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Protocols of rehabilitation and return to sport, and clinical outcomes after medial patellofemoral ligament reconstruction with and without tibial tuberosity osteotomy: a systematic review

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Abstract

Purpose

No consensus exists on rehabilitation programmes after medial patellofemoral ligament reconstruction (MPFLR) with or without tibial tuberosity osteotomy (TTO). This systematic review examined the content and timeline of rehabilitation (weightbearing, range of motion [ROM] and exercise therapy) and return to sport (RTS), as well as patient-reported outcomes after MPFLR with or without TTO.

Methods

The PubMed, Cochrane Library, Web of Sciences, CINAHL and SPORTDiscus databases were searched from inception to December 2021. Studies that reported postoperative rehabilitation programmes and patient-reported outcomes for patients aged ≥ 18 years who underwent MPFLR with or without concomitant TTO were included.

Results

Eighty-five studies were included, 57 of which were case series and only one randomised controlled trial on rehabilitation programmes. Non-weightbearing was set within one week post-operatively in approximately 80% of weightbearing programmes for MPFLR without and with TTO. Joint immobilisation was set within one week post-operatively in 65.3% and 93.8% of programmes for MPFLR without and with TTO, respectively. Weightbearing and ROM (≤ 90°) restriction were within three weeks post-operatively for > 50% of the programmes. Quadriceps strengthening was the most cited exercise therapy (33 programmes), most often initiated within two weeks post-operatively. However, few other exercise programmes were cited (only nine programmes). RTS was mostly noted at six months post-operatively (35 programmes). The weighted mean Kujala score was 87.4 points.

Conclusion

Regardless of TTO addition to MPFLR, most studies restricted weightbearing and ROM only in the early post-operative period, with seemingly favourable clinical results. Limited information was available on post-operative exercise therapy.

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Data availability

The data used and analysed in this review are available from the corresponding author upon reasonable request.

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Acknowledgements

The authors are grateful to Mr. Takumi Okunuki of Graduate School of Sport Sciences, Waseda University, for the assistance in performing the literature search.

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Authors and Affiliations

  1. Rehabilitation Center, NTT Medical Center Sapporo, South 1, West 15, Chuo-ku, Sapporo, Hokkaido, 060-0061, Japan

    Yuta Koshino & Shohei Taniguchi

  2. Department of Rehabilitation, Hokkaido Chitose College of Rehabilitation, Chitose, Japan

    Takumi Kobayashi

  3. Faculty of Health Sciences, Hokkaido University, Sapporo, Japan

    Mina Samukawa

  4. Department of Orthopaedic Surgery, NTT Medical Center Sapporo, Sapporo, Japan

    Masayuki Inoue

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  1. Yuta Koshino
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  2. Shohei Taniguchi
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  3. Takumi Kobayashi
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  4. Mina Samukawa
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  5. Masayuki Inoue
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Contributions

YK, ST and MI had the ideas for this review; YK and ST performed the literature search; YK, ST and TK performed the data analysis; YK and ST drafted the work; and TK, MS and MI revised it critically.

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Correspondence to Yuta Koshino.

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The protocol for this systematic review was prospectively registered with PROSPERO (CRD42020173169).

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Koshino, Y., Taniguchi, S., Kobayashi, T. et al. Protocols of rehabilitation and return to sport, and clinical outcomes after medial patellofemoral ligament reconstruction with and without tibial tuberosity osteotomy: a systematic review. International Orthopaedics (SICOT) 46, 2517–2528 (2022). https://doi.org/10.1007/s00264-022-05480-4

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