What is the treatment for lateral patella dislocation?

Treatment for Lateral Patella Dislocation

For first-time lateral patellar dislocation, nonoperative treatment with functional support and exercise therapy is the preferred approach, as surgical intervention shows no significant advantage in preventing recurrent dislocations in the majority of patients. 1

Initial Diagnostic Imaging

Radiography is the first-line imaging modality for acute lateral patellar dislocation 2:

• Obtain minimum two views: anteroposterior and lateral radiographs of the affected knee 2
• Add a patellofemoral (axial) view to evaluate for patellar fractures and degree of subluxation or dislocation 2
• Weight-bearing axial radiographs best demonstrate patellofemoral kinematics and the degree of patellar tilt 3

MRI should be considered after initial radiographs to characterize associated injuries 2:

• MRI aids in diagnosis and characterization of bone and soft-tissue injuries associated with transient lateral patellar dislocation 2
• Particularly useful for detecting osteochondral fractures, bone marrow contusions, and ligamentous injuries (especially medial patellofemoral ligament rupture) 2

Nonoperative Treatment (First-Line)

Functional Support

Use an ankle-style functional brace for 4-6 weeks 3:

• Functional support is strongly preferred over rigid immobilization 3
• Braces show the greatest treatment effects compared to other types of functional support 3
• If immobilization is used for severe pain or edema, limit to maximum 10 days, then transition to functional support 2

Exercise Therapy

Initiate early exercise therapy programs focusing on neuromuscular and proprioceptive training 4:

• Exercise therapy reduces the prevalence of recurrent dislocations (level 2 evidence) 4
• Programs should target both hip and knee strengthening with progressive isolated and multijoint exercises 4
• Early initiation is associated with quicker recovery and enhanced functional outcomes 4

Pain Management

Use NSAIDs or acetaminophen for pain control during the acute phase (general medical knowledge, though not specifically cited in provided evidence for patellar dislocation).

Surgical Treatment Indications

Surgery is indicated primarily for:

1. Osteochondral fractures or significant concomitant injuries identified on imaging 1
2. Recurrent dislocations after failed comprehensive nonoperative treatment 1, 4

Medial patellofemoral ligament (MPFL) reconstruction is the most effective surgical intervention for recurrent instability 4:

• Prevents recurrent dislocations with excellent outcomes and high return-to-sport rates 4
• Approximately 90% of lateral patellar dislocations involve MPFL rupture 1

Special Surgical Considerations

Avoid surgery as first-line treatment because 1:

• No significant difference exists between surgical and conservative treatment after first-time dislocation in children, adolescents, and adults 1
• 60-70% of patients respond well to nonoperative treatment 2
• Unnecessary surgical exposure carries risks of complications, ankle stiffness, and impaired mobility 2

Exception: Professional athletes may benefit from earlier surgical intervention to ensure quicker return to play 2

Anatomical Risk Factor Assessment

Evaluate for predisposing anatomical factors early to guide prognosis and counseling 1:

• Patella alta (high-riding patella) 1
• Increased tibial tuberosity-trochlear groove (TT-TG) distance 1
• Trochlear dysplasia 1
• Torsional abnormalities of the femur or tibia 1
• Generalized ligamentous laxity 1, 5

Patients with subluxation on knee extension or generalized ligament laxity have poor outcomes with lateral release procedures and should be counseled accordingly 5.

Return to Activity Criteria

Before returning to sports, assess 4:

• Leg symmetry strength using both functional and isolated knee strength measurements 4
• Patient-reported outcome measures for perceived physical abilities and patellofemoral joint stability 4
• Resolution of pain and edema with full range of motion restored 4

Common Pitfalls to Avoid

• Do not perform isolated lateral release for first-time dislocation; outcomes deteriorate over time (50% excellent results at 4 years declining to 37% at 8 years) 5
• Do not use rigid immobilization beyond 10 days, as it produces inferior outcomes compared to functional treatment 2
• Do not overlook osteochondral fractures on initial imaging, as these require surgical intervention 1
• Do not proceed with lateral release in patients with generalized ligament laxity or subluxation on extension, as results are consistently poor 5