The guidelines established by the New York State Workers Compensation Board aim to provide assistance to physicians, podiatrists, and healthcare professionals in determining the suitable treatment for Patellar Subluxation.

Healthcare professionals specializing in Patellar Subluxation disorders can rely on the Workers Compensation Board’s guidelines to make well-informed decisions regarding the optimal level of care for their patients.

It is essential to highlight that these guidelines are not intended to replace clinical judgment or professional expertise. The decision regarding care should ultimately be a collaborative effort involving the patient and their healthcare provider.

 

Patellar Subluxation

Description / Definition

An incomplete subluxation or dislocation of the patella. Recurrent episodes can lead to subluxation syndrome that can cause frank dislocation of the patella.

 

Mechanism of Injury

Primarily associated with contusion, lateral force direct contact. Secondary causes associated with shearing forces on the patella.

 

Specific Physical Findings

Patient may report buckling sensation. Findings on physical exam may include retinacular weakness, swelling, effusion, marked pain with patellofemoral tracking/compression and glides. In addition, other findings include atrophy of muscles, positive patellar apprehension test, patella alta.

 

Diagnostic Testing Procedures

Radiographs
Recommended – in select patients as clinically indicated and may include Merchant views, Q-angle versus congruents.

 

Non-Operative Treatment

Rest/restricted activity, off-loading with crutches or cane, NSAIDs, APAP that may be followed by active and/or passive therapy, bracing, therapeutic injection.
Recommended – in select patients as clinically indicated.

 

Operative Treatment

Open reduction internal fixation with fracture.
Recommended – in select patients as clinically indicated.
Indications: Fracture, recurrent subluxation or recurrent effusion, or symptoms not responsive to conservative therapy.
Note: Following a patellar dislocation, surgical consultation no sooner than two to three months of conservative therapy. Retinacular release, quadriceps reefing, and patellar tendon transfer should only be considered after a minimum of four to five months of conservative therapy.

 

Post-Operative Therapy

Therapy, bracing.
Recommended – in select patients as clinically indicated.