Types of Arthroscopic Lateral Release Surgery

Arthroscopic lateral release surgery is a minimally invasive orthopedic procedure often performed to correct patellar maltracking and reduce anterior knee pain caused by tight lateral structures. By releasing the lateral retinaculum, which pulls the kneecap outward, the procedure aims to restore proper alignment and biomechanics of the patellofemoral joint. Let’s explore the various types of arthroscopic lateral release surgery, their indications, techniques, and differences.

This surgery is particularly beneficial for athletes, individuals with recurrent patellar dislocation, or those suffering from chondromalacia patella. Over the years, advancements in arthroscopy have led to the development of different types and techniques of lateral release surgeries, each tailored to specific patient needs and anatomical variations.

Types of Arthroscopic Lateral Release Surgery

1. Standard Arthroscopic Lateral Release :- The standard arthroscopic lateral release is the most commonly performed variant. It involves using an arthroscope and small surgical instruments to cut the tight lateral retinaculum through small incisions on the side of the knee.

   Indications

   • Lateral patellar compression syndrome

   • Mild to moderate patellar maltracking

   • Early-stage chondromalacia patella

   • Patients unresponsive to conservative therapy

   Technique :- Under general or spinal anesthesia, the surgeon inserts a camera and instruments through small portals in the knee. The lateral retinaculum is then precisely released under direct visualization. This approach allows minimal disruption of soft tissues and faster recovery.

   Benefits

   • Less postoperative pain

   • Quicker rehabilitation

   • Minimal scarring

   • Outpatient procedure

   This method works well for patients who don’t have severe instability or high-grade cartilage damage.

2. Selective Lateral Release :- Selective lateral release is a more conservative variation, targeting only the pathological part of the retinaculum rather than a full release. It avoids cutting across the entire lateral structure and focuses only on the tightest segment.Indications
   • Patients with localized lateral tightness
   • Early intervention in young athletes
   • Pain without instability

   Technique :- This type of release focuses on precise anatomical mapping and only releasing tension in the area contributing to symptoms. Surgeons use pre-operative imaging and intraoperative assessment to identify specific fibers for release.

   Benefits

   • Preserves structural integrity
   • Lower risk of medial patellar instability
   • Targeted intervention with better long-term outcomes

   Selective release is especially useful when preserving the lateral patellar stabilizers is a priority.

3. Extended Lateral Release (with Adjunct Procedures) :- In cases where patellar instability is accompanied by structural deformities or advanced cartilage damage, a more comprehensive release may be needed, often combined with procedures such as medial patellofemoral ligament (MPFL) reconstruction, tibial tubercle transfer, or chondroplasty.

   Indications

   • High-grade patellar instability

   • Failed previous lateral release

   • Structural deformities like trochlear dysplasia

   • Advanced patellofemoral arthritis

   Technique :- This surgery involves not only the release of the lateral retinaculum but also adjunctive procedures to realign the patella or restore soft-tissue balance. For instance, realigning the tibial tubercle (Fulkerson osteotomy) or tightening the medial stabilizers through MPFL reconstruction can be done simultaneously.

   Benefits

   • Comprehensive correction of underlying pathology

   • Suitable for complex or recurrent cases

   • Long-term stabilization and pain relief

   However, this type of procedure has a longer recovery time and requires close post-operative rehabilitation.

4. Thermal or Radiofrequency Lateral Release :- This newer method utilizes thermal energy or radiofrequency ablation to cut and cauterize the lateral retinaculum. Instead of using scissors or a knife, energy devices precisely burn the tissue, reducing bleeding and promoting clean incisions.

   Indications

   • Minimally invasive demands

   • Patients with bleeding risks

   • Patients requiring precise control over tissue removal

   Technique

   The surgeon introduces a radiofrequency probe through arthroscopic portals. Energy is delivered in a controlled manner to ablate tight lateral tissues. The heat causes immediate shrinkage and dissection of the collagen fibers.

   Benefits

   • Reduced intraoperative bleeding

   • Enhanced visual clarity during surgery

   • Minimal postoperative swelling

   • Ideal for outpatient settings

   This approach is gaining popularity in centers equipped with advanced arthroscopic technologies.

5. Lateral Release as Part of Diagnostic Arthroscopy :- Sometimes, lateral release is performed during a diagnostic arthroscopy where knee pain of uncertain origin is explored. Upon identifying tight lateral structures or impingement during scope evaluation, a lateral release is performed simultaneously.

   Indications

   • Unexplained anterior knee pain during diagnostic evaluation

   • Co-existing meniscal or synovial pathologies

   • Cases with multi-factorial knee discomfort

   Technique

   During diagnostic arthroscopy, the surgeon inspects all compartments of the knee. If lateral tightness is confirmed as a contributing factor to the symptoms, a limited or full lateral release is carried out using the same portals.

   Benefits

   • One-time diagnostic and therapeutic approach

   • Efficient use of surgical time and resources

   • Immediate symptom relief in select cases

   This type is commonly done when patients present with overlapping or poorly understood patellar symptoms.

Choosing the Right Type of Arthroscopic Lateral Release

The choice of procedure depends on several factors, including:

• Patient’s age and activity level

• Severity of patellar maltracking or instability

• Presence of cartilage degeneration

• Prior surgical history

• Anatomical variations on imaging

Surgeons often rely on a combination of clinical examination, MRI, and dynamic patellar tracking analysis to determine the best surgical route. Personalized treatment planning is key to achieving optimal functional outcomes and avoiding overcorrection, which can lead to medial patellar instability.

Postoperative Considerations

Recovery protocols differ depending on the type of lateral release performed. In general:

• Standard or thermal release :- Return to normal activity within 4–6 weeks

• Extended release with adjunct procedures :- May require 8–12 weeks or longer

• Physical therapy :- Crucial for strengthening the quadriceps and improving patellar tracking

• Bracing and immobilization :- Sometimes used in the initial healing phase

Patients typically experience reduced anterior knee pain, improved patellar alignment, and increased confidence in knee stability within a few months.

Conclusion

Arthroscopic lateral release is a versatile and effective procedure for treating patellofemoral disorders. With several types available ranging from standard to extended and thermal releases surgeons can tailor the intervention to match the patient’s unique anatomical and functional needs.

Advances in arthroscopic techniques continue to improve precision, reduce downtime, and enhance patient outcomes. Whether performed alone or alongside other corrective procedures, arthroscopic lateral release plays a key role in restoring knee mobility and quality of life for individuals affected by patellar dysfunction.