What is the recommended timeframe for returning to activity after a patella subluxation?

Return to Activity After Patella Subluxation

The recommended timeframe for returning to activity after a patella subluxation is at least 6 weeks for moderate to severe injuries, with a gradual progression based on functional recovery rather than time alone.

Initial Management and Rehabilitation Phases

Early Phase (0-2 weeks)

• Rest and protection
  • Use of brace or tape to prevent recurrent subluxation 1
  • Weight-bearing as tolerated with appropriate support
  • Avoid activities that stress the patellofemoral joint

Intermediate Phase (2-6 weeks)

• Progressive rehabilitation
  • Begin balance and coordination training 1
  • Initiate quadriceps strengthening exercises
  • Start with isometric exercises and progress to open kinetic chain exercises from 90° to 40° of knee flexion 1
  • Gradually introduce closed kinetic chain exercises

Advanced Phase (6+ weeks)

• Return to activity preparation
  • Progress to functional activities
  • Continue strengthening and neuromuscular training
  • Introduce sport-specific or activity-specific exercises

Criteria for Return to Activity

Functional Criteria (must meet all)

• Full or near-full range of motion
• Minimal to no pain during activities
• Adequate quadriceps and hamstring strength (at least 80-90% compared to unaffected side)
• Good dynamic stability during functional movements
• No apprehension with lateral stress to patella

Activity Progression

1. Low-impact activities (walking, swimming)
2. Moderate-impact activities (jogging, cycling)
3. Higher-impact activities (running, jumping)
4. Sport-specific activities with cutting, pivoting, and direction changes

Special Considerations

Risk of Recurrence

• Up to 40% of patients with primary patellar dislocation experience recurrent instability 2
• Use of a brace or tape reduces the risk of recurrent injuries in those active in sports 1
• Bracing is preferable to taping based on practical usability and cost considerations 1

Surgical vs. Non-surgical Management

• Most first-time subluxations can be managed non-surgically
• MRI is valuable in identifying the exact nature of associated injuries, particularly chondral lesions that may require expedited surgical treatment 3
• Consider surgical consultation if:
  • Osteochondral fracture is present
  • Significant anatomical predisposing factors exist
  • Recurrent instability occurs despite appropriate rehabilitation

Common Pitfalls to Avoid

1. Returning too early - Premature return to activities, especially high-impact or pivoting sports, increases risk of recurrence
2. Neglecting quadriceps strengthening - Inadequate quadriceps rehabilitation leads to poor patellar tracking and increased risk of recurrence
3. Focusing only on time-based criteria - Return should be based on functional recovery, not just time elapsed
4. Ignoring proprioceptive training - Balance and coordination exercises are essential to prevent recurrence 1
5. Failing to address biomechanical factors - Underlying issues like hip weakness or foot pronation may contribute to patellar instability

By following these guidelines and ensuring adequate rehabilitation before returning to activity, patients can minimize the risk of recurrent patellar subluxation and achieve better long-term outcomes.