Lateral Ligament Laxity and Treatment Options for Knee Pain

Lateral collateral ligament laxity

Hello Doctor: My left knee has severe patellar valgus.
Since January 12 of this year, it has been about six months, and the lateral pain has not improved significantly despite physical therapy.
I can walk on flat surfaces, but going up and down hills causes pain that makes me want to hold onto something to walk.
Recently, I have been doing exercises to strengthen my lower limb muscles, but during this time, I accidentally jogged a little, and the pain spread from the lateral side to the medial side.
My therapist mentioned that my posture is incorrect, and a doctor diagnosed me with a congenital laxity of the ligaments, which causes a more pronounced angle of the knee.
I would like to ask whether I should continue training with this congenital structure or adjust to what is considered a normal alignment, but I feel pain when trying to train in a normal position.
This situation is quite challenging! Recently, I also tried frog swimming, but the tibia on the affected side experiences pain.
Is this normal, and can I continue to try it as long as the pain does not increase? After six months of physical therapy, I still experience pain and have considered undergoing "lateral release surgery of the knee" to reposition the patella.
My doctor mentioned that they could completely release it and then stitch the medial tendons or ligaments for reinforcement, but he also said that working on the medial side would be challenging.
Does this indicate that the surgery might fail to achieve the expected results? What is the success rate of the surgery? Should I consider undergoing this surgery? My doctor’s comments have left me feeling a bit confused! Thank you for taking the time to respond!

kina, 20~29 year old female. Ask Date: 2012/07/11

Dr. Hong Ximing reply Orthopedics

Severe patellar valgus, combined with training, will definitely lead to cartilage damage.
It is advisable to seek evaluation from a sports medicine specialist at a medical center to determine whether surgical correction is the best course of action.

Reply Date: 2012/07/11

More Info

Understanding lateral ligament laxity and its treatment options for knee pain is crucial, especially for individuals experiencing persistent discomfort and functional limitations. Based on your description, it seems that you are dealing with significant issues related to patellar malalignment and ligamentous laxity, which can lead to pain and instability in the knee joint.

Understanding Lateral Ligament Laxity
Lateral ligament laxity refers to the looseness of the ligaments on the outer side of the knee, which can contribute to patellar instability. In your case, the patella (kneecap) is positioned laterally, which can cause pain during activities such as walking, running, or climbing stairs. This condition can be exacerbated by factors such as muscle imbalances, improper biomechanics, and inherent ligamentous laxity, which you mentioned is a concern for you.

Treatment Options
1. Physical Therapy: Continuing with physical therapy is essential. A skilled therapist can help you strengthen the muscles around the knee, particularly the quadriceps and hamstrings, which play a crucial role in stabilizing the patella. They can also work on correcting your posture and movement patterns to reduce pain during activities.

2. Activity Modification: It’s important to modify your activities to avoid exacerbating your symptoms. While swimming is generally a low-impact exercise, if you experience pain while doing frog kicks, it may be wise to switch to a different stroke or focus on upper body workouts until your knee feels more stable.

3. Bracing: A knee brace may provide additional support and stability, especially during activities that provoke pain. However, if you experience discomfort or a feeling of pressure when wearing a brace, it may be beneficial to consult with your healthcare provider about alternative options or adjustments.

4. Surgical Options: If conservative treatments do not yield satisfactory results after a reasonable period (usually 6-12 months), surgical intervention may be considered. The procedure you mentioned, which involves lateral ligament release and medial reinforcement, can be effective in realigning the patella and stabilizing the knee. The success rate of such surgeries can vary based on individual factors, including the extent of ligament laxity, the presence of any associated injuries, and overall knee health. Generally, these surgeries have a good success rate, but it is essential to have a thorough discussion with your orthopedic surgeon about the potential risks and benefits.

5. Post-Surgical Rehabilitation: If you opt for surgery, a structured rehabilitation program will be critical for recovery. This typically involves gradual progression from passive range of motion exercises to strengthening and functional activities.

Conclusion
In summary, your situation requires a multifaceted approach that includes physical therapy, activity modification, and possibly surgical intervention if conservative measures fail. It is crucial to maintain open communication with your healthcare providers, including your physical therapist and orthopedic surgeon, to ensure that you are on the right track. They can help tailor a treatment plan that considers your unique anatomy and lifestyle, ultimately aiming to restore function and alleviate pain in your knee.
If you have further questions or concerns, don’t hesitate to reach out to your healthcare team for personalized advice and support.

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