Return-to-Sport Assessment After Medial Patellofemoral Ligament Reconstruction Shows Substantial Variability in Objective Criteria.

PURPOSE: To evaluate objective return-to-sport (RTS) outcomes and limb symmetry index (LSI) data after primary medial patellofemoral ligament reconstruction (MPFLR) in patients with patellar instability.

METHODS

A systematic search of Scopus, PubMed, CINAHL, and Embase (2000-2024) identified studies reporting RTS outcomes and LSI-based performance testing in patients undergoing primary MPFLR. Clinical and observational studies reporting objective metrics such as isokinetic strength and hop testing were included.

RESULTS

Six studies including 243 patients (64% women, mean age 19.4 years) undergoing primary MPFLR were included. Several studies included patients undergoing concomitant bone procedures (41%), such as tibial tubercle osteotomy or trochleoplasty. Objective RTS testing commonly included isokinetic strength (4 studies), hop testing (3 studies), and Y-Balance testing (2 studies). Follow-up testing ranged from 6 to 8 months postoperatively. Reported LSI values ranged from 83% to 94% for isokinetic flexion, 70% to 96% for isokinetic extension, 85% to 93% for single hop, and 90% to 97% for triple hop. Time to RTS ranged from 6.1 to 8.1 months across studies, with RTS rates from 85% to 100%. However, only 14% to 40% of patients met all study-specific RTS criteria when reported. Testing protocols and thresholds varied across studies, contributing to heterogeneity in outcomes.

CONCLUSIONS

Few studies reporting RTS outcomes after MPFLR incorporate LSI measures as part of RTS assessment, and only a minority define explicit RTS criteria based on objective testing. Among studies that reported LSI, quadriceps strength frequently remained below 90% LSI at the time of RTS. Despite high reported RTS rates, substantial variability exists in RTS assessment after MPFLR.

LEVEL OF EVIDENCE: Level IV, systematic review of Level III to IV studies.