Patellofemoral Brace Recommendation for Patellar Dislocation
Yes, a patellofemoral brace is recommended for patellar dislocation, but it should be used as part of a comprehensive rehabilitation program rather than as standalone treatment, and evidence shows that simple neoprene braces are equally effective as complex motion-restricting braces while avoiding complications.
Type of Brace to Use
A neoprene nonhinged knee brace is preferred over motion-restricting braces for first-time patellar dislocation, as the most recent high-quality randomized controlled trial found no difference in redislocation rates (34.4% vs 37.5%) but significantly better outcomes with the simpler brace 1.
Motion-restricting braces that limit knee range of motion to 0-30° cause quadriceps muscle atrophy (75% vs 50% of patients at 4 weeks), reduced knee range of motion (90° vs 115° at 4 weeks), and worse functional outcomes at 6 months compared to simple neoprene braces 1.
Patellofemoral braces with elastic material (such as neoprene) and lateral buttresses or straps are the standard design, and off-the-shelf versions are sufficient for most patients without requiring customization 2.
Evidence Quality and Limitations
The evidence supporting brace effectiveness is weak: subjective patient-reported benefits consistently exceed objective findings 2.
A kinematic MRI study found no statistically significant differences in patellar tilt angle, bisect offset, or lateral patellar displacement when comparing braced versus unbraced knees during active motion in patients with patellar subluxation or dislocation 3.
The most recent ESSKA 2024 consensus concluded that bracing offers no clear long-term benefit for first-time patellar dislocation 4.
Clinical Indications for Bracing
Despite limited objective evidence, patellofemoral braces are indicated for:
Patellar subluxation and/or dislocation as a listed indication in clinical guidelines 2.
Patients report significant subjective improvements in pain and disability with brace wear, even when objective measurements don't confirm mechanical benefits 2.
The brace may be useful during the acute phase (first 4 weeks) while initiating rehabilitation 1.
Critical Component: Rehabilitation Program
Bracing must be combined with a comprehensive knee rehabilitation program that includes:
Vastus medialis strengthening exercises 5.
Lower extremity muscle strengthening and flexibility improvements 2.
Physical therapy is recommended as an essential complement to treatment 4.
Strengthening, flexibility, and technique refinement are more important than bracing alone 2.
Fitting and Application
When fitting a patellofemoral brace:
Measure leg circumference 3 inches above and 3 inches below mid-patella, or around the center of the knee joint with the leg relaxed and extended 2.
Position the lateral buttress support comfortably if adjustable 2.
Align the patella in the center of the cutout if applicable 2.
Secure straps with moderate tension and remove excess strap material 2.
Periodically inspect for brace migration, strap loosening, or material fatigue 2.
Duration of Use
Brace use for 4 weeks continuously is the typical recommendation based on the highest quality trial 1.
Prolonged use may completely eliminate symptoms in some cases of patellar subluxation 5.
Common Pitfalls to Avoid
Avoid motion-restricting braces that limit knee flexion, as they cause quadriceps atrophy and delayed functional recovery without reducing redislocation rates 1.
Do not rely on bracing alone without implementing a structured rehabilitation program focusing on quadriceps strengthening 2.
Recognize that the brace mechanism of action remains unclear, likely involving improved patellar tracking through medially directed force, changes in regional temperature, neurosensory feedback, or circulation 2.
Consider shoe orthotics in addition to bracing for patients with recalcitrant patellofemoral pain syndrome 2.