What is the treatment for patella subluxation?

Treatment for Patella Subluxation

The primary treatment for patella subluxation should include knee-targeted exercise therapy focusing on quadriceps strengthening, combined with patellar taping and bracing to resist lateral displacement of the patella. 1

Initial Assessment and Diagnosis

• Evaluate for physical impairments including:

  • Muscle strength (hip and knee)
  • Movement patterns of the lower extremity
  • Tissue tolerance to load
  • Patellofemoral joint structure/function (e.g., patella alta, hypermobility)
  • Contextual factors related to symptoms (e.g., fear avoidance)

• Radiographic assessment:

  • Standard radiographs are appropriate for initial evaluation 1
  • Axial radiographs to demonstrate degree of patellar tilt or subluxation 1
  • Weight-bearing axial radiographs provide better assessment of patellofemoral kinematics 1
  • CT may be used for measuring axial malrotation if needed 1

Treatment Algorithm

1. Exercise Therapy (First-line Treatment)

• Quadriceps strengthening exercises (Grade B recommendation) 1

  • Focus on vastus medialis obliquus strengthening to improve patellar tracking
  • Straight leg raises
  • Quadricep sets
  • Avoid deep knee flexion exercises initially

• Hip muscle strengthening

  • Hip abductor and external rotator exercises
  • Hip adductor exercises
  • Hip flexor exercises

• Flexibility training

  • Hamstring stretching (cornerstone of treatment) 2
  • Iliotibial band stretching to reduce abnormal lateral stress on patella 2

2. Patellar Stabilization

• Patellar taping (Grade B recommendation) 1

  • Apply medial taping for short-term relief of pain and functional improvement
  • Provides statistically significant and possibly clinically important effects on pain reduction 1
  • Most effective when compared to no taping rather than sham taping

• Patellofemoral bracing 1

  • Use braces that incorporate elastic material (e.g., neoprene) with straps or buttresses
  • Select appropriate size by measuring 3 inches above and below mid-patella
  • Position buttress support(s) to apply medially directed force to lateral border of patella
  • Maintain constant pressure during knee flexion, extension, and rotation
  • Success rate of approximately 80% with proper bracing and exercise 2

3. Education

• Explain the mechanism of patellofemoral subluxation
• Set realistic expectations regarding recovery timeframes
• Emphasize the importance of adherence to exercise program
• Provide guidance on activity modification and load management

4. Additional Interventions

• Activity modification

  • Avoid activities that exacerbate symptoms (e.g., running stairs, deep squats)
  • Gradually reintroduce activities as symptoms improve

• Pain management

  • NSAIDs for short-term pain relief if needed

Treatment Progression

1. Initial Phase (0-4 weeks)

   • Focus on pain control and protected range of motion
   • Emphasize patellar taping and bracing
   • Begin gentle quadriceps strengthening

2. Intermediate Phase (4-8 weeks)

   • Progressive strengthening exercises
   • Continue with bracing as needed
   • Introduce more functional exercises

3. Advanced Phase (8-12 weeks)

   • Occupation/sport-specific training
   • Functional exercises
   • Gradual return to previous activities

Surgical Considerations

Surgical intervention should only be considered when conservative measures fail after 3-6 months of well-managed treatment 3. Primary surgical intervention may be indicated in cases of:

• Substantial disruption of medial patellar stabilizers
• Laterally subluxated patella with normal alignment of contralateral knee
• Large loose bodies requiring removal

Common Pitfalls and Caveats

• Avoid focusing solely on quadriceps strengthening without addressing hip muscle weakness
• Do not neglect hamstring and IT band flexibility
• Ensure proper brace fitting and application to prevent migration and ineffectiveness
• Avoid excessive immobilization which can lead to muscle atrophy
• Recognize that patellofemoral braces are meant to be used in conjunction with a comprehensive rehabilitation program, not as standalone treatment 1
• Be aware that complications of conservative treatment may include low back pain, iliopsoas tendinitis, and muscle soreness 2

Regular assessment at 2,6, and 12 weeks is necessary to evaluate pain levels, range of motion, functional improvement, and signs of recurrent instability.