Treatment Options for Full Thickness Tear of Lateral Patella Facet

Initial Conservative Management

• The American Academy of Family Physicians recommends beginning with relative rest by reducing activities that involve repetitive loading of the patellofemoral joint, while avoiding complete immobilization to prevent muscular atrophy 1, 2
• Eccentric exercise programs are specifically recommended to reduce symptoms, increase strength, and promote tendon healing in patellar pathology, with moderate evidence supporting their use 1
• NSAIDs should be administered as initial pain management, with moderate evidence supporting their use for rotator cuff and tendon pathology 3
• Paracetamol can be used concurrently with NSAIDs for more effective pain control 3
• Deep transverse friction massage is recommended to reduce pain in patellar tendinopathy 1
• Stretching exercises are widely accepted and thought to be helpful, with tensile loading of damaged tissue stimulating collagen production and guiding normal alignment of newly formed collagen fibers 2

Diagnostic Imaging Considerations

• MRI or ultrasonography should be obtained when diagnosis remains unclear after history and physical examination, or when pain is recalcitrant despite adequate conservative management, with MRI showing moderate sensitivity (78%) and specificity (86%) and ultrasonography being more specific (94%) than sensitive (58%) for patellar tendinopathy 2

Surgical Management

• Failure of conservative treatment after 3-6 months of appropriate therapy is an indication for surgery, according to the American Academy of Family Physicians 1, 2

Common Pitfalls to Avoid

• The American College of Family Physicians advises against overusing corticosteroid injections, limiting them to single injections for short-term relief rather than repeated injections 3
• Complete immobilization should be avoided as it leads to muscular atrophy and deconditioning, according to the American Academy of Family Physicians 2
• Opioids should be reserved strictly for rescue analgesia, rather than being used as first-line treatment, as recommended by the American College of Family Physicians 3
• Rushing to surgery should be avoided, ensuring adequate trial of conservative management for at least 3-6 months before considering surgical intervention, as advised by the American Academy of Family Physicians 1, 2
• Older age is associated with higher failure rates and poorer outcomes, which should influence treatment decisions, according to the American College of Family Physicians 3