Don't be left behind.

Age: 39
Height: 6'0"
Weight: 150 lbs.

Medical History: Active, healthy 39-year-old female athlete with osteochondral patellar lesion on the lateral facet of the left knee. Suffers from occasional migraine headaches (controlled with sumatriptan injections) and a severe addiction to competitive volleyball. Has torn ligaments in left wrist that could not be fully repaired with surgery in Dec 1999. Married; one child (normal delivery several years ago). Tonsillectomy as a young child. Hospitalized for croup as a young child. Lateral release in January 1993 on left knee. Knee surgery on right knee in August 2000 for an operation unrelated to chondromalacia. This surgery ended up "disturbing the mechanics" of the knee joint, and while the right knee has only Grade 3 chondro, it now functions worse than the left knee (Grade 4).

My Lateral Release (In Color!)

1) (Grade 4) Osteochondral Lesion

Go ahead. You can say "OUCH!" if you want to. ;-) If you're having trouble spotting it, it's the pinkish area with the arrow pointing to it.

2) The Lateral Release in Action

The arrow on the left side of the image shows where the chopping is happening.

3) Normal Lateral Meniscus

See? There's something that's right with my knee!

4) Normal Medial Meniscus

This baby's just peachy, too!

Lateral Release Notes

Lanchester, Darla
Age: 29
Date: 1/21/93

Preoperative Diagnosis: Recurrent subluxation of left patella with osteochondral lesion under patella.

Postoperative Diagnosis: Recurrent subluxation of left patella with osteochondral lesion under patella.

Procedure: Arthroscopy. Atrhroscopic lateral release.

Patient was brought in to the operating room. Anesthesia was given. The leg was exsanguinated and prepped and draped in the usual orthopedic manner. Inflow was inserted through a medial superior approach into the suprapatellar pouch. Arthroscope was inserted through the medial joint space. Suprapatellar pouch was visualized and photographed, and there was a significant osteochondral lesion seen on the lateral facet. Medial and lateral joint spaces were visualized and photographed. They were normal. Putting a cautery device through the superior portal now and delineating the extent of the lateral release with percutaneous needles, a lateral release was done. The scope has to be switched to the superior approach and cautery to the joint line approach to complete the last 2 cm. The skin bulged with the fluid inside the knee as the release was completed. The length of the release was about 2.5 inches. It extended from the vastus lateralis muscle fibers down to and excluding the lateral meniscus. Preoperative exam revealed that the patient did have a significant problem with subluxation, but no frank dislocation. Fluid was all removed from the knee. Compression bandage was applied after closeing the knee wound with stitches, and she was sent to the recovery room in good condition.

Dr. "X"

Second Opinion Notes

(I'm only re-typing these. I'm not responsible for the myriad run-on sentences!! <g>)

Division of Orthopedics
Re: Darla Lanchester
Date: 11/29/93

This 30 year old female comes to the office today complaining of left knee pain. She states she is here for a second opinion after seeing Dr. "X" back in January for chondromalacia patella. At that time he performed a lateral release, and the patient states that since that time she really hasn't had any decrease in her pain in her left knee. She states that actually this problem began about 4 years ago and she has been playing volleyball and been very active on that knee until January when the pain became too much for her to take and she had to see someone and she saw Dr. "X" who performed the surgery. The patient further states that she played basketball in college at "University X" approximately 10 years ago and has maintained a high level of activity since that time.

After the surgery she states she has been trying to rehabilitate her left leg to get the strength back by doing bicycling and leg presses, but just really hasn't had any improvement in her pain at all. She also states that she has particular pain when she is jumping and playing volleyball, as well as when she has been sitting for a long time, and has pain when she climbs stairs.

On physical exam, she has a negative Lachman, a negative posterior drawer, negative varus/valgus. She does have pain in her left patella when tightening her quadriceps, particularly when tightening her quadriceps against resistance. She also has a positive apprehension test.

PLAN:
The disease of chondromalacia patella was explained in great detail to the patient. About a 15 or 20 minute discussion followed about what she could do to help relieve this condition. It was explained that because of a demonstrated lesion on her patella that she clearly had patellar joint arthritis that she could probably never become pain free with her level of activity. Several exercises were suggested to her that could help relieve this condition and strengthen her quadriceps including leg lifts, holding the quadriceps tight, lifting the leg for 10 seconds, doing 3 sets of 10 with that and increasing the ankle weight beginning with one pound up to six pounds, then after that 30 degree arc leg lifts. While she was very persistent in trying to find a solution to her problem, the suggestions of removal of the patella and building up of the tibial tuberosity were suggested but strongly discouraged against these options.

Dr. "Y"

Page last updated: 03/07/06

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