From the Guidelines
Patella subluxation treatment should prioritize a combination of rest, ice, compression, and elevation (RICE protocol) for acute cases, followed by individualized knee-targeted exercise therapy, with a focus on hip and knee strengthening, as well as education to address pain, fear, and self-efficacy, as recommended by the most recent and highest quality study 1. The goal of treatment is to improve patellar tracking and stability, reduce pain, and promote long-term knee stability. Key components of treatment include:
- Rest, ice, compression, and elevation (RICE protocol) for acute cases
- Individualized knee-targeted exercise therapy, with a focus on hip and knee strengthening
- Education to address pain, fear, and self-efficacy
- Consideration of prefabricated foot orthoses, taping, and manual therapy as adjuncts to exercise therapy
- Movement/running retraining to address task-specific biomechanics Treatment should be guided by a thorough assessment of symptom severity and irritability, as well as objective evaluation of hip and knee strength, movement patterns, and tissue tolerance to load. By prioritizing these components, patients with patella subluxation can achieve improved outcomes in terms of morbidity, mortality, and quality of life, as supported by the latest evidence 1.
From the Research
Definition and Prevalence of Patella Subluxation
- Patellofemoral subluxation is a common knee problem, as pointed out in the preface of a book 2.
- It is characterized by chronic anterior knee pain, instability, limited knee motion, and pain with squatting and stair climbing, particularly in the case of medial patellar subluxation 3.
Conservative Treatment
- A conservative treatment program for patellofemoral subluxation has been shown to have a success rate of approximately 80% 2.
- The program includes exercises such as quadricep sets, straight leg raises, hip abductors, hip adductors, hip flexors, and hamstring stretches 2.
- Prevention of flexion extension activity and stretching of the hamstring muscles are also important components of conservative treatment 2.
- A systematic review found that unstructured lower limb physical therapy programmes can have similar outcomes to specific exercises, and the use of a knee brace with a limited range of motion, stretching, and neuromuscular exercises are commonly recommended physiotherapy methodologies 4.
Surgical Treatment
- Surgical management is associated with a lower rate of re-dislocation, but it is unclear whether surgery produces greater functional outcomes than conservative management 4.
- Medial patellofemoral ligament reconstruction is an effective treatment for preventing recurrent dislocations, and various surgical techniques have been described 5.
- The medial quadriceps tendon-femoral ligament reconstruction technique is considered the most anatomic repair, avoiding patellar tunnels and the risk of patella fracture 6.
Diagnosis and Treatment of Medial Patellar Subluxation
- Medial patellar subluxation is a poorly recognized clinical condition, and diagnosis is typically confirmed during diagnostic arthroscopy 3.
- Nonsurgical management, such as physical rehabilitation and patella-stabilizing bracing, can be effective, but surgery may be necessary when these methods fail 3.