Rehabilitation and Return to Sport After Medial Patellofemoral Complex Reconstruction

Abstract

The medial patellofemoral complex (MPFC) consists of the medial patellofemoral ligament and medial quadriceps tendon femoral ligament, which play a critical role stabilizing the patella against lateral translation. After a patellar dislocation, athletes with recurrent dislocations have functional limitations that may limit their return to their prior level of competition, requiring surgical reconstruction. Although ample literature exists delineating return-to-play (RTP) considerations after anterior cruciate ligament reconstruction, there is a paucity of evidence specific to MPFC reconstruction. Athletes aiming to return to sport after MPFC reconstruction require the same methodical treatment approach to ensure safe RTP. A criterion-based periodical assessment of progress that measures range of motion, strength, neuromuscular control, balance, agility, and power are pivotal components of rehabilitating this population. A combination of objective and subjective criteria should be assessed when determining an individual’s readiness for sports-specific activities. A battery of functional tests, including quadriceps strength testing, single-limb hop testing, lateral step-down test, the lateral leap and catch test, the Y-balance test, and the depth jump should be considered when evaluating the athlete for readiness for sport, incorporating specific understanding of the biomechanics of the patellofemoral joint. We discuss the considerations for return-to-sport rehabilitation and testing after MPFC reconstruction, to provide clinicians working with an athletic population a framework to adequately prepare their athletes for safe return to sport.

Rehabilitation after surgery for patellar instability

“…The primary aim of treatment, for both surgery and rehabilitation, is to restore patellar stability, enable normal everyday function and allow participation at the individual patient's desired level of activity [ 3 , 10 , 33 , 62 ]. Given that the disorder predominantly affects adolescents and young adults, many seek to return to—or even excel in—previous activities after surgery.…”

“…Given that the disorder predominantly affects adolescents and young adults, many seek to return to—or even excel in—previous activities after surgery. Hence, comprehensive rehabilitation, including regular functional testing is important to facilitate patients in achieving their goals [ 5 , 33 , 44 ]. The knowledge base on functional assessment and rehabilitation before and after surgery is, however, sparse [ 13 , 30 , 33 ].…”

“…Hence, comprehensive rehabilitation, including regular functional testing is important to facilitate patients in achieving their goals [ 5 , 33 , 44 ]. The knowledge base on functional assessment and rehabilitation before and after surgery is, however, sparse [ 13 , 30 , 33 ]. In light of the current knowledge of the biomechanics of the patellofemoral joint, and our experience with surgical techniques, we discuss pre‐ and postoperative rehabilitation including the role of functional assessment in patients with PI.…”

“…To deliver relevant and targeted rehabilitation, clinicians need a comprehensive understanding of the anatomy and biomechanics of the lower extremities and extensive expertise in the musculoskeletal field [ 5 , 33 ]. It has been suggested that impaired core muscle function, weak gluteal muscles and reduced balance prior to surgery might lead to prolonged rehabilitation [ 3 ].…”

Comparison of patellar anchor fixation graft and graft through patellar tunnel reconstruction of medial patellofemoral ligament in the treatment of recurrent patellar dislocation: A protocol for a meta-analysis of comparative studies

“…[1] Prevalent in obese adolescent females, this population frequently includes congenital pathological changes such as high patella, increased anterior femoral inclination, and femoral talus dysplasia. [2–5] Epidemiological surveys have found that the incidence of patellar dislocation can be as high as 43/100,000 and is mostly associated with young women. [6,7] The clinical symptoms are mainly pain (aggravated by going up and down stairs, squatting), instability (weakness, limpness), knee strangulation, recurrent swelling and movement disorders (afraid to run and jump or easily fall down).…”