Abstract
BackgroundLateral patellar dislocations mainly affect active teenagers and young adults. To help people recover, non-surgical exercise-based treatment is often recommended but the optimal exercise-based treatment is unknown. Currently, treatment outcomes after this injury are variable. Common problems include recurrent dislocation, reduced activity levels, and later surgery. A programme of intense leg resistance exercises, and dynamic exercises related to participants’ activity-related goals, has rationale, but has not been previously reported. In line with the Medical Research Council guidance, this study aimed to assess the acceptability of a novel evidence-based exercise programme for adults after acute lateral patellar dislocation and the feasibility of future research evaluating this treatment.MethodsA single-group prospective study was conducted at the John Radcliffe Hospital, Oxford, UK. Participants were 16 years or older with an acute first-time or recurrent lateral patellar dislocation. Participants received up to six face-to-face, one-to-one, physiotherapy sessions, over a maximum of 3 months, and performed intensive home exercises independently at least three times per week. Strategies to increase exercise adherence were used. Primary objectives were to determine the number of eligible patients, the recruitment rate (proportion of eligible patients that provided written informed consent), participant adherence to scheduled physiotherapy sessions and self-reported adherence to prescribed exercise, and intervention acceptability to participants measured by attrition and a study-specific questionnaire. Data were analysed using descriptive statistics.ResultsFifteen of 22 (68%) patients with a lateral patellar dislocation were eligible. All eligible (100%) were recruited. Two of 15 (13%) participants provided no outcome data, 2/15 (13%) provided partial outcome data, and 11/15 (73%) provided all outcome data. Questionnaire responses demonstrated high intervention acceptability to participants. Participants attended 56/66 (85%) physiotherapy sessions and 10/11 (91%) participants reported they ‘always’ or ‘often’ completed the prescribed exercise. One participant redislocated their patella; another experienced knee pain or swelling lasting more than one week after home exercise on three occasions.ConclusionThe intervention appeared acceptable to adults after acute lateral patellar dislocation, and a future randomised pilot trial is feasible. This future pilot trial should estimate attrition with increased precision over a longer duration and assess participants’ willingness to be randomised to different treatments across multiple centres.Trial registrationClinicalTrials.govNCT03798483, registered on January 10, 2019
Highlights
Patellar dislocations occur when the patella is forced out of the femoral trochlear groove, normally in a lateral direction
The intervention appeared acceptable to adults after acute lateral patellar dislocation, and a future randomised pilot trial is feasible
Reporting adheres to template for intervention description and replication (TIDieR) guidelines [19] and Consolidated Standards of Reporting Trials (CONSORT) extension to randomised pilot and feasibility trial guidelines [20]
Summary
Patellar dislocations occur when the patella is forced out of the femoral trochlear groove, normally in a lateral direction. This is usually a non-contact injury [1] that mainly happens during sport [2]. Current evidence shows approximately two-thirds of patients treated non-surgically will not redislocate their patella at 6 to 9 years after injury and experience fewer complications and similar knee function and activity levels, compared to surgically treated patients [4]. Common problems include reduced activity levels [7, 8], later surgery [4], recurrent dislocation [9], and increased risk of symptomatic patellofemoral osteoarthritis [10]. Common problems include recurrent dislocation, reduced activity levels, and later surgery. In line with the Medical Research Council guidance, this study aimed to assess the acceptability of a novel evidence-based exercise programme for adults after acute lateral patellar dislocation and the feasibility of future research evaluating this treatment
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