What is the treatment for patellar subluxation?

Treatment of Patellar Subluxation

The primary treatment for patellar subluxation should include quadriceps strengthening exercises, patellar taping, and bracing to stabilize the patellofemoral joint and prevent recurrence. 1

Diagnostic Assessment

Before initiating treatment, proper assessment is crucial:

• Radiographic evaluation: Standard radiographs including axial (skyline) views are usually sufficient to assess patellar position, tilt, and subluxation 1
• Physical examination findings:
  • Patellar tracking abnormalities during knee flexion/extension
  • Tenderness at the inferior pole of patella
  • Positive decline squat test that reproduces pain 1
  • Assessment for anatomic misalignments that may contribute to subluxation

Treatment Algorithm

First-line Treatment

1. Quadriceps strengthening exercises

   • High-quality evidence supports quadriceps strengthening for pain reduction and functional improvement 1
   • Focus on progressive loading of quadriceps in both open and closed chain exercises
   • Emphasize vastus medialis oblique (VMO) strengthening to improve patellar tracking

2. Patellar taping

   • Medial taping provides statistically significant and clinically important pain reduction 1
   • Apply tape to create a medially-directed force on the patella
   • Can be used for immediate symptom relief while other interventions take effect

3. Dynamic patellar bracing

   • Braces that apply an active, medially displacing force to the lateral border of the patella help maintain proper patellar tracking 2
   • Particularly useful during specific activities that trigger symptoms
   • Can be used in conjunction with rehabilitation exercises

Additional Interventions

1. Hip and knee targeted exercise therapy

   • Combined hip and knee exercises show superior efficacy compared to knee exercises alone 1
   • Focus on hip abductor and external rotator strengthening to improve lower limb alignment

2. Stretching program

   • Hamstring stretching is a cornerstone in treating patellofemoral problems 3
   • Iliotibial band stretching to reduce lateral patellar stress

3. Manual therapy

   • Deep transverse friction massage to reduce pain 1
   • Lower quadrant manual therapy has demonstrated efficacy 1

Special Considerations

• Acute vs. chronic subluxation:

  • Acute cases: Initial period of relative rest, ice, compression, and elevation
  • Chronic cases: More emphasis on progressive strengthening and addressing biomechanical factors

• Bracing recommendations:

  • Use knee braces with limited range of motion in the early rehabilitation phase 4
  • Dynamic patellar stabilizing braces are superior to other methods of patellar splinting 2

• Common pitfalls to avoid:

  • Neglecting hamstring tightness, which can contribute to patellofemoral problems 3
  • Overemphasis on flexion-extension activities (like stair climbing) early in rehabilitation 3
  • Failure to address hip muscle weakness that contributes to abnormal patellar tracking

When to Consider Surgical Referral

Surgical intervention should be considered when:

• Conservative treatment fails after 3-6 months of compliant therapy
• Recurrent dislocations occur despite appropriate conservative management
• Significant anatomical abnormalities are present (e.g., severe trochlear dysplasia)

Surgical management is associated with lower rates of re-dislocation compared to conservative treatment, though functional outcomes between surgical and non-surgical approaches remain comparable 4.

Monitoring and Progression

• Gradually increase exercise intensity as pain permits
• Progress from non-weight-bearing to partial weight-bearing to full weight-bearing exercises
• Monitor patellar tracking during functional activities
• Assess for proper biomechanics during sport-specific movements before return to full activity

The combination of quadriceps strengthening, patellar taping, and appropriate bracing provides the most evidence-based approach to managing patellar subluxation while improving function and preventing recurrence.