Research Article| Volume 50, ISSUE 3, P752-757, March 2019

Early functional rehabilitation after patellar dislocation—What procedures are daily routine in orthopedic surgery?

Published:January 17, 2019DOI:



      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.

      Materials and methods

      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.


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        • Palmu S.
        • Kallio P.E.
        • Donell S.T.
        • Helenius I.
        • Nietosvaara Y.
        Acute patellar dislocation in children and adolescents: a randomized clinical trial.
        J Bone Joint Surg Am. 2008; 90: 463-470
        • Burks R.T.
        • Desio S.M.
        • Bachus K.N.
        • Tyson L.
        • Springer K.
        Biomechanical evaluation of lateral patellar dislocations.
        Am J Knee Surg. 1998; 11: 24-31
        • Choueau J.
        Surgical reconstruction of the medial patellofemoral ligament.
        Orthop Traumatol Surg Res. 2016; 102: 189-194
        • Balcarek P.
        • Jung K.
        • Ammon J.
        • Walde T.A.
        • Frosch S.
        • Schuttrumpf J.P.
        • et al.
        Anatomy of lateral patellar instability: trochlear dysplasia and tibial tubercle-trochlear groove distance is more pronounced in women who dislocate the patella.
        Am J Sports Med. 2010; 38: 2320-2327
        • Maenpaa H.
        • Huhtala H.
        • Lehto M.U.
        Recurrence after patellar dislocation. Redislocation in 37/75 patients followed for 6-24 years.
        Acta Orthop Scand. 1997; 68: 424-426
        • Smith T.O.
        • Donell S.
        • Song F.
        • Hing C.B.
        Surgical versus non-surgical interventions for treating patellar dislocation.
        Cochrane Database Syst Rev. 2015; 26 (CD008106)
        • Fisher B.
        • Nyland J.
        • Brand E.
        • Curtin B.
        Medial patellofemoral ligament reconstruction for recurrent patellar dislocation: a systematic review including rehabilitation and return-to-sports efficacy.
        Arthroscopy. 2010; 26: 1384-1394
        • Fithian D.C.
        • Paxton E.W.
        • Stone M.L.
        • Silva P.
        • Davis D.K.
        • Elias D.A.
        • et al.
        Epidemiology and natural history of acute patellar dislocation.
        Am J Sports Med. 2004; 32: 1114-1121
        • Asaeda M.
        • Deie M.
        • Fujita N.
        • Shimada N.
        • Orita N.
        • Iwaki D.
        • et al.
        Knee biomechanics during walking in recurrent lateral patellar dislocation are normalized by 1 year after medial patellofemoral ligament reconstruction.
        Knee Surg Sports Traumatol Arthrosc. 2016; 24: 3254-3261
        • Hewett T.E.
        • Myer G.D.
        The mechanistic connection between the trunk, hip, knee, and anterior cruciate ligament injury.
        Exerc Sport Sci Rev. 2011; 39: 161-166
        • Felus J.
        • Kowalczyk B.M.
        Age-related differences in medial patellofemoral ligament injury patterns in traumatic patellar dislocation: case series of 50 surgically treated children and adolescents.
        Am J Sports Med. 2012; 40: 2357-2364
        • Buckens C.F.
        • Saris D.B.
        Reconstruction of the medial patellofemoral ligament for treatment of patellofemoral instability: a systematic review.
        Am J Sports Med. 2010; 38: 181-188
        • Sherry Marc
        Rehabilitation guidelines for medial patellofemoral ligament repair and reconstruction.
        UW Health Sports Medicine Center, 2011
        • Sanchis-Alfonso V.
        Guidelines for medial patellofemoral ligament reconstruction in chronic lateral patellar instability.
        J Am Acad Orthop Surg. 2014; 22: 175-182
        • McGee T.G.
        • Cosgarea A.J.
        • McLaughlin K.
        • Tanaka M.
        • Johnson K.
        Rehabilitation After Medial Patellofemoral Ligament Reconstruction.
        Sports Med Arthrosc. 2017; 25: 105-113
        • Manske R.C.
        • Prohaska D.
