Treatment of Recurrent Patellar Subluxation with Self-Reduction

Initial Conservative Management

The American College of Radiology recommends a structured 3-6 month trial of conservative management centered on eccentric strengthening exercises, as this approach successfully resolves symptoms in approximately 80% of patients 1
Eccentric quadriceps exercises should be implemented as the cornerstone of treatment, specifically targeting the vastus medialis obliquus (VMO) to improve patellar tracking and stability 1
Heavy slow resistance training serves as an evidence-based alternative to traditional eccentric protocols 1
Reduce repetitive loading activities that reproduce subluxation episodes, particularly jumping, pivoting, and stair navigation 1
Implement relative rest rather than complete immobilization, as the latter causes muscular atrophy and deconditioning 1
Topical NSAIDs should be used preferentially over oral formulations to eliminate gastrointestinal hemorrhage risk while providing short-term pain relief 1
Cryotherapy through a wet towel for 10-minute periods can be applied for acute pain episodes 1
Deep transverse friction massage to the patellar retinaculum reduces pain and may provide additional benefit 1

The American College of Radiology recommends obtaining knee radiographs as the initial imaging study, including anteroposterior, lateral, and tangential patellar views 2, 3
Look specifically for small osseous fragments along the medial patellar margin suggesting prior dislocation-relocation events 3
MRI without IV contrast should be ordered if radiographs show osseous fragments or clinical concern for recurrent instability persists 3
MRI effectively evaluates medial patellofemoral ligament integrity, medial patellar retinaculum status, cartilage injury extent, and identifies loose bodies 3
CT without IV contrast may be indicated to evaluate patellofemoral anatomy, trochlear morphology, and tibial tubercle-trochlear groove distance in cases of repetitive subluxation 2, 3

Surgery is justified only after 3-6 months of well-managed conservative treatment has failed 1
Open or arthroscopic excision of abnormal tissue with longitudinal tenotomies to release scarring and fibrosis can be performed 1

Never inject corticosteroids directly into patellar supporting structures, as this inhibits healing, reduces tensile strength, and predisposes to spontaneous rupture 1
Do not proceed to surgery without documenting an adequate 3-6 month trial of properly executed conservative treatment 1
Avoid multiple corticosteroid injections as they weaken structural integrity despite providing short-term symptom relief 1
If multiple tendons are symptomatic simultaneously, evaluate for underlying rheumatic disease 1
Do not recommend complete immobilization, as this worsens outcomes through deconditioning 1

Approximately 80% of patients recover completely within 3-6 months with appropriate conservative treatment 1