What is the recommended rehabilitation program for patella dislocation repair?

From the Guidelines

The recommended rehabilitation program for patella dislocation repair should follow a progressive, phased approach over 4-6 months, focusing on pain management, range of motion exercises, strengthening, balance, and proprioception, with an emphasis on proper patellar tracking to prevent recurrence. This approach is based on the principles of rehabilitation for knee injuries, although the provided evidence primarily discusses anterior cruciate ligament (ACL) reconstruction rehabilitation 1. The initial phase (weeks 0-2) should focus on pain management, reducing swelling, protected weight-bearing, and gentle range of motion exercises within a safe zone, typically 0-30 degrees, while wearing a knee brace or immobilizer.

In the subsequent phase (weeks 2-6), patients should gradually increase weight-bearing, expand range of motion to 0-90 degrees, and begin basic strengthening exercises including straight leg raises, quadriceps sets, and hamstring curls. The middle phase (weeks 6-12) should emphasize progressive strengthening of the quadriceps, hamstrings, and hip muscles, particularly the vastus medialis obliquus (VMO), which plays a crucial role in stabilizing the patella. Balance and proprioception exercises should be introduced, along with stationary biking.

Key aspects of the rehabilitation program include:

• Progressive strengthening and range of motion exercises
• Emphasis on proper patellar tracking
• Introduction of balance and proprioception exercises
• Gradual return to functional activities and sport-specific training

The final phase (months 3-6) should focus on functional exercises, sport-specific training, and return-to-activity progression. Throughout rehabilitation, the goal is to achieve full range of motion, adequate strength, and functional stability, allowing patients to return to full activities between 4-6 months post-repair, depending on surgical technique, individual healing, and achievement of rehabilitation milestones 1. Although the evidence provided does not directly address patella dislocation repair, the principles of progressive rehabilitation, strengthening, and emphasis on proper joint mechanics can be applied to guide the rehabilitation process for patella dislocation repair, prioritizing morbidity, mortality, and quality of life as outcomes.

From the Research

Patella Dislocation Repair Rehab Program

The recommended rehabilitation program for patella dislocation repair is not clearly defined due to the lack of high-quality evidence. However, some studies provide insights into the conservative management and surgical interventions for treating patellar dislocation.

• Conservative management:
  • Physiotherapy and rehabilitation are commonly used after patellar dislocation [ 2 ]
  • The use of a knee brace with a limited range of motion, stretching, and neuromuscular exercises are recommended physiotherapy methodologies [ 3 ]
  • Immobilization using a cylinder cast or removable splint, or functional mobilization after applying a brace or patellar tape are options in conservative management [ 4 ]
• Surgical interventions:
  • Surgical management is associated with a lower rate of re-dislocation [ 5 ]
  • Surgical stabilization of recurrent instability has a high success rate and is usually required if nonoperative measures fail [ 6 ]
• Comparison of surgical and non-surgical interventions:
  • There is insufficient high-quality evidence to confirm any significant difference in outcome between surgical or non-surgical initial management of people following primary patellar dislocation [ 2 ]
  • The certainty of the evidence for all outcomes in this review was judged to be very low [ 5 ]

Rehabilitation Program Components

The rehabilitation program for patella dislocation repair may include:

• Physiotherapeutic interventions, such as exercises and neuromuscular training [ 3 ]
• The use of a knee brace with a limited range of motion [ 3 ]
• Stretching and strengthening exercises [ 3 ]
• Functional mobilization after applying a brace or patellar tape [ 4 ]

Future Research Directions

Further research is needed to determine the optimal rehabilitation program for patella dislocation repair, including:

• High-quality randomized controlled trials comparing surgical and non-surgical interventions [ 2 ]
• Studies examining the effectiveness of different conservative management strategies [ 4 ]
• Research on the pathological variations that may be relevant to both choice of interventions and outcomes [ 5 ]