Background: First-time patellar dislocation (FTPD) is a disabling
musculoskeletal disorder. Whilst physiotherapy is considered the
cornerstone treatment in FTPD, its evidence-base is limited. Three studies
were undertaken to develop knowledge on this area.
Study 1: All 306 National Health Service acute hospitals with an accident
and emergency and/or an orthopaedic department were sent a fourteen-item
questionnaire pertaining to the management of FTPD. Physiotherapists
reported they most commonly assessed this population for reduced
quadriceps or vastus medialis oblique (VMO) capacity, patellar maltracking
and excessive patellar glide. Reassurance, proprioceptive, knee
mobility, quadriceps and VMO-specific exercises were the most commonly
cited treatments.
Study 2: Ninety people who had experienced recurrent patellar instability
completed a questionnaire which assessed the frequency with which they
perceived patellar instability during various activities. Sporting and multidirectional
activities were frequently associated with patellar instability.
Females and those without a family history of patellar instability reported
more frequent patellar instability symptoms compared to males, or those
with a family history of this disorder. The results were used to construct the
Norwich Patellar Instability Score.
Study 3: A pragmatic multi-centre randomised controlled trial was
conducted to compare the prescription of a general quadriceps exercise and
rehabilitation programme (n=15) to a VMO-specific exercise and
rehabilitation regime (n=12). Whilst Lysholm Knee Score was statistically
different between the groups (p=0.02) this was not clinically significant.
The general quadriceps exercise group reported a statistically significantly
greater Tegner Level of Activity Score at six weeks (p=0.03) but not at six
months (p=0.42). There was no significant difference between the groups
for isometric knee extension, Short Form-12 or recurrent patellar dislocation
at either follow-up (p>0.05).
Conclusions: The studies undertaken have significantly developed the
evidence-base in this field. Further investigations are recommended to
further inform the clinical decision-making of physiotherapists who manage
people following FTPD
