From the Guidelines
No, you should not weight bear in a Zimmer knee splint after a patella dislocation without specific clearance from your healthcare provider. Initially after a patella dislocation, non-weight bearing or partial weight bearing with crutches is typically recommended while the knee is immobilized in the Zimmer splint. The splint is designed to keep your knee straight and protect the injured structures as they begin to heal. Weight bearing too soon can disrupt the healing process, potentially causing re-dislocation or further damage to the supporting structures around your kneecap.
According to the most recent and highest quality study 1, early unrestricted motion and weight-bearing may be recommended in some cases, but this should be done under the guidance of a healthcare provider. The study also highlights the importance of early strength training and rehabilitation protocols. However, it is essential to note that these recommendations are for anterior cruciate ligament reconstruction and may not be directly applicable to patella dislocation.
In the context of patella dislocation, it is crucial to prioritize a gradual return to weight bearing based on the individual's injury severity and healing progress. Your doctor will typically advise a gradual return to weight bearing, usually starting around 1-2 weeks after the injury if healing is progressing well. During this time, you should follow RICE principles (Rest, Ice, Compression, Elevation) and take prescribed pain medications as directed. Physical therapy will likely be recommended once some healing has occurred to strengthen the muscles that help stabilize your kneecap, particularly the quadriceps and vastus medialis obliquus muscle.
Some key points to consider in the rehabilitation process include:
- Early knee mobilization and strength/neuromuscular training may be recommended, as suggested by 1
- Continuous passive motion and functional bracing should not be used, as stated in 1
- Cryotherapy and neuromuscular electrostimulation may be used according to individual circumstances, as mentioned in 1
- It is essential to follow your healthcare provider's specific instructions regarding weight bearing status, as they will tailor recommendations to your individual case.
From the Research
Weight Bearing in Zimmer Knee Splint after Patella Dislocation
- There is limited evidence to suggest the best approach for weight bearing in a Zimmer knee splint after patella dislocation 2, 3, 4, 5, 6.
- A study published in the Journal of Orthopaedic Surgery and Research found that the use of a knee brace with a limited range of motion, stretching, and neuromuscular exercises are commonly recommended physiotherapy methodologies after patella dislocation 2.
- Another study published in The Cochrane Database of Systematic Reviews found that the certainty of evidence for all outcomes in the review was very low, and it is uncertain whether surgery or non-surgical management is the best approach for treating patellar dislocation 3.
- A review published in EFORT Open Reviews found that the current available literature on conservative treatment after a first-time patellar dislocation is little and of low quality of evidence, and new research is strongly needed 4.
- A randomized controlled trial published in The American Journal of Sports Medicine found that the use of a patella-stabilizing, motion-restricting knee brace did not result in a statistically significant reduction in redislocations versus a neoprene nonhinged knee brace 5.
- A review published in the International Journal of Emergency Medicine found that a posterior splint might be the best therapeutic option because of the low redislocation rates and knee joint restrictions, but this recommendation is based on only one study with significant limitations 6.
Immobilization and Weight Bearing
- Immobilization with a cylinder cast, posterior splint, or removable knee brace is commonly used for conservative management of patellar dislocation 6.
- A study found that immobilization with a cylinder cast causes less redislocation and joint movement restriction than a knee brace or posterior splint, but the evidence level remains low 6.
- There is no clear consensus on the most appropriate means of conservative treatment or the duration of immobilization for patellar dislocation 6.
Recommendations
- Further investigation with modern braces and standardization of immobilization time is needed to find the most appropriate conservative treatment for patellar luxation 6.
- Expert consensus should be achieved on the minimal description of both surgical and non-surgical interventions, and the pathological variations that may be relevant to both choice of these interventions 3.