What is the treatment for knee patella laxity using a lateral buttress?

Treatment of Knee Patella Laxity Using a Lateral Buttress

Knee sleeves with patellar reinforcement and lateral buttress straps are the most effective non-surgical treatment for patella laxity, providing stability and pain relief while allowing for functional movement. 1

Bracing Options for Patella Laxity

Recommended Bracing Approach

• Sleeve-style braces with patellar stabilization are the first-line treatment for most patients with patellofemoral instability 1
• Wrap-style braces with dynamic patellar stabilization provide additional support for more severe cases 1
• Key features to look for in an effective brace:
  • Patellar cutout
  • C- or J-shaped cushions
  • Lateral buttress straps
  • Built-in lateral stays for increased stiffness 2

Mechanism of Action

The lateral buttress works by:

1. Applying a medially displacing force on the patella
2. Resisting lateral displacement during knee movement
3. Maintaining proper patellar alignment in the trochlear groove
4. Helping decrease knee pain through improved tracking 1

Patient Selection and Fitting

Optimal Candidates

• Patients with early patellofemoral instability or laxity
• Those with recurrent subluxation rather than complete dislocation
• Individuals with mild to moderate symptoms 2

Proper Fitting Technique

• Measure leg circumference according to manufacturer guidelines
• Select appropriate brace size based on measurements
• Position the brace correctly with the buttress aligned against the lateral edge of the patella 1
• Ensure the brace is snug but not restricting circulation 2

Treatment Outcomes and Expectations

Patients using lateral buttress braces typically experience:

• Subjective improvements in pain and disability 1
• Reduced frequency of patellar subluxation events
• Improved patellar tracking during knee flexion and extension 1
• Superior outcomes compared to analgesic medications alone 2

However, it's important to note that bracing is less effective than corrective surgery for severe cases with anatomical abnormalities such as trochlear deficiency or patella alta 3.

Potential Pitfalls and Considerations

Common Issues to Avoid

• Improper fitting: An ill-fitted brace will not provide adequate support
• Using lateral release for hyperlax joints: This adds additional laxity to an already unstable system 3
• Prolonged use without rehabilitation: Can lead to muscle weakness and dependency
• Ignoring underlying biomechanical issues: Bracing treats symptoms, not structural causes 1

When to Consider Surgery

For patients with severe or recurrent instability despite bracing, surgical options may include:

• Medial patellofemoral ligament (MPFL) reconstruction, which has shown excellent outcomes 4
• Combined procedures for severe cases with ligamentous laxity and trochlear aplasia 5

Comprehensive Management Algorithm

1. Initial Treatment: Begin with a sleeve-style brace with lateral buttress for mild to moderate patella laxity
2. Advance to: Wrap-style brace with dynamic patellar stabilization if symptoms persist
3. Combine with: Quadriceps strengthening, flexibility improvements, and technique refinement
4. Consider: Shoe orthotics for recalcitrant cases 1
5. Surgical Referral: If conservative management fails after 3-6 months

The lateral buttress brace should be worn during physical activity but should not be relied upon as the sole treatment. Rehabilitation exercises focusing on quadriceps strengthening, particularly the vastus medialis obliquus, are essential for long-term stability 1.