Dear Running Doc:
My son developed knee pain while playing college lacrosse 3 years ago. It was recommended that he have lateral release surgery. He had the surgery and now his knee pain is worse. He has been told basically that he will have to live with this pain. He is 25 yrs. old. I find it hard to believe that nothing can be done for him. He was supposed to go into the military, but his knee has caused him so much physical and mental anguish. He feels this surgery has “ruined” his life. Any suggestions?
— Melissa R., Cedar Rapids, IA
Thanks for the question Melissa. Apparently, your son was being poorly treated for patello femoral disorder (commonly referred to as Runner’s Knee). The surgery he had made it worse, but all hope is not gone. Let’s discuss Runner’s Knee.
The kneecap is V-shaped and sits in a V-shaped groove. If you were born with pronating feet your knee cap tracks laterally and the back of the kneecap’s cartilage becomes rough, irritated and painful. The lateral retinaculum, a fibrous connective tissue on the outside of the kneecap tightens down over time and contributes to the lateral tracking of the kneecap. Conservative treatment, which works 99% of the time, consists of an orthotic to lessen pronation, strengthening of the medial quad and physical therapy to stretch the retinaculum. These treatments usually are enough to re-center the kneecap in the middle of the groove thereby decreasing pain, inflammation and roughness.
Lateral release surgery is meant to decrease lateral retinaculum pull laterally. This surgery works for a very short period of time. Whenever you cut something it heals back with scar tissue. Some say if you do aggressive physical therapy after the surgery that the symptoms resolve. In my experience, this is never the case. You are left with, after healing, with a tighter lateral retinaculum than you had before. Pain and frustration are the end result.
Treating an overtight post-surgical retinaculum requires diligence and patience. The first step is to stretch the connective tissue with aggressive physical therapy. At the same time orthotics and medial quad exercises are essential. Sometimes the retinaculum gets so tight that these measures are not enough. Luckily, we now have the ability to use PRP treatments to sufficiently loosen the retinaculum and allow the other treatments to work.
I hope this helps Melissa. We wish you and your son luck in getting rid of this painful condition. If you have any other questions please write.
Enjoy the Ride!
Lewis G. Maharam, MD, FACSM is one of the world’s most extensively credentialed and well-known sports health experts. Better known as Running Doc™, Maharam is author of Running Doc’s Guide to Healthy Running and past medical director of the NYC Marathon and Rock ‘n’ Roll Marathon series. He is also past president of the New York Chapter of the American College of Sports Medicine. Learn more at runningdoc.com.