Treatment for Lateral Patellar Subluxation

First-Line Conservative Management

Patellofemoral braces are designed to resist lateral displacement of the patella, maintain patellar alignment, and decrease knee pain 1
Most patients report significant subjective improvements in pain and disability with brace wear 1, 2
Braces work by improving patellar tracking through a medially directed force 2
For most patients, an off-the-shelf brace can be successfully fitted without customization 2
More active individuals may benefit from a patellofemoral brace with a lateral hinge and adjustable patellar buttress 2
Progressive quadriceps strengthening is effective and should be included in the treatment regimen, as recommended by the American Academy of Orthopaedic Surgeons 3

Patellar taping is recommended for short-term relief of pain and improvement in function (Grade B recommendation) 3, 4
Medial taping has shown statistically significant and possibly clinically important effects on pain reduction immediately and within days of application 3
Shoe orthoses should be considered in addition to a brace for patients with recalcitrant patellofemoral pain syndrome, according to the American Family Physician 2
Prefabricated foot orthoses may benefit patients who respond favorably to treatment direction tests 4

Lateral heel wedges should not be prescribed as there is limited evidence for their effectiveness and they may worsen symptoms, as stated by the American Academy of Orthopaedic Surgeons 3
Avoid activities that increase patellofemoral joint loading during the acute phase 4

Radiographs are usually satisfactory for assessment of patellar complications, according to the American College of Radiology 5, 6
Axial radiographs demonstrate the degree of patellar tilt or subluxation 6
Weight-bearing axial radiographs are recommended to better assess patellofemoral kinematics 6

Initial focus should be on pain reduction and improving patellar tracking through bracing and taping 2, 4
Patients should be informed that recovery may take several months, as recommended by the American Academy of Orthopaedic Surgeons and other guideline societies 4

Periodically inspect brace for migration, strap loosening, or material fatigue, as advised by the American Family Physician 2
Patients should be informed that recovery may take several months 4