From the Guidelines
The treatment for patellar dislocation should prioritize a comprehensive rehabilitation approach, focusing on individualized knee-targeted exercise therapy, education, and supporting interventions, as outlined in the most recent and highest quality study 1. The initial management of patellar dislocation involves immediate reduction, followed by the RICE protocol: rest, ice, compression, and elevation. Pain management typically involves NSAIDs, and a knee immobilizer or brace may be recommended for 1-3 weeks.
- Key components of rehabilitation include:
- Quadriceps strengthening, particularly the vastus medialis obliquus muscle
- Hip and knee strengthening exercises, with a focus on hip exercises in people with poor tolerance to loaded knee flexion 1
- Education to build confidence, understanding, and autonomy, and to reduce fear and promote recovery 1
- Supporting approaches, such as prefabricated foot orthoses, taping, and manual therapy, may be considered for individuals with elevated symptom severity and irritability 1
- The treatment approach should be individualized, taking into account the person's specific needs, symptoms, and biomechanical issues, as well as their expectations, self-efficacy, and perceived resilience 1.
- A gradual return to weight-bearing activities and progressive resistance training over 6-12 weeks is crucial for restoring normal patellar tracking and preventing recurrence.
- For recurrent dislocations or cases with significant anatomical abnormalities, surgical intervention may be necessary, including procedures like medial patellofemoral ligament reconstruction or tibial tubercle osteotomy, followed by an extended rehabilitation period of 4-6 months.
- The goal of treatment is to restore normal patellar tracking, prevent recurrence, and improve quality of life, by addressing the underlying biomechanical issues that contributed to the dislocation, as supported by the most recent and highest quality study 1.
From the Research
Treatment Options for Patellar Dislocation
The treatment for patellar dislocation can be divided into non-surgical and surgical methods.
- Non-surgical methods include immobilization using a cylinder cast, removable splint, or functional mobilization after applying a brace or patellar tape 2, 3.
- Surgical methods include medial patellofemoral ligament reconstruction, tibial tubercle osteotomy, trochleoplasty, lateral retinacular release, and derotation osteotomy 4, 5.
Non-Surgical Treatment
Non-surgical treatment is often recommended for first-time traumatic patellar dislocation, except in cases with osteochondral fracture, substantial disruption of the medial patellar stabilizers, or laterally subluxated patella 6.
- A posterior splint may be the best therapeutic option due to low redislocation rates and knee joint restrictions 2.
- However, the current literature on conservative treatment is limited and of low quality, making it essential to approach conclusions with caution 3.
Surgical Treatment
Surgical treatment is considered for recurrent lateral patellar dislocation or in cases where non-surgical treatment has failed.
- Medial patellofemoral ligament reconstruction is a common surgical method, which can be combined with other procedures such as tibial tubercle osteotomy or trochleoplasty 4, 5.
- A four-pronged treatment approach, including VY quadricepsplasty, distal femoral osteotomy, medial patellofemoral ligament reconstruction, and lateral retinacular and capsular reconstruction with a dermal allograft, may be necessary for obligate flexion patellar dislocation and valgus malalignment 5.