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The Chronister Protocol: Early Experience With Immediate Immobilization in Flexion and Rapid Return to Play After Acute Lateral Patellar Dislocation

Raymond Chronister, LCDR George C. Balazs, CPT Adam Pickett, CDR John-Paul H. Rue, and CAPT David J. Keblish


Acute lateral patellar dislocation is a common injury sustained by athletes, and often requires several months to recover and return to play.


To describe a novel protocol for the treatment of acute lateral patellar dislocation that returns patients to play far sooner than traditional treatment protocols.


Case series and review of the literature.


Division I NCAA institution.


Two collegiate athletes who sustained first-time acute lateral patellar dislocations.


Traditional standard of care for acute lateral patellar dislocation after reduction involves 1–7 weeks of immobilization in full extension. Knee stiffness commonly results from this method, and return to full activity typically takes 2–4 months. We used a protocol involving immobilization in maximal flexion for 24 hr, with early aggressive range of motion and quadriceps strengthening in the first week after injury.

Main Outcome Measures:

Time to return to play.


Immediate on-site reduction of the patella followed by 24 hr of immobilization in maximal knee flexion was performed. Following an accelerated rehabilitation regimen, patients were able to return to sport an average of 3 days postinjury. Neither patient has experienced a recurrent dislocation.


Our protocol is based on anatomic studies demonstrating reduced tension on the medial patellofemoral ligament, reduced hemarthrosis, and reduced soft tissue swelling in maximal knee flexion. This method apparently bypasses the knee stiffness and deconditioning commonly seen with traditional nonoperative regimens, allowing return to sport weeks or months sooner.

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Nonoperative Treatment of a Patient With Shoulder Pain and a History of Sternoclavicular Fracture-Dislocation

Federico Jose Villalba and Melina Soledad Martínez

third most common musculoskeletal condition presenting to primary care physicians, physiotherapists, and athletic trainers worldwide. 1 For all injuries of the shoulder girdle, the global incidence of sternoclavicular (SC) injuries are less than 1%, and only 6% of those are fracture-dislocations 2 (i.e., dislocations

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Operative Versus Nonoperative Treatment After Acute Patellar Dislocation: Which Is More Effective at Reducing Recurrence in Adolescents?

Julie A. Fuller, Heidi L. Hammil, Kelly J. Pronschinske, and Chris J. Durall

Clinical Scenario Acute patellar dislocation most commonly affects young, active individuals. 1 Regardless of treatment, patellar dislocation may lead to patellofemoral instability. Two common approaches for treating acute patellar dislocation are surgical stabilization and nonoperative treatment

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The Anatomy of the Sports Scandal: An Outline for a Theoretical Contextualization

Rasmus K. Storm and Ulrik Wagner

Sports scandals are often discussed in the media and research literature without any deeper reflection on their specificities or development. As the economic and political significance of sport seem to grow in correlation with the development of globalization and new social media, the call for a sociological understanding of the downsides of sport becomes imperative. By deploying a communication-theory framework supplemented with insights from discourse theory, this article aims to develop a theoretical model of the sports scandal. It presents a 5-step model encompassing initial steps of transgression, followed by a publicly observed dislocation destabilizing the social order, which subsequently results in moral communication, environmental pressure for appropriate action, and, finally, an institutional solution.

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A Rare injury in Collegiate Athletics—The Lisfranc Fracture-Dislocation

Keith M. Gorse, Graham Johnstone, and Jennifer Cruse

A rare injury in collegiate athletics is the Lisfranc fracture-dislocation of the foot. This case study will give team physicians and athletic trainers an idea of what to look for in this type of injury. It will be shown how an 18-year-old college football player received the injury, how it was evaluated by the sports medicine staff, and how it was surgically treated by the team physician. Finally, the athlete's rehabilitation will be summarized and the time frame during which full activities were started again will be outlined. This case study will give sports medicine specialists a better understanding of the Lisfranc topic and how to deal with it.

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The Relationship Between Fear Avoidance Beliefs, Muscle Strength, and Short-Term Disability After Surgical Repair of Shoulder Instability

Uri Gottlieb and Shmuel Springer

Anterior shoulder instability (SI), which often develops following primary shoulder dislocation, is a common cause for reduced performance that impairs quality of life of young, active individuals. 1 Incidence rate of shoulder dislocation have been reported to be as high as 2.8% in a 9-month

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Functional Neuromuscular Rehabilitation of Posterior Shoulder Dislocation in a High School Baseball Player

David Logerstedt

Posterior glenohumeral dislocations are rare, comprising only 4 percent of all shoulder dislocations. While early and accurate diagnosis of a posterior dislocation increases the likelihood of success with non-operative management, traditional rehabilitation may not adequately address the sensorimotor deficits that are evident following dislocation. Restoration of the sensorimotor system is critical to successfully return a throwing athlete safely to sports. The use of functional neuromuscular rehabilitation (FNR) attempts to address deficits in the compromised sensorimotor system. With a good understanding of the specific demands placed on the overhead athlete’s shoulder, knowledge of glenohumeral and scapulothoracic joints’ biome-chanics, respect for the athlete’s level of symptoms and pain, adherence to soft tissue healing, and application of a rehabilitation program that incorporates FNR, an athlete can successfully return to a high level of competition following an acute posterior glenohumeral dislocation.

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Rehabilitation Following a Traumatic Dislocation of the Talus: A Case Study

Kelly Copperthite Ranalli

Total talar dislocations without associated fractures are extremely rare traumatic events that are described sparingly in research and are currently without a standardized treatment protocol. This report highlights rehabilitation for this injury following a fall from a great height with eventual return to prior level of function and with minimal complications.

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Fracture Dislocation of the Ankle in a High School Football Player: A Case Study

Michael J. Carroll

Dislocation with an associated fracture of the ankle is a rare injury. A medial dislocation of the subtalar joint is uncommon, because the normal direction of the subtalar dislocation is lateral. This paper discusses a fracture medial dislocation of the ankle in a high school football player. Initial treatment of the injury included on-the-field management and referral to a hospital and an orthopedic surgeon. Rehabilitation of this injury was very slow and conservative in the initial stage after surgery. This included range of motion exercises for the ankle, full leg conditioning, and ice. After the fracture site was found stable the injury was treated much the same as a Grade II ankle sprain. The goal of rehabilitation was to return the range of motion, strength, and girth measurements of the affected side to those of the contralateral side as quickly as possible, so the athlete could resume athletics. When the affected side met these criteria, there was little to no pain with activity, and the orthopedic physician granted clearance, the athlete was allowed to return to competition.

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Uncomplicated Elbow Dislocation Rehabilitation

Tim L. Uhl