Pain > Patellar Dislocation > Patellar Subluxation Syndrome
Patellar Subluxation Syndrome Physiotherapy
Patellar subluxation syndrome refers to a painful knee injury that is concerned specificly with our kneecap (patella bone). Patellar subluxation is more common than patellar dislocation and can be just as disabling.
In this condition, the patella repetitively subluxates and places strain on the medial restraints and excessive stress/tension on the patellofemoral joint.
Patellar subluxation can be caused by osseous abnormalities, such as incorrect articulation of the
- femoral groove with the patella
- trochlear dysplasia
- or patella alta
which is a distance of greater than 20 mm between the tibial tubercle and the trochlear groove.
It can also happen due to soft-tissue abnormalities, such as
Symptoms are regulated by the amount of activity. Such pain is commonly caused and/or aggravated by
- sports and activities that place large forces on the patellofemoral joint
Signs and symptoms
Symptoms usually include:
- Knee buckles and can no longer support your weight
- Kneecap slips off to the side
- Knee catches during movement
- Pain in the front of the knee that increases with activity
- Pain when sitting
- Creaking or cracking sounds during movement
Patellar subluxation was once thought to occur mainly in women, due to the frequency of genu valgum and lax ligaments. However, now the frequency of this condition in any athletic person, man or woman, is apparent.
Diagnosis of patellar subluxation is typically done with a combination of
Conservative treatment in primary acute LPD (lateral patellar dislocation) is the therapy of choice (mostly don't require surgical knee correction unless severe case).
It includes a multimodal approach with behavioural education of the patient, knee physiotherapy, braces, weight reduction and pain medication.
Physiotherapy especially focuses on muscle strengthening and proprioceptive exercises.
- The vastus medialis oblique muscle is described to have an important role in functional stabilization of the patella against lateral vector force.
- Proprioceptive exercises and strengthening of the hip abductors and positioning of the foot are crucial, especially indicated in patient with miserable malalignment syndrome or medial collapse.
Several patellar braces or taping methods exist to improve return to sport. They may however not alter medial or lateral displacement, but can be helpful as a diagnostic tool for occult patellofemoral instability.
Surgical Treatment Options
Increasing age is associated with decreased physical activity after surgical stabilization, and therefore in growing and very active athletes early surgical treatment intervention needs to be considered.
Reconstruction of the MPFL (medial patellofemoral ligament) in patients with minor trochlear dysplasia is technically possible without interfering with distal growth plate of the femur, however, large studies are missing. Osseous articular correction before epiphyseal closure is contraindicated.
In adult patients with recurrent LPD and without trochlear dysplasia or type A or C according to Dejour classification, MPFL reconstruction alone might be beneficial, in which unchanged osseous or dynamic instability will be compensated.
Patients with an important supra-trochlear spur as in type B and D trochlear dysplasia and chronic instability are more reluctant to conservative and softtissue surgical treatment options. In such cases sulcus-deepening trochleoplasty should be performed.
Typically, post-surgical results are more favourable when instability was the main symptom. Hence, in such patients low-pivoting physical activity may be re-achieved.
An effective rehabilitation program reduces the chances of re-injury and of
other knee-related problems such as patellofemoral pain syndrome and osteoarthritis.
Typically patella dislocations are initially immobilized for the first 2–3
weeks to allow the stretched structures to heal.
Rehabilitation focuses on maintaining strength and range of motion to reduce
pain and maintain the health of the muscles and tissues around the knee
The objective to any good rehabilitation program is to
A common physiotherapy plan is to strengthen the
Commonly used exercises include isometric quadricep sets, side lying clamshells,
leg dips with internal tibial rotation, etc.
The idea is that because the medial side is most often stretched by the more
common lateral dislocation, medial strengthening will add more stabilizing
With progression more intense range of motion exercises are incorporated.
Our senior physiotherapists will also use treatment modalities such as
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