Summary

This qualitative systematic review of peer-reviewed literature from 2000 to 2022 was conducted to analyze factors that affect return to sport after medial patellofemoral ligament reconstruction, and it was found that 60.0-100% of athletes returned to sport, with 55.6-84.0% returning at the same level or higher and those who didn’t return being impacted by fear of re-injury and sport played.

Abstract

Objectives: The most common surgical procedure to treat patellar instability is medial patellofemoral ligament reconstruction (MPFLR). While patients that have undergone MPFLR generally have high return to sport rates, factors that affects patients’ ability to return are less clear. It is possible that psychological factors may play a role in patients’ ability to return, similarly to athletes after ACL reconstruction. The purpose of this study was to analyze factors that affect return to sport after MPFLR, such as psychological factors, sport played, and a positive apprehension test following surgery, and to determine the average return to sport rates and time to return to sport.

Materials And Methods

A qualitative systematic review of the available literature was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines in July 2022. A second search was performed in March of 2024 with identical search criteria. Included studies were those that were peer-reviewed and published in English from 2000-2022 and met the following criteria: patients underwent MPFLR for patellar instability, return to sport was recorded, and a factor that affected return to sport was mentioned. Search terms included medial patellofemoral ligament, tibial tubercle osteotomy, tibial tubercle transfer, return to play, and return to sport. Data on return to sport, the percentage of those who returned at the same or higher level, time to return to sport, and factors affecting return to sport were extracted from each study that was included in the review.

Results

Eighteen of 632 identified studies met inclusion criteria. A total of 1,072 patients that underwent MFPLR were recorded. Demographic data was only available for 976 patients, and 668 of 976 patients (68.4%) were female. Return to sport rates and mean/median time ranged from 60.0-100% and 3-10.4 months, respectively. Return to sport rates at the same level of competition or higher were recorded in 14 studies and ranged from 55.6-84.0%. Six of 12 studies (50.0%) reported fear of re-injury as the top reason for patients not returning or returning at a lower level of sport. Volleyball/handball had the lowest return to the same level following surgery (18.2-50.0%).

Conclusion

Athletes that underwent MPFLR following recurrent patellar instability returned to sport at a range of 60.0-100%. Return to sport at the same level or higher was found to have a lower high end rate at 55.6-84.0%. Fear of re-injury and sport played were found to have a substantial impact on ability to return to sport. Surgeons can use this information to advise patients on expectations following surgery.