Return to Play Considerations After Patellar Instability

Lampros, Rachel E.; Tanaka, Miho J.

doi:10.1007/s12178-022-09792-1

Cited by 10 publications

(9 citation statements)

References 55 publications

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“…Based on the current literature and present study, athletes can expect good outcomes after MPFL repair or reconstruction, 3,9,26 but there remains a paucity of data regarding the level of RTS and time to RTS. 21 When accounting for demographic, clinic, and imaging factors, MPFL reconstruction and older age at the time of surgery were protective against recurrent dislocations. 18 These findings are corroborated by numerous studies, including a recent meta-analysis by Hurley et al 18 Although this study did not identify additional risk factors, factors predicting MPFL repair and reconstruction failure have been described, including a Caton-Deschamps Index 1.3 and a preoperative positive J-sign for failure of repair, 28 trochlear dysplasia, patella alta, preoperative J-sign, and femoral tunnel malposition for failure of reconstruction.…”

Section: Discussionmentioning

confidence: 97%

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Comparison of Failure Rates at Long-term Follow-up Between MPFL Repair and Reconstruction for Recurrent Lateral Patellar Instability

Kruckeberg,

Wilbur,

Song

et al. 2024

Orthopaedic Journal of Sports Medicine

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Background: The medial patellofemoral ligament (MPFL) is the primary soft tissue restraint to lateral patellar translation and is often disrupted by lateral patellar dislocation. Surgical management for recurrent patellar instability focuses on restoring the MPFL function with repair or reconstruction techniques. Recent studies have favored reconstruction over repair; however, long-term comparative studies are limited. Purpose: To compare long-term clinical outcomes, complications, and recurrence rates of isolated MPFL reconstruction and MPFL repair for recurrent lateral patellar instability. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 55 patients (n = 58 knees) with recurrent lateral patellar instability were treated between 2005 and 2012 with either MPFL repair or MPFL reconstruction. The exclusion criteria were previous or concomitant tibial tubercle osteotomy or trochleoplasty and follow-up of <8 years. Pre- and postoperative descriptive, surgical, imaging, and clinical data were recorded for each patient. Results: MPFL repair was performed on 26 patients (n = 29 knees; 14 women, 15 men), with a mean age of 18.4 years. MPFL reconstruction was performed on 29 patients (n = 29 knees; 18 women, 11 men), with a mean age of 18.2 years. At a mean follow-up of 12 years (range, 8.3-18.9 years), the reconstruction group had a significantly lower rate of recurrent dislocation compared with the repair group (14% vs 41%; P = .019). There were no differences in the number of preoperative dislocations or tibial tubercle–trochlear groove distance. The reconstruction group had significantly more time from initial injury to surgery compared with the repair group (median, 1460 days vs 627 days; P = .007). There were no differences in postoperative Tegner, Lysholm, or Kujala scores at the final follow-up. In addition, no statistically significant differences were detected in return to sport (RTS) rates (repair [81%] vs reconstruction [75%]; P = .610) or reoperation rates for recurrent instability (repair [21%] vs reconstruction [7%]; P = .13). Conclusion: MPFL repair resulted in a nearly 3-fold higher rate of recurrent patellar dislocation (41% vs 14%) at the long-term follow-up compared with MPFL reconstruction. Given this disparate rate, the authors recommend MPFL reconstruction over repair because of the lower failure rate and similar, if not superior, clinical outcomes and RTS.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Comparison of Failure Rates at Long-term Follow-up Between MPFL Repair and Reconstruction for Recurrent Lateral Patellar Instability

Kruckeberg,

Wilbur,

Song

et al. 2024

Orthopaedic Journal of Sports Medicine

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“…Long-term subjective and functional results of conservatively managed patients following patellar dislocation are for the most part satisfactory [ 46 ]. Lampros et al [ 47 ] report that studies with objective measures combined with psychological readiness and a comprehensive understanding of the individual's specific tasks should be considered when assessing the ability to safely and successfully return to sport and, to a lesser extent, to daily life. Therefore, the level of functional demand is discussed to reflect on rehabilitation when working with non-operative and operative management of patellar instability.…”

Section: Discussionmentioning

confidence: 99%

Conservative management following patellar dislocation: a level I systematic review

et al. 2023

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Background Patellar instability is a common and disabling clinical condition. Treatment of acute primary patellar dislocation aims to reduce the risk of recurrence or painful subluxation and improve function. However, the actual clinical efficacy of any management modality following an acute dislocation has never been demonstrated in prospective or retrospective studies, and the optimal way in which the various management modalities should be used is at best unclear. Methods A search was conducted in PubMed, Bireme and Embase databases. Inclusion criteria followed the acronym PICOS, (P) subjects with patellar instability, (I) therapeutic interventions, (C) placebo or control or surgical treatments, (O) rate of dislocations and function, and (S) clinical trials. The Medical Subject Headings (MeSH) terms used were: ((“patellar instability”) OR (“patellar dislocation”)) AND ((physiotherapy) OR (rehabilitation) OR (“conservative treatment”) OR (therapy) OR (therapeutic)). The risk of bias was analysed using the PeDRO scale. Results Seven randomized controlled trials including 282 patients were considered. The quality of studies detailing the results of conservative treatment was higher than that of surgical procedures, but all studies have relatively low methodological quality. Four studies compared physiotherapeutic interventions with surgical procedures, and three studies compared conservative intervention techniques. Conclusion An unstructured lower limb physical therapy programme evidences similar outcomes to specific exercises. Surgical management is associated with a lower rate of re-dislocation; however, whether surgery produces greater functional outcomes than conservative management is still unclear. The use of a knee brace with a limited range of motion, stretching and neuromuscular exercises are the most commonly recommended physiotherapy methodologies.

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“…Readiness for return to normal daily activities can be assessed, for example, with a lateral step‐down test [ 33 ] and 30 s sit‐to‐stand [ 63 ]. Consistent evidence for RTS guidelines in PI patients remains sparse [ 13 , 30 , 32 ]. In our opinion, RTS assessment should comprehensively evaluate all aspects of a patient's knee function—including mental readiness—and comprise both self‐reported and functional measures [ 32 , 43 , 70 ].…”

Section: When Are Patients Ready To Return To Demanding Activities An...mentioning

confidence: 99%

Rehabilitation after surgery for patellar instability

Hysing‐Dahl,

Inderhaug

2024

J. exp. orthop.

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Return to Play Considerations After Patellar Instability

Cited by 10 publications

References 55 publications

Comparison of Failure Rates at Long-term Follow-up Between MPFL Repair and Reconstruction for Recurrent Lateral Patellar Instability

Comparison of Failure Rates at Long-term Follow-up Between MPFL Repair and Reconstruction for Recurrent Lateral Patellar Instability

Conservative management following patellar dislocation: a level I systematic review

Rehabilitation after surgery for patellar instability

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