Arthroscopic Lateral Release Surgery Procedure

Arthroscopic lateral release surgery is a modern, minimally invasive orthopedic procedure primarily used to treat patellar maltracking or patellofemoral pain syndrome (PFPS). This condition occurs when the kneecap (patella) does not move properly within the femoral groove during knee movement, often causing pain, discomfort, and instability. When conservative treatments fail, arthroscopic lateral release surgery offers a promising solution by releasing the tight lateral retinaculum that pulls the patella outward.

What is Arthroscopic Lateral Release Surgery procedure?

Arthroscopic lateral release surgery is a keyhole surgical procedure performed to correct patellar alignment issues in the knee. The primary goal of this procedure is to release or cut the tight lateral retinaculum a band of fibrous tissue on the outer side of the kneecap that causes the patella to be pulled laterally (towards the outside of the knee).

By releasing this tight tissue, the patella is allowed to realign more centrally within the trochlear groove of the femur, promoting proper biomechanics and reducing pain or instability.

When is Arthroscopic Lateral Release Surgery Needed?

This procedure is recommended only after non-surgical interventions have failed, such as:

• Physical therapy

• Bracing

• Activity modification

• Non-steroidal anti-inflammatory drugs (NSAIDs)

• Corticosteroid injections

Typical indications for arthroscopic lateral release include:

• Chronic anterior knee pain caused by lateral patellar compression

• Recurrent patellar dislocations or subluxation

• Patellofemoral syndrome with lateral tracking

• Pain unresponsive to conservative treatment for more than 6 months

• Chondromalacia patellae or cartilage wear caused by improper patellar tracking

It’s essential to have a thorough evaluation, including physical examination and imaging (MRI or CT scan), to confirm the diagnosis and determine if surgery is appropriate.

Preoperative Preparation

Before the surgery, patients undergo:

• Detailed physical examination

• MRI or X-ray imaging to evaluate patellar tracking

• Anesthesia evaluation

• Instructions to avoid certain medications (e.g., blood thinners)

• Fasting 8–12 hours before surgery if general anesthesia is used

Patients are also educated about the procedure, potential risks, and recovery expectations.

Step-by-Step Overview of the Arthroscopic Lateral Release Procedure

Arthroscopic lateral release surgery is typically performed as a day-care procedure under general or spinal anesthesia. Here’s how the surgery is carried out:

• Patient Positioning and Anesthesia :- The patient is positioned on their back with the leg elevated and secured. A tourniquet may be applied to reduce bleeding. General or spinal anesthesia is administered based on the surgeon’s recommendation.
• Arthroscopic Portals :- Small incisions, approximately 0.5–1 cm long, are made around the knee to insert the arthroscope (a fiber-optic camera) and surgical instruments. Saline fluid is pumped into the joint to expand it for better visibility.
• Joint Examination :- The surgeon uses the arthroscope to inspect the joint cavity, identifying the patellar tracking and the extent of tightness in the lateral structures.
• Lateral Retinaculum Release :- Using specialized arthroscopic tools, the lateral retinaculum is carefully incised or cut. This “release” allows the patella to shift medially (towards the center), improving alignment and reducing excessive lateral pressure.
• Hemostasis and Closure :- Any bleeding is controlled, and the joint is irrigated. The arthroscopic tools are withdrawn, and the small incisions are closed using sutures or adhesive strips. A sterile dressing is applied.

The entire procedure typically takes 30 to 60 minutes, depending on the complexity.

Postoperative Recovery and Rehabilitation

Recovery from arthroscopic lateral release is usually faster compared to open knee surgeries due to the minimally invasive nature of the procedure.

1. Immediate Post-Surgery

   • The patient is monitored for a few hours in the recovery room.

   • Pain is managed with oral or intravenous medications.

   • Most patients can return home the same day.

2. First Few Weeks

   • Crutches or a knee brace may be used initially to aid mobility.

   • Icing and elevation help reduce swelling.

   • Patients begin gentle range-of-motion exercises within days.

3. Physical Therapy :- A structured rehabilitation program is essential for optimal recovery. Goals include:

   • Improving range of motion

   • Strengthening quadriceps and hamstrings

   • Enhancing patellar tracking and knee stability

   • Preventing complications such as stiffness or muscle atrophy

   Patients often attend supervised physical therapy 2–3 times per week for 6–12 weeks.

4. Expected Results and Success Rate

   Arthroscopic lateral release has shown positive outcomes in carefully selected patients. Many experience:

   • Significant reduction in anterior knee pain

   • Improved patellar tracking and stability

   • Better knee function during physical activities

   However, success depends on multiple factors, including proper patient selection, the presence of associated anatomical abnormalities (such as trochlear dysplasia), and adherence to rehabilitation.

5. Long-Term Outcome

   Studies suggest 70–85% of patients report favorable outcomes post-surgery, especially when combined with physical therapy and lifestyle adjustments.

Risks and Complications

As with any surgery, there are some risks involved. Although complications are rare, they may include:

• Persistent or worsened pain

• Hemarthrosis (bleeding in the joint)

• Infection at incision sites

• Over-release leading to medial patellar instability

• Knee stiffness or reduced mobility

• Blood clots (deep vein thrombosis)

Close follow-up with the orthopedic surgeon can help manage or prevent these complications.

When to Consult Your Surgeon

Contact your orthopedic specialist immediately if you experience:

• Uncontrolled pain or swelling

• Signs of infection (fever, warmth, redness)

• Difficulty walking even after a few weeks

• Sensation of patellar instability or “giving way”

Timely communication ensures early intervention and optimal outcomes.

Conclusion

Arthroscopic lateral release surgery is a highly effective and minimally invasive procedure for individuals struggling with persistent patellar maltracking and associated knee pain. It offers substantial relief and improved knee mechanics for those unresponsive to conservative treatments. With a short recovery time and a strong emphasis on rehabilitation, this procedure can restore functionality and quality of life for many patients.

If you or someone you know is dealing with chronic knee pain or instability related to patellar tracking, consult an experienced orthopedic surgeon to determine whether arthroscopic lateral release is the right option.