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. 2020 Dec 15;8(12):2325967120966134.
doi: 10.1177/2325967120966134. eCollection 2020 Dec.

Return-to-Play Guidelines After Patellar Instability Surgery Requiring Bony Realignment: A Systematic Review

Rishi Chatterji  1 , Alex E White  2 , Christopher J Hadley  3 , Steven B Cohen  4 , Kevin B Freedman  4 , Christopher C Dodson  4
Affiliations

Return-to-Play Guidelines After Patellar Instability Surgery Requiring Bony Realignment: A Systematic Review

Rishi Chatterji et al. Orthop J Sports Med. .

Abstract

Background: Recurrent patellar instability can be treated nonoperatively or surgically, and surgical management may vary based on the causative pathology in the structures surrounding the patella. Although isolated soft tissue reconstruction is among the most common operative treatments, certain patient populations require bony realignment for adequate stabilization.

Purpose: To evaluate postoperative guidelines, including return to play and rehabilitation, after bony procedures involving the tibial tubercle for patellar instability.

Study design: Systematic review; Level of evidence, 4.

Methods: A systematic review on return-to-play guidelines was conducted with studies published from 1997 to 2019 that detailed procedures involving bony realignment by tibial tubercle osteotomies and tibial tubercle transfers with or without soft tissue reconstruction. Exclusion criteria included animal or cadaveric studies, basic science articles, nonsurgical rehabilitation protocols, and patients with mean age <18 years. Studies were assessed for return-to-play criteria, rehabilitation protocols, and bias.

Results: Included in the review were 39 studies with a total of 1477 patients and 1598 knees. Mean patient age ranged from 17.5 to 34.0 years, and mean follow-up ranged from 23 to 161 months. All 39 studies described postoperative rehabilitation; however, only 16 studies specifically outlined return-to-play criteria. The most commonly cited return-to-play criterion was quadriceps strength (62.5%). Range of motion (50.0%), physical therapy protocols (18.8%), and radiographic evidence of healing (18.8%) were other cited objective criteria for return-to-play. Four of 16 (25.0%) studies described subjective criteria for return to play, including pain, swelling, and patient comfort and confidence. Of the 11 studies that described a timeline for return to play, the range was between 2 and 6 months.

Conclusion: The results revealed that 100% of papers evaluated lacked adequate return-to-play guidelines. Moreover, timelines significantly varied among studies. More clearly defined return-to-play guidelines after tibial tubercle transfer for patellar instability are required.

Keywords: bony procedure; patellar instability; realignment surgery; return to play.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: S.B.C. has received consulting fees from Zimmer Biomet. K.B.F. has received educational support from Liberty Surgical, consulting fees from DePuy/Medical Device Business Services, speaking fees from Aastrom Biosciences and Vericel, and honoraria from Vericel. C.C.D. has received consulting fees from Arthrex and DePuy and speaking fees from Arthrex. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) diagram detailing the review of articles from the search build.
Figure 2.
Figure 2.
Tibial tubercle osteotomy procedures performed for patellar instability in the studies reviewed. MPFLr, medial patellofemoral ligament reconstruction.
See this image and copyright information in PMC

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