Lateral Retinacular Release, Bruising after surgery

Bribabz,

Though the bruising is not "normal", it is not uncommon after lateral releases, especially ones done through the arthroscope.

When the releases used to be done in an open method, hemostasis was easily obtained before closing the wound. But, with the 'scope, the release is done indirectly and there is a small artery on the lateral side of the patella (actually there is a ring of arteries that go completely around the patella) that is easy to cut during the release. Usually, it is cauterized with the instrument used to cut the retinaculum. But, occasionally, it continues to bleed, and the blood goes into the soft tissues of the leg. With gravity, the hematoma (bruise) is pulled down towards the foot. So, the bruise can extend all the way to the toes.

Usually, if the knee is noted to be bruising after a release, we placed a compression wrap around the knee, usually using a thigh high TED hose over a pad on the release. This compression was left in place for a minimum of 72 hours, without being taken off. If it was removed, the compression was lost, the tampenade effect was lost, and the bleeding could start again. But, since you are now several days out from the surgery, it is a moot point. The bleeding has occurred.


One complication that can rarely occur from bleeding into the soft tissues is a compartment syndrome. But, again, you are several days out, so you are basically out of danger from this problem.


The bruising will slowly go away, as the body resorbs the heme in the tissues. You can still use the compression to help the body resorb the edema and blood in the soft tissues. Elevation of the foot above heart level (that is really up in the air, like laying with your back flat on the couch with the foot on the back on the couch) will also help to pull the edema back into your core. Ice would have helped at the beginning, but now, heat is probably better in increase the circulation, to pump the edema/blood back into the body.


So, again, though it is not "normal", it is not uncommon. You do have quite a bit of blood in the soft tissues, but I have seen worse. We had one case referred, where the patient was dark purple from the knee to the toes. He almost developed a compartment syndrome. You will have a colorful leg for a while, but the body will eventually resorb all of that heme.


Hope your lateral release takes care of your knee problem and that your rehab goes smoothly. Good luck.

Thank you so much for the informative answer.
I have another question about recovery, if you dont mind...
My knee cap..dead center of it, hurts sooooo bad, I have a hard time putting any weight on it...
This started today, Day 13, the pain in the patella was just horrible... Did I do something wrong to cause this? I woke up that way.. perhaps I moved it wrong in my sleep?? (sometimes it feels like it may be coming from underneath the knee cap)
I go see my surgeon tomorrow, but I would still like another opinion, for comparison.

Bribabz,

It is most likely nothing that you did to cause this. It can be coming from several different reasons.

Could be that the way the patella is now tracking within the femoral groove is putting pressure on the underside of the patella, and it has not gotten used to it yet.

Your muscles have not yet relearned how they are supposed to be pulling the patellar through the groove. There is going to be a steep learning curve, so that everything starts to work correctly to get rid of the major problem. It does take work, not just a snip here and a snip there, and everything falls wonderfully into place and works happily ever after.

The articular cartilage on the underside of the patella and deep in the groove, have spend a long time rubbing over each other abnormally, so now they have to get "into the groove", so to speak. That can cause some problems.

And, of course, it is possible that the blood supply to the patella was interrupted for a period of time, while there was the extra bleeding. It would be very rare to cause a problem by cutting just one artery, as the other arteries take up the slack, but it is still something that has to be put in the back of your mind.


Just be sure to tell the surgeon, in as much detail as possible, what is going on in the knee. If possible, show the surgeon what happens when you do certain motions.

Realigning the patella is one of the hardest things to do correctly. It seems so simple, but it is not.

Good luck.