Purpose
The purpose of this study was to establish consensus statements via the modified Delphi process on the diagnosis, nonoperative management, MPFL reconstruction MPFC repair, tibial tubercle osteotomy, trochleoplasty, and rehabilitation & return to play for patellar instability.
Methods
A consensus process on the treatment of patellar instability utilizing a modified Delphi technique was conducted. Sixty surgeons (sports medicine fellowship-trained) across 11 countries were invited to participate based on their level of expertise. Experts were assigned to one of 7 working groups defined by specific subtopics of interest within patellar instability. Consensus was defined as achieving 80-89% agreement, whereas strong consensus was defined as 90-99% agreement and unanimous consensus was defined by 100% agreement with a proposed statement.
Results
Of the 68 total questions and consensus statements on patellar instability, 3 achieved unanimous consensus, 33 achieved strong consensus, 20 achieved consensus and 12 did not achieve consensus.
Conclusion
The majority of statements reached unanimous or strong consensus. The statements that reached unanimous consensus were that in paediatric patients with patellar instability that the status of the physes should be assessed. Furthermore, there was unanimous consensus on mobilizing and working on resistance training following non-operative management once comfort permits and there is no apprehension. In contrast, the statements that did not achieve consensus related to the role of knee immobilization, the use of orthobiologics in nonoperative management, anchor use in MPFL reconstruction and whether the patellar or femoral side should be fixed first with the graft. The statements did not achieve consensus on MPFC repair related to the preferred technique and whether a VMO advancement should be performed. There was no consensus on indications for trochleoplasty or ostechondral flap elevations effect on cartilage. Finally, there was no consensus on weightbearing and immobilization post-operatively, or whether paediatric patients should avoid early return to play.