Treatment for Lateral Patellar Subluxation
Patellofemoral braces should be used as the primary initial treatment for lateral patellar subluxation, in conjunction with a comprehensive knee rehabilitation program that includes quadriceps strengthening, flexibility exercises, and technique improvements. 1
First-Line Conservative Management
Bracing
- Patellofemoral braces are designed to resist lateral displacement of the patella, maintain patellar alignment, and decrease knee pain 1
- Most patients report significant subjective improvements in pain and disability with brace wear 1
- Braces work by improving patellar tracking through a medially directed force 1
- For most patients, an off-the-shelf brace can be successfully fitted without customization 1
- More active individuals may benefit from a patellofemoral brace with a lateral hinge and adjustable patellar buttress 1
Exercise Therapy
- Progressive quadriceps strengthening is effective and should be included in the treatment regimen 1, 2
- Avoid exercises that exacerbate patellofemoral pain, such as running stadium stairs 3
- Classic exercises that have proven effective include quadricep sets, straight leg raises, hip abductor strengthening, hip adductor strengthening, and hip flexor exercises 3
- Hamstring stretching is a cornerstone in the treatment of patellofemoral problems 3
- Stretching tight iliotibial bands is important as they can put abnormal stress on the lateral aspect of the patella 3
Adjunctive Treatments
Patellar Taping
- Patellar taping is recommended for short-term relief of pain and improvement in function (Grade B recommendation) 1, 2
- Medial taping has shown statistically significant and possibly clinically important effects on pain reduction immediately and within days of application 1
Foot Orthoses
- Shoe orthoses should be considered in addition to a brace for patients with recalcitrant patellofemoral pain syndrome 1
- Prefabricated foot orthoses may benefit patients who respond favorably to treatment direction tests 2
Treatment Considerations
What to Avoid
- Lateral heel wedges should not be prescribed as there is limited evidence for their effectiveness and they may worsen symptoms 1, 2
- Avoid activities that increase patellofemoral joint loading during the acute phase 2
Diagnostic Imaging
- Radiographs are usually satisfactory for assessment of patellar complications 1
- Axial radiographs demonstrate the degree of patellar tilt or subluxation 1
- Weight-bearing axial radiographs are recommended to better assess patellofemoral kinematics 1
When to Consider Surgery
- Conservative treatment has a success rate of approximately 80% 3
- Surgical intervention should be considered for patients with recurrent subluxation/dislocation that fails to respond to conservative management 4, 5
- Surgical options may include medial patellofemoral ligament (MPFL) reconstruction, as the MPFL is responsible for 60% of the resistance to lateral dislocation 4
- However, the evidence comparing surgical versus non-surgical interventions is uncertain, with very low certainty evidence for all outcomes 6
Rehabilitation Progression
- Initial focus should be on pain reduction and improving patellar tracking through bracing and taping 1, 2
- Progress to strengthening exercises once acute pain has subsided 3
- Include proprioceptive-focused and dynamic rehabilitation exercises as the patient improves 5
- A home exercise program should be established and maintained throughout treatment 5