Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany.
Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany.
Injury. 2019 Mar;50(3):752-757. doi: 10.1016/j.injury.2018.10.020. Epub 2019 Jan 17.
Patellar dislocation and rupture of the medial patellofemoral ligament (MPFL) are frequently seen in daily orthopedic practice. Besides initial non-surgical treatment, surgery and subsequent rehabilitation are crucial for restoring stability in the femoropatellar joint. This study investigated current rehabilitation strategies after patellar dislocation because knowledge on this topic has been severely limited so far.
The current rehabilitation protocols of 42 orthopedic and trauma surgical institutions were analyzed regarding their recommendations on weight bearing, range of motion (ROM), and use of movement devices and orthosis. All protocols for conservative treatment and postoperative rehabilitation after MPFL reconstruction were compared. Descriptive and statistical analyses were carried out when appropriate.
The different rehabilitation strategies for conservative and surgical treatment after patellar dislocation showed a tendency towards earlier functional rehabilitation after surgical MPFL reconstruction than after conservative treatment. Both surgical and conservative treatment involved initial restrictions in weight bearing, ROM, and use of movement devices and orthosis at the beginning of rehabilitation. The rehab protocols showed a significant earlier full weight bearing after surgical MPFL reconstruction (p > 0.001). Due to the presence of other parameters for early functional treatment, the absence of an indication for using orthosis (surgical: 44%, conservative: 33%; p = 0.515) or start of unlimited ROM of the knee (surgical: 4.9 weeks, conservative: 5.7 weeks; p = 0.076) showed by trend an earlier functional strategy after MPFL reconstruction than after conservative therapy.
Both conservative and surgical treatment after patellar dislocation showed restrictions in the early phase of the rehabilitation. Earlier functional therapy was more common after MPFL reconstruction than after conservative treatment. Further clinical and biomechanical studies on rehabilitation strategies after patellar dislocation are needed to improve patient care und individualized therapy.
髌脱位和内侧髌股韧带（MPFL）撕裂在日常骨科实践中较为常见。除了初始的非手术治疗外，手术和随后的康复对于恢复髌股关节的稳定性至关重要。本研究调查了髌脱位后的当前康复策略，因为迄今为止，人们对这一主题的了解非常有限。
分析了 42 家骨科和创伤外科机构的当前康复方案，评估了它们对负重、关节活动度（ROM）以及运动器械和矫形器使用的建议。比较了所有保守治疗和 MPFL 重建术后康复的方案。在适当的情况下进行了描述性和统计分析。
髌脱位后保守和手术治疗的不同康复策略显示，手术 MPFL 重建后功能康复较早，而非保守治疗。两种治疗方法在康复的早期都限制了负重、ROM、运动器械和矫形器的使用。康复方案显示，手术 MPFL 重建后可以更早地完全负重（p>0.001）。由于早期功能治疗的其他参数的存在，手术治疗中使用矫形器的指征缺失（44%）或膝关节不受限的 ROM 开始时间（手术：4.9 周，保守：5.7 周；p=0.076）显示出比保守治疗更早的功能策略。
髌脱位后的保守和手术治疗都在康复的早期阶段存在限制。MPFL 重建后功能康复更早，而非保守治疗。需要进一步的临床和生物力学研究来改善髌脱位后的康复策略，以提高患者的护理和个体化治疗。
