Pain Syndrome > Treatments
Preparing for Surgery
Physicians usually prescribe
physical therapy for minor patellofemoral pain. However,
if your knee does not respond to therapy, lateral release
surgery may be recommended. The decisions you make and
the actions you take before your surgery can be every
bit as important as the procedure itself in ensuring
a healthy recovery.
sure you have received any equipment you will need when
you get home from the hospital. This may include a knee
brace, crutches, ice packs or coolers, or a continuous
passive motion (CPM) machine. You should receive prescriptions
for any of these from your doctor when your surgery
the potential risks and benefits of the surgery, and
ask your surgeon any questions that will help you better
understand the procedure. It can also help to talk to
someone else who has undergone the same surgery.
physical problems, such as a fever or infection, should
be reported to your surgeon, and you should notify your
surgeon of any medication you are taking.
reduce the risk of infection, try to refrain from smoking
for at least a week prior to surgery.
possible, practice walking with your crutches in case
you need to use them after surgery.
insurance companies require a second opinion before
agreeing to reimburse a patient for a surgical procedure.
Getting a second opinion from a surgeon who is as qualified
as the surgeon who gave the initial diagnosis is advisable
in any case.
sure the orthopedist performing the surgery is board-certified,
which can be determined by calling the American Board
of Orthopaedic Surgery at 919-929-7103.
to ask the doctor
to take to the hospital
At most medical centers, you will
go to "patient admissions" to check in for
your lateral release surgery. If your surgery is going
to be inpatient, there may be a separate department,
so be sure to ask your doctor. After you have checked
in to the hospital or clinic, you will go to a holding
area where the final preparations are made. The paperwork
is completed and your knee area may be shaved (this
is not always necessary). You will wear a hospital gown
and remove all of your jewelry. You will meet the anesthesiologist
or nurse anesthetist (a nurse who has done graduate
training to provide anesthesia under the supervision
of an anesthesiologist). You will then walk or ride
on a stretcher to the operating room. Most patients
are not sedated until they go into the operating room.
Here are some important steps to remember for the day
of your surgery:
will probably be told not to eat or drink anything after
midnight on the night before your surgery. This will
reduce the risk of vomiting while you are under general
you will most likely be able to go home within a few
hours of surgery, and because the anesthetic and pain
medications may make you drowsy, arrange for someone
to drive you home when you are released.
a loose pair of pants or other clothing that will fit
comfortably over your knee bandage when you leave the
it easy. Keeping a good frame of mind can help ease
any nerves or anxiety about undergoing surgery. Distractions
such as reading, watching television, chatting with
visitors, or talking on the telephone can also help.
to take to the hospital
lateral release procedure for patellofemoral pain syndrome
usually takes one hour or less.
anesthesia is administered, which may be regional or
general, the surgical team sterilizes the leg with antibacterial
solution. The instruments are then set up and the television
monitors are turned on.
from one to three small four-millimeter incisions are
used for the diagnostic portion of the operation. Further
incisions are usually made just below and beside the
an arthroscope and microsurgery instruments, the surgeon
cuts the kneecap's lateral band (retiniculum), which
reduces the lateral pull on your kneecap. The kneecap
can then move back into place in its track along the
cut lateral band scars and heals in this new, lengthened
are sewn up and the patient is taken to the recovery
After lateral release surgery for patellofemoral pain
syndrome, you usually stay in the recovery room for
at least two hours while the anesthetic wears off. You
will be given adequate pain medicine, either orally
or through an IV (intravenous) line, as well as instructions
for what to do over the next couple of days. In addition,
you will be given an appointment to return and a prescription
for pain medicine. Your knee will be bandaged and may
have ice on it. You may have significant pain early
on and you should take the pain medicine as directed.
Remember that it is easier to keep pain suppressed than
it is to treat pain once it becomes present. When you
feel the pain coming on, take another pill, as long
as it is within the time limit on the bottle. You should
try to move your feet while you are in the recovery
room to improve circulation. Your temperature, blood
pressure, and heartbeat will be monitored by a nurse,
who, with the assistance of the doctor, will determine
when you are ready to leave the hospital or, if necessary,
be admitted for an overnight stay. It is likely that
you will be able to bear some weight on your leg, but
your surgeon may suggest that you use crutches or a
cane for a couple of days. For most people, crutches
are used only until you feel steady on your feet. As
soon as you are fully awakened, you are usually allowed
to go home. You will probably be unable to drive a car,
so be sure to have arranged a ride home.
Here is what you can expect and how
you can cope after lateral release surgery for patellofemoral
will likely feel pain or discomfort for the first few
days, and you will be given a combination of pain medications
as needed. A prescription-strength painkiller is usually
prescribed and should be taken as directed on the bottle.
Taking one every four to six hours as directed is a
good idea in the first 24 hours to suppress pain.
may be some minor drainage on the bandage since fluid
may have accumulated during the surgery. Expect some
blood to show through the bandage during the first 24
should usually continue with the ice for at least 24
hours and remove the dressing within the first 48 hours.
