs will be a challenge until you get used to them

One more thing, I know you have been over your fit- but have you had your cleats gone over by a professional fitter?(someone who is a certified fitter)

[OakLeaf]

One more thing, I know you have been over your fit- but have you had your cleats gone over by a professional fitter?(someone who is a certified fitter)

Or your crankarm length? And did the PT assess your feet (which can be a source of all kinds of knee trouble) and/or hips?

It hardly sounds to me like three weeks of PT is enough to decide that you aren't getting stronger. Does the PT think you won't continue to get stronger enough to resolve the issues?

[Wahine]

You've seen a few posts already about the success of a lateral release. In my 17 years (OMG, how is it that long since I graduated!!!!) experience as a PT, I have not seen a successful lateral release, except in those cases where recurrent patellar dislocations (much more serious than a subluxation) is an issue. I think that Possegal falls into that category.

Hips have a huge part to play in these problems as mentioned by Kathi. Often there is a lack of flexibility in the hips (usually they don't turn out well) and/or a lack of strength (of the muscles that turn the hips out. There can also be a problem with the feet. If you have very flat arches that will cause bad things to happen at the patella. So be sure to have your PT look at your hips and feet.

Treatments that can be very effective:
1) Manual treatments to release the quads, IT band complex, tensor fascia lata, gluteus medius and minimus. Including trigger point dry needling.
2) Exercises to increase hip external rotation and gluteus maximus strength
3) Exercises to increase the medial longitudinal arch height and control in the foot and/or foot beds to support the arch
4) Bike fitting and analysis of pedaling technique!!


3 weeks is definitely not enough time in PT to decide if conservative (ie non-surgical) treatment can be effective. If it was me, I'd go through at least 3 months of PT before making that decision.

I hope that helps.

Sincerely,
Your friendly neighborhood PT, triathlon coach, personal trainer person.

Cassie

[Wahine]

Here are some links to tests that I use on runners to see what their stabiliaztion strength in the pelvis and hip area is like. They can give you some great ideas for places besides your VMO where you can work on strengthening.

Single leg mini-squat
Supine Bridge
Front plank
Side plank

Hope that helps.