Online Rehabilitation Protocols for Medial Patellofemoral Ligament Reconstruction With and Without Tibial Tubercle Osteotomy Are Variable Among Institutions

Abstract

Purpose: To compare and contrast the various rehabilitation protocols for medial patellofemoral ligament (MPFL) reconstruction and MPFL reconstruction plus tibial tubercle osteotomy (TTO) published online by academic orthopaedic surgery residency programs and private practice institutions throughout the United States. Methods: We performed a systematic electronic search of MPFL reconstruction rehabilitation protocols in academic orthopaedic surgery residency programs in the United States using Google's search engine (www.google.com) based on the Fellowship and Residency Electronic Interactive Database Access System (FREIDA). Private practice organizations publishing MPFL reconstruction or MPFL reconstructioneTTO rehabilitation protocols that were found on the first page of search results were also included, but no comprehensive search for private practice protocols was performed. Protocols specifying an MPFL reconstruction with TTO were included for separate review because of altered weight-bearing status postoperatively. A list of comparative criteria was created to assess the protocols for the presence and timing of the various rehabilitation components. Results: From the list of 189 U.S. academic residency programs, as well as additional private practice protocols found in the Google search, 38 protocols were included for review (31 protocols for isolated MPFL reconstruction and 7 protocols for MPFL reconstruction plus TTO). A return to full range of motion by week 6 was recommended by 15 (48.4%) of the isolated MPFL reconstruction protocols and 6 (85.7%) of the MPFL reconstructioneTTO protocols. Six weeks of knee brace wear was recommended by 13 isolated MPFL reconstruction protocols (43.3%) and 4 MPFL reconstructioneTTO protocols (57.1%). Moreover, 6 isolated MPFL reconstruction protocols (19.4%) and 3 MPFL reconstructioneTTO protocols (42.9%) recommended use of a patellar stabilizing brace postoperatively. Conclusions: There is substantial variability among rehabilitation protocols after MPFL reconstruction, as well as MPFL reconstruction plus TTO, including postoperative range of motion, weight-bearing status, and time until return to sport. Furthermore, many online protocols from academic orthopaedic surgery residency programs and private practices in the United States fail to mention several of these parameters, most notably functional testing to allow patients to return to sport. Clinical Relevance: Proper rehabilitation after MPFL reconstruction with or without TTO is an important factor to a patient's postoperative outcome. This study outlines the variability in online rehabilitation protocols after MPFL reconstruction with or without TTO published online by academic residency programs and private practice institutions.

Patients who undergo tibial tubercle anteromedialization with medial patellofemoral ligament reconstruction demonstrate similar rates of return to sport compared to isolated MPFL reconstruction

“…Although it is important to carefully manage patient expectations regarding the timing of return to sport, this metric has been underreported in the literature [17]. One contributing factor could be the wide range of rehabilitation protocols for MPFLR—recent systematic reviews of postoperative protocols have found a wide range of recommendations regarding appropriate return to sport timing [34, 35]. This study highlights the need to refine and synthesize postoperative management for MPFLR with and without TTO.…”

Rehabilitation and Return to Sport After Medial Patellofemoral Complex Reconstruction

“…evaluated 38 publicly available protocols, and only 13 of the 38 protocols (34.2%) included specific strength or functional testing guidelines for criteria to RTS. 28 Without clearly established return-to-play guidelines, athletes may be returning to sport with functional deficits that may increase injury risk or decrease ability to resume prior level of sport. Currently, RTS guidelines are most commonly seen within ACL literature.…”