ARTHROSCOPY SYNOVECTOMY AND LATERAL RELEASE

Indications and Goals:

An arthroscopy synovectomy (removal of the joint lining in the knee) can be done arthroscopically as
well as open .

Indications include:

 pigmented villonodular synovitis (PVNS),

 synovial chondromatosis,
 rheumatoid arthritis, and
 a variety of other disorders.

Synovial plicae, which are thickenings of the synovium, can sometimes become symptomatic and
abrade the articular surfaces, especially the medial femoral condyle.

Pathologic plicae, although rare, should be removed. Lateral release should also be a relatively
uncommon procedure for the knee arthroscopist. Indications are limited to patients with refractory
anterior knee pain and objective evidence of patellar tilting (lateral patellar compression syndrome).

Procedure and Technique:

Arthroscopic synovectomy of the knee is accomplished with a large shaver. The entire synovium is
shaved. Fortunately, the pathologic synovium is dark colored and it is relatively easy to see what
needs to be removed. Typically, the superior joint is addressed first (using superomedial and
superolateral portals), then the gutters, and then the anterior part of the knee. Additional portals
are necessary to debride the posteromedial and posterolateral aspects of the knee. These portals
are localized using a spinal needle as viewed through the notch. Medially, the saphenous vein and
nerve branches need to be protected and laterally, the common peroneal nerve should be
protected by staying anterior to these structures. Plicae can be easily resected with a combination of
a biter and a shaver. A lateral release is usually accomplished under direct visualization using an
electrocautery device. Care should be taken to avoid excessive bleeding (from the superolateral
geniculate artery).

Post-surgical Precautions/Rehabilitation:

Post-operative precautions following an isolated synovectomy involve a gradual progression to

weight bearing, with range of motion exercises implemented immediately.

The focus is on minimizing post-operative effusion and regaining neuromuscular control. With a
lateral release performed, post-operative emphasis should be placed on quadriceps muscle activity
and joint proprioception.

Care should be taken early on to consider the use of a patella-stabilizing orthotic of some kind. It is
also important to assess one’s posture and avoid a pronated foot, thus foot orthotics may be of
assistance to minimize any excessive valgus forces placed on the knee.

Expected Outcomes:
Anterior knee pain has been reported to subside post-operatively in the number of

patients as compared to preoperative findings as much as 2 years post-operative. However, an

isolated lateral retinacular release of the patella has not proven to be effective for long-term benefit
of reducing patellar instability. It is not uncommon for a person who undergoes a lateral release to
have repetitive episodes of complaints of instability and pain years later if in fact continued
quadriceps strengthening has not been maintained.

Return to Play: A return to sport participation can occur with days to weeks with only a
synovectomy being performed. However, with the lateral release procedure, restoration of
quadriceps strength and function is required

prior to any competitive return to sport. This may be as early as 1 month post-operatively but is
often longer.