Batheja Aashish, Robles Rafael, Mack Jonathan, Smith Mathew S, Goodloe J Brett
Department of Physical Therapy and Orthopedic Surgery, VCU Health, Richmond, Virginia, USA.
Video J Sports Med. 2025 Apr 3;5(2):26350254241299459. doi: 10.1177/26350254241299459. eCollection 2025 Mar-Apr.
Patellar instability, the subluxation or dislocation of the patella within the patellofemoral joint, is common in adolescents and can significantly affect their function. This study evaluates conservative management for first-time patellar instability events, discussing rehabilitation strategies and criteria for return to activity/sport.
Conservative management is typically indicated for patients experiencing a first-time patellar dislocation, particularly when there are no osteochondral injuries or significant anatomic abnormalities.
Physical therapy management begins with an initial evaluation assessing swelling, core and lower extremity strength, range of motion (ROM), and special tests. This management is divided into 3 phases: acute, intermediate, and late. In the acute phase (0-4 weeks), cryotherapy and compression manage effusion, while early ROM exercises prevent stiffness. The intermediate phase (4-6 weeks) focuses on strengthening dynamic knee stabilizers and incorporating progressive open- and closed-chain exercises. The late phase (6-8 weeks) aims to restore full strength and prepare the patient for return to activity through sports-specific drills and higher-intensity exercises.
Conservative management for first-time patellar dislocations shows promising outcomes. Early active ROM and strength training are associated with improved knee function, increased ROM, and higher patient satisfaction. Interventions such as patellar taping and nonrigid bracing provide immediate stability and relief, promoting muscle preservation and improved ROM at subsequent follow-ups. Systematic reviews indicate no significant difference in redislocation rates between partial and full weightbearing protocols, supporting the recommendation to avoid immobilization. Key International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) guidelines emphasize complete healing, neuromuscular training, core strength, and psychological readiness for a safe return to sport. Functional assessments like the Y-balance and triple-hop tests help evaluate limb symmetry and functional readiness before resuming activities.
DISCUSSION/CONCLUSION: Conservative management is a suitable plan for most first-time patellar dislocations. While there is no single best rehabilitation plan, important principles for management include early ROM and strengthening exercises to promote knee function. Patient evaluation and criteria can help establish a safe timeline for returning to sport, ensuring optimal recovery, and minimizing recurrence risk.
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
髌骨不稳定，即髌骨在髌股关节内半脱位或脱位，在青少年中很常见，会显著影响其功能。本研究评估首次髌骨不稳定事件的保守治疗方法，讨论康复策略以及恢复活动/运动的标准。
保守治疗通常适用于首次发生髌骨脱位的患者，尤其是在没有骨软骨损伤或明显解剖异常的情况下。
物理治疗管理始于初始评估，评估肿胀情况、核心及下肢力量、活动范围（ROM）和特殊检查。这种治疗分为三个阶段：急性期、中期和后期。在急性期（0 - 4周），冷冻疗法和加压处理可控制积液，同时早期的ROM练习可预防僵硬。中期（4 - 6周）着重加强动态膝关节稳定器，并纳入渐进性开链和闭链练习。后期（6 - 8周）旨在恢复全部力量，并通过特定运动训练和高强度练习让患者为恢复活动做好准备。
首次髌骨脱位的保守治疗显示出良好的效果。早期主动ROM和力量训练与改善膝关节功能、增加ROM以及更高的患者满意度相关。诸如髌骨贴扎和非刚性支具等干预措施可提供即时稳定性并缓解症状，在后续随访中促进肌肉保护并改善ROM。系统评价表明，部分负重和完全负重方案之间的再脱位率无显著差异，支持避免固定的建议。国际关节镜、膝关节手术和骨科运动医学学会（ISAKOS）的关键指南强调完全愈合、神经肌肉训练、核心力量以及安全恢复运动所需的心理准备。诸如Y平衡和三级跳测试等功能评估有助于在恢复活动前评估肢体对称性和功能准备情况。
讨论/结论：保守治疗是大多数首次髌骨脱位的合适方案。虽然没有单一的最佳康复计划，但治疗的重要原则包括早期ROM和强化练习以促进膝关节功能。患者评估和标准有助于确定恢复运动的安全时间表，确保最佳恢复，并将复发风险降至最低。
作者证明已获得本出版物中出现的任何患者的同意。如果个体可能被识别，作者已随本提交材料附上患者的豁免声明或其他书面批准形式以供发表。
