Is an Individually Tailored Programme of Intense Leg Resistance and Dynamic Exercise Acceptable to Adults with an Acute Lateral Patellar Dislocation? A Feasibility Study

Abstract

Background: lateral 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 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.Methods: a 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 maximum three 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.Results: 15/22 (68%) patients with a lateral patellar dislocation were eligible. All eligible (100%) were recruited. 2/15 (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 prescribed exercise. One participant redislocated their patella; another experienced knee pain or swelling lasting more than one week after home exercise on three occasions.Conclusion: the intervention appeared acceptable to adults after acute lateral patellar dislocation and future larger-scale research appears feasible. Future research should estimate feasibility outcomes with increased precision and assess participants’ willingness to be randomised to different treatments across multiple centres.Trial registration: ClinicalTrials.gov NCT03798483, registered January 10, 2019 https://clinicaltrials.gov/ct2/show/NCT03798483?term=INDEX-KD&draw=2&rank=1