Lateral Lengthening

What is Lateral Lengthening?

Lateral lengthening, also known as lateral retinacular lengthening or release, is a surgical procedure to release a tightened lateral retinaculum on the outer aspect of the knee. This procedure is mostly performed to treat knee pain or patellofemoral instability related to chronic pulling of the patella (kneecap) to the outer aspect of the knee, and the inability of the patella to rest properly in the center of the femoral groove as the knee bends and straightens.

The patella is a small piece of bone in front of the knee joint that slides up and down the groove in the femur (thigh bone) during bending and stretching movements. The soft tissues (ligaments) on the inner and outer sides of the patella hold it in the femoral groove and avoid dislocation of the patella from the groove. These tissues are called the medial (inside) and the lateral (outside) retinaculum.

Indications for Lateral Lengthening

Lateral retinacular lengthening is indicated to treat various patellofemoral disorders causing lateral retinaculum tightness and patellar tilt. These disorders include:

• Lateral patellar compression syndrome
• Patellofemoral arthritis
• Patellofemoral instability (dislocation and subluxation)
• Patellofemoral pain syndrome

Preparation for Lateral Lengthening

Preoperative preparation for lateral lengthening will involve the following steps:

• A thorough examination by your doctor to check for any medical issues that need to be addressed prior to surgery.
• Depending on your medical history, social history, and age, routine blood work and imaging may be ordered for safely conducting surgery.
• You will be asked if you have any allergies to medications, anesthesia, or latex.
• You should inform your doctor of any medications, vitamins, or supplements that you may be taking.
• You should refrain from medications or supplements such as blood thinners, aspirin, or anti-inflammatory medicines for a week or two prior to surgery.
• You should refrain from alcohol or tobacco at least 24 hours prior to surgery.
• You should not consume any solids or liquids at least 8 hours prior to surgery.
• Arrange for someone to drive you home as you will not be able to drive yourself post surgery.
• A written consent will be obtained from you after the surgical process has been explained in detail.

Procedure for Lateral Lengthening

The procedure is usually performed arthroscopically under general or spinal anesthesia in the operating room. Your surgeon makes 2 to 3 small surgical cuts around your knee. An arthroscope, a narrow tube with a tiny camera on the end is inserted through one of the incisions to view the knee joint. Specialized instruments are inserted into the joint through other small incisions. The camera attached to the arthroscope displays the image of the joint on the monitor. A sterile solution is pumped into your knee to stretch the knee and provide a clear view and room for your surgeon to work. With the images from the arthroscope as a guide, your surgeon releases or cuts the tight ligaments on the lateral side (outside) of the patella, enabling it to slide more easily in the femoral groove. The surgical cuts are then closed with sutures and dressed.

Postoperative Care Instructions and Recovery

In general, postoperative care and recovery process after lateral lengthening involves the following:

• You will be transferred to the recovery area to be monitored until you are awake from the anesthesia.
• Your nurse will monitor your blood oxygen level and other vital signs as you recover.
• You will be placed in a knee brace for the first few weeks with instructions on restricted weight-bearing. You are encouraged to walk with assistance as frequently as possible to prevent blood clots.
• You are advised to keep your leg elevated while resting to prevent swelling and pain.
• Gentle range of motion exercises is advised to facilitate knee movement post surgery.
• Use of continuous passive motion machine (CPM) at home may be advised to avoid developing scar tissue and stiffness in the joint as the ligament heals.
• You will experience some pain and discomfort in the knee area. Application of ice packs and taking prescription medications as directed are advised for comfort.
• Anti-nausea medications will be prescribed as needed for discomfort associated with anesthesia.
• Keep your surgical site clean and dry for at least 48 hours. Instructions on surgical site care and bathing will be provided.
• Refrain from smoking as it can negatively affect the healing process.
• Eating a healthy diet rich in vitamin D is strongly advised to promote healing and a faster recovery.
• Refrain from strenuous activities or lifting heavy objects for the first couple of months. A gradual increase in activities over a period of time is recommended.
• Physical therapy is begun a few weeks after surgery to restore normal knee function and improve flexibility and strength.
• You will be able to return to your normal activities in a month or two; however, return to sports may take 4 to 6 months.
• A follow-up appointment will be scheduled to monitor your progress.

Risks and Complications of Lateral Lengthening

Lateral lengthening is a relatively safe procedure; however, as with any surgery, there are risks and complications that could occur, such as:

• Infection
• Blood clots (deep vein thrombosis)
• Nerve and blood vessel damage
• Joint stiffness
• Anesthetic complications
• Medial patella instability due to over release of the lateral structures