What is the treatment for patellar subluxation (kneecap subluxation)?

From the Guidelines

Treatment for patella subluxation should prioritize conservative measures, including knee-targeted exercise therapy, education, and supporting approaches, before considering surgical options, as recommended by the most recent and highest quality study 1.

Key Components of Conservative Treatment

• Knee-targeted exercise therapy, with a focus on strengthening the quadriceps muscles, particularly the vastus medialis obliquus (VMO), to help stabilize the kneecap 1
• Education to build confidence and understanding of the diagnosis, explore the concept of pain not correlating with tissue damage, and promote autonomy and reduce fear 1
• Supporting approaches, such as prefabricated foot orthoses, taping, and manual therapy, to be used as adjuncts to successful exercise delivery 1

Considerations for Treatment Selection

• Objective evaluation to identify key impairments that can influence treatment selection, including hip and knee strength, movement patterns, tissue tolerance to load, and PFJ structure/function 1
• Individualized treatment plans, taking into account symptom severity and irritability, and modifying exercise parameters accordingly 1
• Regular reassessment and adjustment of treatment plans as needed, to ensure optimal outcomes and minimize the risk of future subluxation episodes 1

Surgical Interventions

• Reserved for severe or recurrent cases that do not respond to conservative treatment after 3-6 months 1
• Options include lateral release, medial patellofemoral ligament reconstruction, or tibial tubercle osteotomy, which aim to address underlying biomechanical issues and prevent long-term cartilage damage 1

From the Research

Patella Subluxation Treatment

• The treatment of patella subluxation can be conservative or surgical, with the choice of treatment depending on the severity of the subluxation and the patient's overall health 2, 3.
• Conservative treatment typically involves a combination of exercises, such as quadricep sets, straight leg raises, hip abductors, hip adductors, hip flexors, and hamstring stretches, as well as the prevention of flexion extension activity 2.
• The use of a knee brace with a limited range of motion, stretching, and neuromuscular exercises are also commonly recommended physiotherapy methodologies for the treatment of patella subluxation 3.
• In cases where there is recurrent subluxation/dislocation, a reconstruction of the medial patellofemoral ligament (MPFL) may be necessary, with post-operative management involving a physical therapy treatment progression including proprioceptive-focused and dynamic rehabilitation 4.

Factors Influencing Treatment Outcome

• The tendency to redislocation is significantly greater in patients younger than 20 years of age than in those older than 20 years of age at the time of primary dislocation 5.
• Patella alta and subluxation are significantly more common in patients without a history of injury than in those with a history of injury 5.
• No single predisposing factor causes more redislocation than any other, and the results of conservative treatment are influenced by a combination of factors, including the patient's age, the severity of the subluxation, and the presence of any underlying conditions 5.

Guidelines for Management

• Consensus-based guidelines recommend initial knee radiographs, nonoperative treatment for first-time patellar dislocation without an osteochondral fracture, and physical therapy starting within the first month postinjury 6.
• Return to sport is recommended after 2 to 4 months, with a brace and further follow-up as needed 6.
• Surgical treatment is recommended if there are patellar subluxation episodes after 6 months of nonoperative treatment, and patellar stabilization should be considered for a first-time dislocation with an osteochondral fracture 6.