        Rehabilitation following medial patellofemoral ligament reconstruction for patellar instability.
        Int J Sports Phys Ther. 2017; 12: 494-511
        • Frankewycz B.
        • Krutsch W.
        • Weber J.
        • Ernstberger A.
        • Nerlich M.
        • Pfeifer C.G.
        Rehabilitation of Achilles tendon ruptures: is early functional rehabilitation daily routine?.
        Arch Orthop Trauma Surg. 2017; 137: 333-340
        • Jagodzinski M.
        • Niemeyer P.
        • Zeichen J.
        • Balcarek P.
        Leitlinienkommission der Deutschen Gesellschaft für Unfallchirurgie e.V. (Hrsg.).
        S1-Leitlinie, Patellaluxation2014 (012/024)
        • Wang S.N.
        • Qin C.H.
        • Jiang N.
        • Wang B.W.
        • Wang L.
        • Yu B.
        Is surgical treatment better than conservative treatment for primary patellar dislocations? A meta-analysis of randomized controlled trials.
        Arch Orthop Trauma Surg. 2016; 136: 371-379
        • Saccomanno M.F.
        • Sircana G.
        • Fodale M.
        • Donati F.
        • Milano G.
        Surgical versus conservative treatment of primary patellar dislocation. A systematic review and meta-analysis.
        Int Orthop. 2016; 40: 2277-2287
        • Arendt E.A.
        • Fithian D.C.
        • Cohen E.
        Current concepts of lateral patella dislocation.
        Clin Sports Med. 2002; 21: 499-519
        • Zaman S.
        • White A.
        • Shi W.J.
        • Freedman K.B.
        • Dodson C.C.
        Return-to-play guidelines after medial patellofemoral ligament surgery for recurrent patellar instability: a systematic review.
        Am J Sports Med. 2017; 1363546517713663
        • Sillanpää P.J.
        • Peltola E.
        • Mattila V.M.
        • Kiuru M.
        • Visuri T.
        • Pihlajamäki H.
        Femoral avulsion of the medial patellofemoral ligament after primary traumatic patellar dislocation predicts subsequent instability in men: a mean 7-year nonoperative follow-up study.
        Am J Sports Med. 2009; 37: 1513-1521
        • Sillanpää P.J.
        • Mäenpää H.M.
        • Mattila V.M.
        • Visuri T.
        • Pihlajamäki H.
        Arthroscopic surgery for primary traumatic patellar dislocation: a prospective, nonrandomized study comparing patients treated with and without acute arthroscopic stabilization with a median 7-year follow-up.
        Am J Sports Med. 2008; 36: 2301-2309
        • Duthon V.B.
        Acute traumatic patellar dislocation.
        Orthop Traumatol Surg Res. 2015; 101: 59-67
        • Frosch S.
        • Balcarek P.
        • Walde T.A.
        • Schüttrumpf J.P.
        • Wachowski M.M.
        • Ferleman K.G.
        • et al.
        Die Therapie der Patellaluxation: eine systematische Literaturanalyse.
        Zeitschrift für Orthopädie und Unfallchirurgie. 2011; 149: 630-645
        • Stefancin J.J.
        • Parker R.D.
        First-time traumatic patellar dislocation: a systematic review.
        Clin Orthop Relat Res. 2007; 455: 93-101
        • Hinton R.Y.
        • Sharma K.M.
        Acute and recurrent patellar instability in the young athlete.
        Orthop Clin North Am. 2003; 34: 385-396
        • Kita K.
        • Tanaka Y.
        • Toritsuka Y.
        • Amano H.
        • Uchida R.
        • Takao R.
        • et al.
        Factors affecting the outcomes of double-bundle medial patellofemoral ligament reconstruction for recurrent patellar dislocations evaluated by multivariate analysis.
        Am J Sports Med. 2015; 43: 2988-2996
        • Ménétrey J.
        • Putman S.
        • Gard S.
        Return to sport after patellar dislocation or following surgery for patellofemoral instability.
        Knee Surg Sports Traumatol Arthrosc. 2014; 22: 2320-2326
        • Petri M.
        • Liodakis E.
        • Hofmeister M.
        • Despang F.J.
        • Maier M.
        • Balcarek P.
        • et al.
        Operative vs conservative treatment of traumatic patellar dislocation: results of a prospective randomized controlled clinical trial.
        Arch Orthop Trauma Surg. 2013; 133: 209-213