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Knee & Hip Problems Message Board

Knee & Hip Problems Board Index

I write both for myself and to benefit people with patellofemoral pain where the knee cap tracks to the lateral side and may consider a ‘lateral release’. I have been through absolute Hell for 4 months. I am scheduled for a lateral release on December 12th 2012.

I have had this issue for 20 years due to genitics – IT bands way too tight. In left knee that combined with a mild injury is the root cause. Pain would be the most severe at night after exercise in the day. Stretching controlled it until last April when it got worse. Note I have some narrowing of space between the medial chondiles so this may have worsened. This can cause more pain since the more bow legged one is the more the patella turns out towards the lateral side.

On June 4th while aggressively stretching I felt a sudden electric shock on the lateral side of my patella. I don’t believe my patella popped out. I believe I broke through a thin layer of cartiledge so the patella now sits against the chondile thus causing near constant pain with bad days of extreme pain. Since then any pressure on the IT band causes pain, so massaging down (distal) of the IT band towards the knee would reduce pain. However when my quads were tight massaging up (proximal) of the quads would reduce pain. Doing the opposite would through me into extreme pain. I did have a Cortisone and Synvisc One injection – both did nothing.

On November 2nd I stopped working and thus stopped sitting much. Therefore am able to wear knee brace that pushes patella up. While I wear the knee brace I am often in mild to moderate pain (again the mild pressure on the IT band pulls on the knee cap) but when I remove it I usually feel little or no pain. No more extreme bouts of extreme pain means I can stretch and exercise. I stretched my quad muscles that were contracting, especially at night. Sitting is impossible with the knee brace and challenging without it. I cannot work without a surgical intervention.

My doctor looks at the MRI and says the patella is tracking further out to the lateral side then 2 years ago. I should have made a note of the exact image he had there but did not - darn. So I’m booked for December 12th.

Dr. often sends people to the physio clinic in the hospital. I am going for a pre-op physio appointment on Nov 27.

So what questions to ask physiotherapy:

-What is the Dr's success rate? He told me 90% and he does not make anybody worse off.
-Do you know of somebody who just had a lateral release and no knee replacement?
-How can I prepare? What exercises?
-When do I know it has worked? Since sitting has been the most painful I expect it to be the real test. Sleeping is a close second so I should know almost immediately

I see one more surgeon on December 5th. What to ask?
When I should have my next MRI since if the surgery does not work it will be needed to operate?

Anything left to tell the Dr. if I see him just before the surgery?
Maybe point out how I might be unique:
-had this for 20 years
-the pain is severe
-sitting is the worst and sleeping pain wakes me up after 4 hours.
-will Dr. watch the patella move to know how much to cut?
-will he check under the patella to see if there is some other issue and check the cartilage that should keep my patella from pushing against the chondile?
-I am just in for the lateral release and not the knee replacement. (I hear they are often done together.)
-It is the LEFT knee.

Final thoughts:
Is my retinaculum very connected to my IT band? For the last 20 years 90% of massage therapists and chiropractors have said my IT band is tight. Massaging of that band has always had a strong relationship to pain, so that gives me the impression this will work. I trust this over the fact my MRI does not show much tilt. Since I believe I broke through the lateral side of my patella with that stretch on June 4th, I will always get terrible knee pain if I pull on my IT band or try a stretch. The only thing that could prevent this is some medial tightening.

Please, your thoughts? I am very interested in answering questions. I read some posts on this site and they put me in tears since I now know extreme pain. On top of that you get a sibling who starts telling you the pain is in your head. But that is another story.

Thanks to all in advance.

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