chapter 8: Patellar Tilt‑Compression and the Excessive Lateral Pressure Syndrome (ELPS)

Treatment of Patients with Tilt‑Compression (Nonoperative)

Nonoperative treatment of patients with patellar tilt should focus on mobilization of tight quadriceps and lateral retinaculum, medial quadriceps strengthening, gait and foot pronation correction, hamstring stretching, bracing or taping, and anti‑inflammatory treatment of any intra‑articular synovitis secondary to articular breakdown. It is particularly important in these patients to recognize that there is likely to be focal lateral facet overload, so isokinetic strengthening or resistance weight training through a range of motion should be avoided. Instead, the rehabilitation program should incorporate selective medial quadriceps strengthening and taping, as discussed in Chapter 12.

Once chronic tilt has progressed to medial and lateral facet arthrosis, nonoperative treatment may be less successful, but still worth pursuing. Lateral facet collapse will not resolve with nonoperative rehabilitation, but retinacular strain may respond to stretching. Synovitis should improve with anti‑inflammatory medication. Correction of pronation may alter articular load distribution slightly. Hvid et al (21) noted that the stage of chondromalacia did not affect the outcome of nonoperative rehabilitation at an average of 5.7 years from onset.

In short, nonoperative treatment of patients with tilt‑compression syndrome should be designed for each specific patient, focusing on each component of the disorder and avoiding any treatment that might aggravate the problem.





Inside Chapter 8: