Diagnosis Explanation:

Patellar subluxation occurs when the kneecap (patella) partially slides out of its normal position but does not fully dislocate. This often happens due to weak thigh muscles, ligament laxity, trauma, or structural misalignment. Symptoms include knee pain, swelling, instability (feeling like the knee may "give out"), popping or clicking sensations, and occasional locking. Recurrent subluxations increase the risk of cartilage damage and full dislocation.

Specific Work Modifications:

• If your job requires standing or walking: Use a patellar-stabilizing brace and take breaks to sit when needed.
• If your job involves lifting: Avoid deep squats, twisting, or sudden side-to-side movements.
• If your job is desk-based: Keep your knee elevated when sitting and perform gentle mobility exercises throughout the day.
• Avoid: Sudden knee twisting, kneeling, deep squats, and prolonged standing without breaks.

Specific Activity Modifications:

• If you play sports: Avoid running, pivoting, and jumping until your knee is stable. Try swimming or cycling instead.
• If you hike: Stick to flat terrain and use trekking poles for additional support.
• If you do weightlifting: Avoid deep squats, lunges, and leg presses. Instead, focus on controlled strength exercises for the hips and quads.
• Avoid: High-impact movements, sudden direction changes, and activities that cause knee instability.

Recommended Supplements:

• Collagen Peptides – 10g daily to strengthen ligaments and cartilage.
• Glucosamine & Chondroitin – 1500mg/1200mg daily for joint health.
• Omega-3 Fatty Acids – 1000mg daily to reduce inflammation.
• Vitamin C – 500mg daily to aid collagen production.
• Calcium & Vitamin D – 1000mg/800 IU daily for bone and joint support.

Recommended Nutrition and Hydration:

• Increase Lean Protein (chicken, fish, eggs, tofu) to support muscle and ligament repair.
• Eat Anti-Inflammatory Foods (berries, leafy greens, turmeric, nuts) to reduce swelling.
• Consume Hydrating Foods (cucumber, watermelon, citrus) to maintain joint lubrication.
• Limit Processed Foods & Sugars to prevent inflammation.
• Hydration: Drink 8-10 cups of water daily to keep joints hydrated.

Home Exercise Prescription (Rehabilitation for Patellar Subluxation)

Early Phase (0-2 Weeks, Reducing Pain & Swelling):

• RICE Protocol – Rest, Ice (15-20 min, 3x/day), Compression (patellar-stabilizing brace), Elevation.
• Quadriceps Sets – Tighten thigh muscles, hold for 5 seconds, repeat 10 reps, 3x/day.
• Heel Slides – Gently slide heel toward buttocks to improve mobility, 10 reps, 2x/day.
• Ankle Pumps – Move ankle up and down to improve circulation, 10 reps, 3x/day.

Strengthening Phase (2-6 Weeks, Restoring Stability & Strength):

• Straight Leg Raises – Keep knee straight, lift leg, hold for 5 seconds, repeat 10 reps, 2x/day.
• Seated Knee Extensions – Slowly extend knee, hold for 5 seconds, repeat 10 reps, 2x/day.
• Glute Bridges – Lie on back, lift hips while keeping knees bent, 10 reps, 2x/day.
• Clamshells (Hip Strengthening) – Lie on side, open and close knees, 10 reps, 2x/day.

Advanced Phase (6+ Weeks, Improving Stability & Return to Activity):

• Mini Squats (No Deep Bending) – Slight knee bends while keeping weight on heels, 10 reps, 2x/day.
• Lateral Band Walks – Step sideways with a resistance band around thighs, 10 steps each way, 2x/day.
• Step-Ups – Step onto a low platform, push through the heel, repeat 10 reps, 2x/day.
• Stationary Cycling – Low resistance for 10-15 minutes/day to improve knee stability.

Helpful Books:

1. The Knee Injury Bible: Everything You Need to Know About Knee Pain, Prevention, and Treatment – Kevin R. Stone, MD.
2. Heal Your Knees: How to Prevent Knee Surgery and What to Do If You Need It – Robert Klapper, MD, and Lynda Huey.

Contact the Key West orthopedic clinic or reach out to Dr. Jason Pirozzolo.