Initial Treatment for Patellar Tendon Subluxation
Critical Clarification: Subluxation vs. Tendinopathy
The question asks about "patellar tendon subluxation," but this appears to be a terminology confusion—the provided evidence addresses either patellar tendinopathy (tendon overuse injury) or patellar subluxation/dislocation (kneecap instability), which are entirely different conditions requiring different treatments.
If This Is PATELLAR SUBLUXATION/DISLOCATION (Kneecap Instability):
Initial treatment should consist of a knee brace with limited range of motion, combined with neuromuscular exercises and stretching, as this represents the most commonly recommended conservative approach for patellar instability. 1
Conservative Management Protocol
Immobilization phase: Use a knee brace with restricted range of motion to allow initial healing and prevent recurrent subluxation 1
Rehabilitation exercises: Implement neuromuscular exercises focusing on quadriceps strengthening and proprioceptive training 1
Stretching program: Include lower limb stretching to address muscle imbalances 1
Duration: Continue conservative management for at least 3-6 months before considering surgical intervention 1
Important Caveat
Surgical management (proximal and distal extensor mechanism reconstruction) is associated with lower re-dislocation rates but should be reserved for failed conservative treatment 1, 2
Patients with Q angles greater than 10 degrees may ultimately require both proximal reconstruction and distal patellar tendon transfer if conservative treatment fails 2
If This Is PATELLAR TENDINOPATHY (Tendon Overuse/Jumper's Knee):
Begin with eccentric strengthening exercises combined with relative rest and activity modification, as eccentric exercises are the cornerstone of treatment and stimulate collagen production while promoting proper tendon healing. 3
First-Line Conservative Protocol
Eccentric strengthening exercises: These reduce symptoms, increase strength, and promote tendon healing by stimulating collagen production and guiding normal collagen fiber alignment 3
Relative rest: Reduce repetitive loading activities that reproduce pain (jumping, stair navigation) while maintaining general activity to prevent deconditioning 3, 4
Cryotherapy: Apply through a wet towel for 10-minute periods to provide acute pain relief 3
NSAIDs: Use oral or topical NSAIDs for short-term pain relief, with topical formulations preferred to eliminate gastrointestinal hemorrhage risk 3
- Important limitation: NSAIDs do not affect long-term outcomes 3
Adjunctive Therapy
Deep transverse friction massage: Reduces pain and may provide additional benefit 3
Heavy loaded isometric contractions: Provide greater immediate pain relief (up to 45 minutes post-intervention) compared to isotonic exercises 5
Expected Timeline and Outcomes
Approximately 80% of patients recover completely within 3-6 months with appropriate conservative treatment 3
Continue conservative management for the full 3-6 month period before considering advanced interventions 3, 4
Critical Pitfalls to Avoid
Never inject corticosteroids directly into the tendon substance—this inhibits healing, reduces tensile strength, and predisposes to spontaneous rupture 3
Do not proceed to surgery without an adequate 3-6 month trial of conservative treatment 3
Avoid multiple corticosteroid injections as they weaken tendon structure despite short-term symptom relief 3