Return to Play after Patellar Stabilization
- 126 Downloads
Purpose of Review
The purpose of this review is to evaluate the existing literature regarding return to play (RTP) and return to prior performance (RPP) following patellar stabilization surgery. It will also discuss suggested guidelines regarding RTP, and finally, to encourage future patellofemoral instability research to report and publish results of RTP rates using standardized RTP guidelines.
There is a lack of validation and universal adoption of standardized RTP guidelines. This has led to a dearth of high-quality studies on RTP and RPP after patellar stabilization. The best available studies to date would suggest high RTP rates (84%–100%), average RPP rates (33%–77%), and a highly variable timeframe for return (3–12 months).
Patellofemoral instability can be a persistent and challenging problem, particularly in the young and active population for which it most often occurs. Much of the previous studies on patellofemoral instability evaluated success and failure as prevention of recurrent dislocation. However, prevention of recurrence alone may not be enough for many patients. The best available data on RTP and RPP following patellofemoral instability is based on lower quality of evidence studies, expert opinion, and published societal guidelines. Future research on this topic should include clinical validation of the International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine (ISAKOS) RTP guidelines and reporting of outcomes based on these guidelines in patellofemoral instability publications.
KeywordsPatella instability Patella stabilization Return to sport Return to prior performance
Compliance with Ethical Standards
Conflict of Interest
Seth L. Sherman grants from Arthrex, Inc., personal fees from Ceterix Orthopaedics, personal fees from CONMED Linvatec, personal fees from Moximed, personal fees from Neotis, personal fees from Regeneration Technologies Inc., personal fees from Vericel, grants from Zimmer, other from ACL Study Group, other from American Journal of Orthopedics, other from American Orthopaedic Society for Sports Medicine, other from Arthroscopy, other from Arthroscopy Association of North America, outside the submitted work. All other authors declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
- 4.• Magnussen RA, Verlage M, Stock E, et al. Primary patellar dislocations without surgical stabilization or recurrence: how well are these patients really doing? Knee Surgery Sport Traumatol Arthrosc. 2017;25(8):2352–6. https://doi.org/10.1007/s00167-015-3716-3. Discusses outcomes of patients without recurrent patellar dislocation. CrossRefGoogle Scholar
- 5.• Atkin DM, Fithian DC, Marangi KS, Stone M Lou, Dobson BE, Mendelsohnʈ C. Characteristics of patients with primary acute lateral patellar dislocation and their recovery within the first 6 months of injury. doi: https://doi.org/10.1177/03635465000280040601. Accessed November 27, 2017. Describes the typical characteristics and early recovery of patients with acute first-time lateral patellar dislocation.
- 6.• Smith TO, Donell S, Song F, Hing CB. Surgical versus non-surgical interventions for treating patellar dislocation. In: Smith TO, editor. Cochrane Database of Systematic Reviews. Chichester: John Wiley & Sons, Ltd; 2015. https://doi.org/10.1002/14651858.CD008106.pub3. Systematic review of clinical and radiological outcomes of surgical vs. non-surgical interventions of primary or recurrent patellar dislocation. CrossRefGoogle Scholar
- 7.•• Zaman S, White A, Shi WJ, Freedman KB, Dodson CC. Return-to-play guidelines after medial patellofemoral ligament surgery for recurrent patellar instability: a systematic review. Am J Sports Med. 2017:36354651771366. doi: https://doi.org/10.1177/0363546517713663. Systematic review of return to play after MPFL reconstruction.
- 8.Fisher B, Nyland J, Brand E, Curtin B. Medial patellofemoral ligament reconstruction for recurrent patellar dislocation: a systematic review including rehabilitation and return-to-sports efficacy. Arthroscopy. 2010;26(10):1384–94. https://doi.org/10.1016/j.arthro.2010.04.005.CrossRefPubMedGoogle Scholar
- 10.• Ambrožič B, Novak S. The influence of medial patellofemoral ligament reconstruction on clinical results and sports activity level. 2017;44(2):133–140. doi: https://doi.org/10.1080/00913847.2016.1148561. Post-operative outcome study evaluating return to physical activities and sport after MPFL reconstruction.
- 11.• Schneider DK, Grawe B, Magnussen RA, et al. Outcomes after isolated medial patellofemoral ligament reconstruction for the treatment of recurrent lateral patellar dislocations: a systematic review and meta-analysis. Am J Sports Med. 2016;44(11):2993–3005. https://doi.org/10.1177/0363546515624673. Systematic review and meta-analysis evaluating outcomes of isolated MPFL reconstruction for recurrent patellar dislocations. CrossRefPubMedPubMedCentralGoogle Scholar
- 14.• Nelitz M, Dreyhaupt J, Williams SRM. Anatomic reconstruction of the medial patellofemoral ligament in children and adolescents using a pedicled quadriceps tendon graft shows favourable results at a minimum of 2-year follow-up. Knee Surgery Sport Traumatol Arthrosc. 2017:1–6. doi: https://doi.org/10.1007/s00167-017-4597-4. Outcomes of a minimally invasive technique for MPFL reconstruction in children.
- 15.• Arshi A, Cohen JR, Wang JC, Hame SL, DR MA, Jones KJ. Operative management of patellar instability in the United States: an evaluation of national practice patterns, surgical trends, and complications. Orthop J Sports Med. 2016;4(8):2325967116662873. Presents patient demographics, surgical trends, and postoperative complications of patellar instability surgery. CrossRefPubMedPubMedCentralGoogle Scholar
- 16.Tjoumakaris FP, Forsythe B, Md Y, Bradley JP. Patellofemoral instability in athletes treatment via modified Fulkerson osteotomy and lateral release. Am J Sports Med. 2010;38(5):992–9. doi: https://doi.org/10.1177/0363546509357682.
- 17.Ntagiopoulos PG, Byn P, Dejour D. Midterm results of comprehensive surgical reconstruction including sulcus-deepening trochleoplasty in recurrent patellar dislocations with high-grade trochlear dysplasia. Am J Sports Med. 2013;41(5):998–1004. https://doi.org/10.1177/0363546513482302.CrossRefPubMedGoogle Scholar
- 18.• Burnham JM, Howard JS, Hayes CB, Lattermann C. Medial patellofemoral ligament reconstruction with concomitant tibial tubercle transfer: a systematic review of outcomes and complications. Arthrosc J Arthrosc Relat Surg. 2016;32(6):1185–95. https://doi.org/10.1016/j.arthro.2015.11.039. Systematic review of outcomes and complications of MPFL reconstruction and concomitant tibial tubercle transfer. CrossRefGoogle Scholar
- 21.•• Ménétrey J, Putman S, Gard S. Return to sport after patellar dislocation or following surgery for patellofemoral instability. Knee Surgery Sports Traumatol Arthroscopy. 2014;22(10):2320–6. Criteria for safe return to sport after patellar dislocation or surgery for patellofemoral instability. CrossRefGoogle Scholar
- 22.• Monk AP, Davies LJ, Hopewell S, Harris K, Beard DJ, Price AJ. Surgical versus conservative interventions for treating anterior cruciate ligament injuries. Cochrane Database Syst Rev. 2016(4). Systematic review of surgical vs nonsurgical treatment of ACL injuries. Google Scholar
- 25.• Ellman MB, Sherman SL, Forsythe B, LaPrade RF, Cole BJ, Bach BRJ. Return to play following anterior cruciate ligament reconstruction. - J Am Acad Orthop Surg. 2015;23(5):283–96. Review of return to play after ACL reconstruction with emphasis on creating guidelines to help facilitate the return to play process. CrossRefPubMedGoogle Scholar