From the Research
For a patient with a patella dislocation within the past 24 hours, immediate reduction of the dislocated patella is necessary if it hasn't spontaneously reduced, and conservative management with immobilization, RICE protocol, and physical therapy is recommended as the initial treatment approach. This approach is based on the most recent and highest quality study available, which suggests that conservative management can be effective in reducing the risk of recurrent dislocation and improving functional outcomes 1.
Initial Management
The initial management of a patient with a patella dislocation within the past 24 hours should include:
- Immediate reduction of the dislocated patella by a healthcare provider using gentle extension of the knee while applying medial pressure on the lateral edge of the patella
- Immobilization with a knee immobilizer or hinged brace locked in extension for 1-2 weeks
- RICE protocol: rest, ice for 20 minutes every 2-3 hours, compression with an elastic bandage, and elevation above heart level
- Pain management with NSAIDs like ibuprofen 400-600mg every 6-8 hours or naproxen 500mg twice daily, with acetaminophen 650mg every 6 hours as needed for breakthrough pain
Physical Therapy and Follow-up
Physical therapy should begin after the initial immobilization period, focusing on quadriceps strengthening and patellar stabilization exercises. Patients should be evaluated with radiographs to assess for associated fractures and potential osteochondral injuries. MRI may be indicated if there is concern for significant soft tissue damage, particularly to the medial patellofemoral ligament which is commonly injured during dislocation. Recurrent dislocations may require surgical intervention, so follow-up with orthopedics is essential, typically within 1-2 weeks after the initial injury.
Evidence Summary
The evidence suggests that conservative management is a viable initial treatment approach for patients with a patella dislocation within the past 24 hours 2, 1. However, the certainty of the evidence is limited by the relatively low methodological quality of the available studies. Further research is needed to determine the optimal treatment approach for this condition.