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Patellar Injury and Dislocation Follow-up

  • Author: Gerard A Malanga, MD; Chief Editor: Craig C Young, MD  more...
 
Updated: Sep 11, 2014
 

Return to Play

Patients with patellar injury and dislocation may return to play after (1) all symptoms and episodes or exacerbations have resolved and (2) full ROM and preinjury strength have been achieved in the affected limb. The timeline for return to play varies from patient to patient. In a 2000 study, Atkin et al found that at 6 months, 58% of their study population still reported deficits in function.[54]

Some variability exists in the time required to return to play, and it depends on multiple factors, including the underlying anatomy and physiology, whether conservative or surgical treatment was used, and the type of surgical treatment performed. In a review article in 2003, Hinton et al suggested that following surgical correction of a patellar injury or dislocation, return to sports can be anticipated to occur 4-6 months after the procedure.[55]

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Prevention

To prevent patellofemoral knee problems, patients must not exceed the optimal patellofemoral joint-loading capacities. In addition, enhancing quadriceps strength prevents most symptoms and pathologies. Athletes involved in soccer and weight lifting should be especially careful. Studies on prophylactic bracing for patellofemoral dysfunction have thus far been inconclusive. The variability in results from bracing is likely due to the different subtleties of patellofemoral biomechanics in each individual. Each brace fits and affects different muscle groups to different degrees in different individuals.

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Prognosis

The prognosis for patellofemoral dysfunction and dislocation has been studied and reports of outcomes vary. Overall, conservative treatment for acute patellar dislocations yields a 30-50% chance of continuing to have long-term symptoms of instability or pain.

  • Cash et al reported on a 30-year noninvasive rehabilitation treatment course for patients with and without congenital anomalies of the extensor mechanism who had an acute patellar dislocation.[56] Of the 54 patients with congenital anomalies, 28 (52%) reported good or excellent results. Of the 20 patients without congential anomalies, 15 (75%) reported good or excellent results.[56]
  • Buchner et al evaluated a total of 126 patients who had a primary traumatic patella dislocation and were treated either conservatively, with arthroscopic exploration, or with immediate surgical repair of the parapatellar ligaments.[33] After a mean follow-up of 8.1 years, the study reported long-term functional results as excellent or good in 85% of patients. However, the investigators also noted a recurrence rate of 26% in the total study population.[33]
  • Atkin et al investigated 74 young athletes who received standardized rehabilitation after acute patellar dislocation during sporting events.[54] After full passive ROM and quadriceps strength were at least 80% compared with the uninvolved knee, these patients returned to sports activity. Up to 6 months after the initial insult, participation in strenuous activity, especially kneeling and squatting, was significantly reduced. At 6 months, 58% continued to note a reduced ability to fully participate.[54]
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Education

See Prevention.

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Contributor Information and Disclosures
Author

Gerard A Malanga, MD Founder and Partner, New Jersey Sports Medicine, LLC and New Jersey Regenerative Institute; Director of Research, Atlantic Health; Clinical Professor, Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey-New Jersey Medical School; Fellow, American College of Sports Medicine

Gerard A Malanga, MD is a member of the following medical societies: Alpha Omega Alpha, American Institute of Ultrasound in Medicine, North American Spine Society, International Spine Intervention Society, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine

Disclosure: Received honoraria from Cephalon for speaking and teaching; Received honoraria from Endo for speaking and teaching; Received honoraria from Genzyme for speaking and teaching; Received honoraria from Prostakan for speaking and teaching; Received consulting fee from Pfizer for speaking and teaching.

Coauthor(s)

Wah Sang Lee, DO, MS Staff Physician, Department of Physical Medicine and Rehabilitation, New Jersey Medical School/Kessler Institute of Rehabilitation

Wah Sang Lee, DO, MS is a member of the following medical societies: American Osteopathic Association

Disclosure: Nothing to disclose.

Thomas Agesen, MD Assistant Clinical Professor, Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey, New Jersey Medical School; Consulting Staff, Mountainside Hospital, Summit Overlook Hospital

Thomas Agesen, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, Physiatric Association of Spine, Sports and Occupational Rehabilitation

Disclosure: Nothing to disclose.

Brian F White, DO Attending Physiatrist, Department of Surgery, Division of Interventional Pain, Bassett Healthcare, Cooperstown, NY

Brian F White, DO is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Osteopathic Association, North American Spine Society, American Society of Interventional Pain Physicians, International Spine Intervention Society

Disclosure: Nothing to disclose.

Daniel Tsukanov, DO Sports Medicine Fellow, Department of Physical Medicine and Rehabilitation, Montefiore Medical Center

Daniel Tsukanov, DO is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, American Osteopathic Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Russell D White, MD Clinical Professor of Medicine, Clinical Professor of Orthopedic Surgery, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center-Lakewood

Russell D White, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Family Physicians, American Association of Clinical Endocrinologists, American College of Sports Medicine, American Diabetes Association, American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Chief Editor

Craig C Young, MD Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Medical College of Wisconsin

Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta Kappa

Disclosure: Nothing to disclose.

Additional Contributors

Andrew L Sherman, MD, MS Associate Professor of Clinical Rehabilitation Medicine, Vice Chairman, Chief of Spine and Musculoskeletal Services, Program Director, SCI Fellowship and PMR Residency Programs, Department of Rehabilitation Medicine, University of Miami, Leonard A Miller School of Medicine

Andrew L Sherman, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, Association of Academic Physiatrists

Disclosure: Nothing to disclose.

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Apprehension sign. The knee is placed at 30° flexion, and lateral pressure is applied. Medial instability results in apprehension by the patient.
Anatomic morphology of patellar insertion into the intercondylar notch.
Muscles influencing patellar biomechanics.
The Q angle can be measured while the patient is standing or while the knee is at 20° of flexion (ie, at neutral), with maximum internal or external rotation of the tibia.
Ligament constraints of the patella.
 
 
 
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