Icing your knee for 20 or 30 minutes a few times a day
during the first two days after lateral release surgery
will help reduce pain. Ice therapy is most effective
in the first 24 to 48 hours.
much as possible, you should keep your knee elevated
above heart level to reduce swelling and pain. It often
helps to sleep with pillows under your ankle.
until you can stand comfortably for 10 or 15 minutes
at a time before you take a shower. You can probably
shower the day after lateral release surgery.
or a cane may be needed for a few days following lateral
release surgery, but you can usually put your weight
on your knee and begin walking. The pain typically feels
like you bumped into a table.
soon as possible after surgery, you should begin doing
physical therapy as directed by your surgeon.
two or three days after surgery, you may experience
night sweats and a fever of up to 101. Your physician
may suggest acetaminophen, coughing, and deep breathing
to get over this. This is common and should not alarm
may return to work the next day after surgery, depending
on the severity of your pain.
to call the doctor after surgery
Your physician may prescribe visits
to a physical therapist to begin supervised strengthening
exercises as soon as possible after lateral release
surgery for patellofemoral pain syndrome. You can begin
therapy immediately after surgery in most cases. Patients
should do stretching and strengthening exercises for
a minimum of four days a week. The workouts should focus
on the knee for at least thirty minutes and be combined
with a cardiovascular workout that does not include
activities, such as running, that place stress on your
knee. Despite your dedication to the rehab program,
you may not feel any improvement for up to six weeks
or longer and your kneecap pain may recur. Though everyone's
rehab program is slightly different, physical therapy
after lateral release surgery follows a general pattern.
Most people can begin stretching the muscles and tendons
around the kneecap within a week. Though your knee may
be weak, it is generally strong enough to handle mild
stretching and slow movements. Working to restore early
range of motion may help reduce swelling and stiffness,
and increase your healing time. Rehab progresses into
strengthening exercises that focus on the quadriceps
and hamstrings – the main stabilizing muscles
for your knee. Physicians suggest you gradually increase
the amount of weight as your leg muscles get stronger.
Strengthening exercises require dedication because results
often take weeks and pain may recur. Once the muscles
of your injured leg are about as strong as the uninjured
leg, the focus of rehab turns to increasing your coordination.
After about six weeks of rehab, physical therapy can
become activity oriented as you regain the ability to
perform complicated movements, using stationary bikes,
elliptical machines, and cross-country skiing machines.
Physicians usually suggest that you continue strength
training even after your kneecap has been rehabilitated.
Have your physician continually check your kneecap for
strength and proper tracking.
strengthening exercises: Kneecap (patella) injuries
To decrease the risk of patellofemoral
pain returning after lateral release surgery, physicians
generally recommend that you make the stretching and
strengthening exercises you learned in rehab part of
your everyday routine. Proper rehab will help your lateral
band scar and heal in a new lengthened position so your
kneecap moves smoothly in its track. To prevent rupturing
your lateral band while it heals, avoid bending your
knee more than 90 degrees. Try to be patient in rehab
and do not rush to return to activities. Many of the
exercises and activities that are popular for fitness
put stress on your knees. To prevent patellofemoral
pain it is important to learn knee-sparing exercise
techniques by dividing your activities into three components:
living – the average person takes between 12,000
and 15,000 steps a day, with each step exerting a force
between two and five times your body weight on your
knees. After a knee injury, take it easy on your knees
during the day whenever possible to save them for activities
and exercise. Avoid stairs when there is an elevator,
take the shortest path when walking, and consider wearing
athletic shoes designed to absorb shock rather than
strengthening and conditioning – activities themselves
are not a substitute for conditioning. Your need for
special conditioning to prepare for activities increases
with age. The best strengthening programs are low-impact
and non-weight-bearing, like stationary bikes and certain
weightlifting programs, so that the knees do not have
to absorb shock.
– sports that require twisting and quick direction
changes put great strain on your knee. Any climbing
or jumping activity where the knee is bent beyond 90
degrees puts undue pressure on the cartilage surfaces
under the kneecap. To prevent injury, stick to light,
non-impact activities for your recreation after lateral
release surgery. If you decide to return to sports like
football and basketball, a physician should carefully
examine your kneecap and test it for proper alignment.
After lateral release surgery, if you plan on participating
in sports, remember to take it easy during daily activities
and to keep your kneecap tracking properly with stretching
and strengthening exercises. Your physician may prescribe
a brace that should be worn during any recreation to
help keep your kneecap in track. A small amount of pain
is normal during physical activity, but if you feel
so much pain in your knee to warrant taking a painkiller
before an activity, you should consider cutting back
| Treatment Introduction
A lateral release to treat patellofemoral
pain syndrome is performed when the fibrous bands (retiniculum)
attached to the outside part of your kneecap are too
tight and pull the kneecap out of position. Surgeons
cut this tight structure, allowing the kneecap to move
back into its track.