Non-Operative — Patellar Dislocation (Non-Operative)

Orthopedic & Sports Medicine Specialists (OSMS)

Weight-Bearing

Brace in full extension at all times, WBAT in brace wks 0-2; brace D/C and advance to patellar stabilization brace ~wks 5-6 if quad control adequate and swelling appropriate

Key Restrictions

ROM goal 0-115 deg by wk 6, 0-120 deg by wk 6-7, full ROM by wk 10; return-to-sport/brace D/C criteria by wk 11-12: full active ROM, quad and hip ER strength >90% contralateral, satisfactory clinical exam, functional hop test >90% contralateral, running program completed

Timeline & Phases

Wks 0-2: brace in full extension at all times, WBAT in brace; wks 2-6: supervised PT 3x/week, gentle patellar mobilization, emphasis on full passive extension, AAROM 4-5x daily (no ROM limit, goal 0-115 deg), flexion exercises PROM/AAROM/AROM with brace off, stationary bike for ROM (short crank/high seat, no resistance), hamstring/calf stretching, mini-squats (0-45 deg) and heel raises, hip strengthening (especially ER), isotonic leg press (0-60 deg), D/C brace to patellar stabilization brace ~wk 5-6 if quad control/swelling adequate, progressive SLR program with weights if no extensor lag, theraband standing TKE, bilateral-stance proprioceptive training, hamstring PREs, double leg balance on tilt boards, 4in step-ups, seated leg extension (0-90 deg) against gravity no weight; wk 6: continue all exercises, ROM stretching with overpressure into extension, initiate retro treadmill 3% incline, regular stationary bike if flexion >115 deg, wall/ball squats, 6in front step-ups, 4in step-downs, SLRs all planes with weight (goal ROM 0-120); wk 7: self ROM 4-5x/day, 8in step-ups, 4in step-downs, single leg proprioceptive training, lateral step-out with theraband, retro treadmill progressive inclines, sportcord (bungee) walking, increase bike resistance; wk 8: Stairmaster, brisk walking, progress balance/board throws, 6in step-downs; wk 9: outdoor/level-surface bike only, start slide board, plyometric leg press, 8in step-downs; wk 10: normal ROM expected (equal to opposite knee), begin resistance for open chain knee extension, jump-downs (double stance landing), progress to running/light sport-specific drills if quad strength >=75% contralateral, AROM 0-125 deg, hop test >70% contralateral, swelling <1cm at joint line, no pain, good jump-down control; wks 11-12: if full ROM, quad strength >=80% contralateral, hop test >=85% contralateral, satisfactory exam — progress to home program for running, backward jogging, figure-8s, zigzags, lateral shuffles, hops/jumps/cuts/sport-specific drills, wean from supervised therapy; return-to-sport/brace D/C criteria: full active ROM, quad and hip ER strength >90% contralateral, satisfactory clinical exam, hop test >90% contralateral, running program completed

Notes

OSMS Rehabilitation Guidelines; non-operative patellofemoral rehabilitation outline — not all exercises need be performed for every patient; emphasizes weekly progress and three-way communication between patient, therapist, and physician