Lateral Release

Mal-alignment of the patella (kneecap) can often lead to pain and swelling during routine or recreational activities. In order to correct the mal-alignment a lateral release procedure is often helpful. The lateral release is designed to loosen the tissues that help guide the kneecap as the knee is flexed and extended. Rehabilitation is crucial to achieving success following a lateral release. The following is a rather technical description of the lateral release procedure.

A standard prep and drape of the lower extremity is made. The operative tourniquet is placed around the thigh, but not inflated. Local anesthesia can be used. Standard antero-lateral, antero-medial, and proximal-lateral arthroscopic portals are utilized. An arthroscopic examination is conducted to identify and address any concomitant injuries. The infrapatellar surface is carefully explored. If the patella exhibits a lateral tilt, lateral subluxation or chondral damage, findings consistent with patellofemoral pain, a lateral release is initiated.

Figure 1

To initiate the lateral release, a scalpel is introduced through the proximal lateral portal with the scope in the distal lateral portal. The blade is introduced under direct arthroscopic visualization (Fig 1). Following this, an insulated-tip cautery probe is introduced through the proximal-lateral portal.

Figure 2

The release of the lateral retinaculum is accomplished by first hooking the intended tissue with the curved cautery probe tip, applying current, cutting through the tissue, and then advancing the probe distally (Fig 2). The release continues until approximately two-thirds of the lateral retinaculum is divided. The use of the cautery probe helps maintain hemostasis throughout the procedure.

The scope is then switched to the proximal lateral portal, through which the distal portion of the lateral retinacular release is now visualized. The scalpel is re-introduced through the distal lateral portal to approximate the area of the previous completion of the lateral retinacular release. Through this, the insulated-tip cautery is again introduced, the release is continued distally to the lateral border to the patellar ligament. The release is complete when it is possible to rotate the lateral border of the patella to 90 degrees.

The knee is irrigated thoroughly \and evacuated of all debris. The portal are closed with Steri-Strips. Sterile dressing and Ace wrap are applied along with a compressive cold therapy cuff. The procedure is accomplished in an outpatient setting, with the patient typically returning home later that same day.