What are the discharge instructions for a patient with a patellar dislocation who is discharged with a knee immobilizer?

Knee Immobilizer Discharge Instructions for Patellar Dislocation

For patients with patellar dislocation, a knee immobilizer should be worn continuously for 4 weeks, with specific activity modifications and rehabilitation protocols to prevent recurrence and promote optimal recovery. 1

Immobilization Protocol

• The knee immobilizer should be worn continuously for 4 weeks following patellar dislocation to stabilize the patella and allow initial healing of the medial patellofemoral ligament, which is injured in 96% of patellar dislocations 2
• The immobilizer should keep the knee in full extension (0°) to maintain proper patellar alignment during the initial healing phase 1
• Remove the immobilizer only for hygiene purposes and prescribed exercises, otherwise it should be worn day and night during the initial recovery period 2, 1

Weight-bearing Instructions

• Partial weight-bearing with crutches or a walker is recommended for the first 1-2 weeks 2
• Progress to full weight-bearing as tolerated while wearing the immobilizer 1
• Use assistive devices (crutches/walker) until you can walk without a limp 2

Pain Management

• Use prescribed pain medications as directed
• Apply ice for 15-20 minutes every 2-3 hours during the first 48-72 hours to reduce pain and swelling 1
• Elevate the affected leg above heart level when sitting or lying down to minimize swelling 2

Exercise Protocol

• Begin gentle isometric quadriceps exercises (static muscle contractions) immediately to prevent muscle atrophy 3
• Perform straight leg raises while wearing the immobilizer as instructed by your healthcare provider 3
• After the initial 4-week immobilization period, begin progressive range of motion exercises under the guidance of a physical therapist 1
• Avoid open kinetic chain exercises (seated knee extension) until at least 4 weeks after injury 3

Warning Signs - Seek Medical Attention If:

• Increasing pain not controlled by prescribed medications
• Numbness or tingling in the foot or toes
• Inability to move the foot
• Signs of infection (increased redness, warmth, drainage from any incision sites)
• Recurrent dislocation of the patella 2

Follow-up Care

• Attend scheduled follow-up appointments to monitor healing and adjust treatment plan
• Physical therapy should begin after the 4-week immobilization period to restore range of motion, strength, and function 1
• A functional knee brace may be prescribed after the immobilization period to provide continued patellar stability during rehabilitation and return to activities 1

Return to Activities

• Driving: Do not drive until you have adequate control of your leg and are no longer using narcotic pain medications
• Return to work/school: Depends on job requirements and mobility needs
• Return to sports: Typically not before 3 months and only after regaining full range of motion, adequate strength, and with physician clearance 2, 1

Long-term Considerations

• Be aware that recurrence rates for patellar dislocation can be high (29-42%) even with appropriate treatment 2, 1
• Complete the full rehabilitation protocol to minimize risk of recurrence 2
• Consider wearing a patellar stabilizing brace during sports activities even after full recovery 1

Important Cautions

• Avoid twisting movements, pivoting on the affected leg, and deep squatting during the recovery period 2
• Do not remove the immobilizer earlier than instructed as this may increase risk of redislocation 1
• The most recent evidence shows that using a motion-restricting knee brace for 4 weeks does not significantly reduce redislocation rates compared to less restrictive bracing, but the standard of care still includes a period of immobilization to allow initial healing 1