Week one Weeks two to four Initial Evaluation Evaluate · Frisbie Memorial Hospital Marsh Brook Rehabilitation Service Wentworth-Douglass Hospital Durham: Rehab and Sports Therapy

Frisbie Memorial Hospital Marsh Brook Rehabilitation Service Wentworth-Douglass Hospital Durham: Rehab and Sports Therapy Center

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Lateral Retinacular Release Week one Weeks two to four

Initial Evaluation Evaluate

Range of motion

Joint effusion

Ability to contract quad/vmo

Gait (Typically WBAT with patellofemoral

brace)

Patella Mobility

Inspect for infection/signs of DVT

Assess RTW and sport expectations

Range of Motion

Pain/Joint effusion

Ability to contract quad/vmo

Patella mobility

Standing balance

Patient Education Patient Education

Support Physician prescribed meds

Ensure compliance w/ pre-op hep

Reinforce use of assistive device to ensure

appropriate gait pattern

Restate surgical precautions

(No forced flexion)

Discuss frequency and duration of treatment (2-

3x/wk is expected for 6-8 weeks)

May D/C brace if patient demonstrates good quad

contraction and no lag with SLR

May D/C crutches when gait pattern is appropriate

and without significant substitution or pain

Therapeutic Exercise Therapeutic Exercise

Review pre-op hep if applicable

Begin ROM and light pre’s (heelslides, heelraises

or ankle pumps, quad set or leg raises and towel

stretch)

Isometrics may be completed with NMES

Initiate bicycle (do not force flexion)

Initiate isotonic exercises in limited/controlled ROM

(wallslide, multi hip, leg press, heelraises and

hamstring curl)

Add single leg static balance activity

May need to continue multi-angle isometrics with

NMES

Manual Techniques Manual Techniques

Grade I and II patella mobilizations focus on

medial glides

PROM as tolerated (focus on extension)

Grade III-IV patella mobilization

Posterior capsule mobilization (if needed)

Incision mobilization

Modalities Modalities

NMES is recommended for quad activity

Interferential / biofeedback as needed

Ice

NMES is recommended for quad activity

Modalities may be used as needed

Goals Goals

Control pain

Reduce effusion

Restore voluntary quad contraction

WBAT gait with crutches

0-90 degrees ROM

Gain full knee extension

Normal gait on flat level surfaces

0-120 degrees ROM

Minimal effusion



Weeks four to eight Weeks eight to discharge

Evaluate Evaluate

Patella mobility / crepitus Gait

ROM

Balance

Patella mobility / crepitus

Any excessive joint laxity

Isokinetic Strength test and/or functional movment

screen based on physicians preference

Address any deficits that may limit return to work or

sport goals

HEP compliance

Therapeutic Exercise Therapeutic Exercise

Progress to squatting, lunging, step-up activities

as appropriate

Single leg isotonic exercises

Single leg dynamic balance activity

Progress to closed chain exercises in multiple

planes and on unstable surfaces

Include abdominal and glut strengthening, typical

emphasis is prevention of medial column

collapse

Encourage participation in the CFA

Cardiovascular training (bike, swim and elliptical)

Begin agility and sport specific activity with

physician approval

Return to running (12 weeks post-op) with physician

approval

Return to sport (12 weeks post-op) with physician

approval

Manual Techniques

Any techniques as needed

Modalities

Any as Indicated

Goals Goals

4+/5 strength with manual testing

No noteable deficits with functional movement

screen

Normal ROM and gait without assistive device

on all surfaces

No pain with ADL’s

Full strength with manual testing

Discharge with full return to work or sport activity

orders



Precautions and related issues

Lateral retinacular release is typically reserved for those patients who

have failed conservative patellofemoral treatment, have no plica related issues

and do not need major structural realignment. Early therapy will focus on

reduction of effusion, restoration of normal extensor mechanism function, and

prevention of lateral scarring. As with any patellofemoral patient, alignment

during exercise is crucial. Lateral release will occasionally be completed in

conjunction with other issues. Some of the typical concerns are listed below.

Meniscectomy

No modification required

Meniscal Repair

Meniscal repair completed in conjunction with lateral release would

require following the meniscal repair protocol as it is the more

conservative procedure

Microfracture

You will want to learn the location and size of the microfracture

procedure as it will have a pronounced effect on determining exercise

progression

Chondromalacia

Typically our physicians will give us insight into the location and

severity of chondromalacia (grades I to IV)

The location of chondromalacia often provides insight regarding

faulty posture and biomechanics.

Both location and severity should be considered when designing

treatment programs

Chondroplasty

You will want to learn the location and severity of the chondroplasty

procedure as it will have a pronounced effect on determining exercise

progression

Consider unloading brace for return to activity if limited by pain

Documents

Week one Weeks two to four Initial Evaluation Evaluate · Frisbie Memorial Hospital Marsh Brook Rehabilitation Service Wentworth-Douglass Hospital Durham: Rehab and Sports Therapy