From the Guidelines
The best treatment for recurrent patellar dislocation involves a combination of physical therapy, specifically knee-targeted exercise therapy, with supportive interventions such as education, prefabricated foot orthoses, and taping, as needed, to address individual patient needs and promote optimal recovery. This approach is supported by recent evidence from high-quality studies, including a 2024 systematic review and expert clinical reasoning published in the British Journal of Sports Medicine 1.
Key Components of Treatment
- Knee-targeted exercise therapy: This should be delivered following a robust assessment of symptom severity and irritability, with exercise parameters modified accordingly 1.
- Education: Education should underpin all interventions, providing a rationale for the delivery of a specific intervention plan, building confidence and understanding of the diagnosis, and promoting autonomy and reducing fear 1.
- Supportive interventions: These may include prefabricated foot orthoses, taping, and movement/running retraining, which should be considered based on individual patient needs and symptoms 1.
Considerations for Treatment
- Assessment: An objective evaluation should be used to identify key impairments that can influence treatment selection, including hip and knee strength, movement patterns, tissue tolerance to load, and patellofemoral joint structure/function 1.
- Individualization: Treatment should be individualized to reflect the needs of the person, taking into account their unique characteristics, symptoms, and goals 1.
- Re-evaluation: If favourable outcomes are not observed after a realistic period, clinicians should revisit assessment findings and review patient engagement to ensure that interventions are aligned with the patient's needs 1.
By prioritizing a comprehensive and individualized approach to treatment, patients with recurrent patellar dislocation can experience improved outcomes, reduced symptoms, and enhanced quality of life, as supported by the latest evidence from high-quality studies 1.
From the Research
Treatment Options for Recurrent Patellar Dislocation
The treatment for recurrent patellar dislocation is a topic of ongoing debate, with various studies investigating the effectiveness of surgical and non-surgical interventions.
- Surgical options, such as medial patellofemoral ligament (MPFL) reconstruction, have shown promising results in reducing the risk of recurrence and improving patient outcomes 2.
- A study published in 2021 found that tailored surgical treatment, addressing the patient's specific anatomic pathologies, may be a more effective approach than conservative treatment for patients with first-time lateral patella dislocation 3.
- However, a 2023 systematic review found that the certainty of evidence for the effectiveness of surgical versus non-surgical interventions for treating patellar dislocation is very low, highlighting the need for further research 4.
Surgical Techniques
Various surgical techniques have been proposed for the treatment of recurrent patellar dislocation, including:
- Proximal realignment, which has been shown to achieve the best results in correcting lateral patellar displacement 5.
- Distal realignment, which requires thorough preoperative assessment of patellar height and malalignment between the femoral groove and tibial tubercle 5.
- MPFL reconstruction, which is considered the preferred surgical technique for addressing medial soft tissue stabilizers 6.
Non-Surgical Interventions
Non-surgical interventions, such as physical therapy and bracing, may also be effective in managing recurrent patellar dislocation.
- A 2024 consensus statement recommended physical therapy as an essential complement to both operative and nonoperative treatments, but found that bracing offers no clear long-term benefit 6.
- However, the effectiveness of non-surgical interventions may depend on individual patient factors, such as the severity of the dislocation and the presence of underlying anatomical abnormalities.
Future Research Directions
Further research is needed to determine the most effective treatment approach for recurrent patellar dislocation, including:
- Randomized controlled trials comparing surgical and non-surgical interventions 4.
- Studies investigating the role of patient-specific factors, such as anatomical abnormalities and activity level, in determining treatment outcomes 3.
- Research on the development of new surgical techniques and technologies, such as MPFL reconstruction and cartilage restoration techniques 2.