Return to Play Considerations After Patellar Instability

Abstract

Purpose of review: To discuss the treatment options and rehabilitation protocols after non-operative and operative treatment of patellar instability, and to discuss expected return to play outcomes and functional performance with non-operative and operative treatment of patellar instability.

Recent findings: A criterion-based program assessing range of motion, joint effusion, strength, neuromuscular control, proprioception, agility, and power are critical measures to assess when rehabilitating this population. A series of functional tests including quadriceps strength testing, single-limb hop testing, lateral step-down test, the side hop test, the lateral leap and catch test, the Y-balance test, and the depth jump should be considered when determining an athlete's return to sport clearance. These objective measures combined with psychological readiness and a comprehensive understanding of the sports-specific tasks required for participation should be considered when evaluating an athlete's ability to safely and successfully return to sport. We discuss rehabilitation management when working with non-operative and operative management of patellar instability and provide considerations for clinicians working with these athletes to facilitate safe return to sport.

Keywords: MPFC; MPFL; Medial patellofemoral complex; Medial patellofemoral ligament; Patellar dislocation; Patellar instability; Patellofemoral; Reconstruction; Return to play; Return to sport.

Fig. 1

Quadriceps Limb Symmetry Index. Quadriceps strength can be measured in a seated-leg extension machine with the hips at 90° of flexion and knees at 60° flexion. The athlete is asked to slowly extend their limb against the fixed lever of the machine and perform a maximal effort against a hand-held dynamometer

Fig. 2

Thirty-second side hop test. The side hop test consists of hopping on one leg between two lines at distance of 40 cm apart as many times as possible in 30 s

Fig. 3

Drop jump test. In the drop jump test, the patient drops off of a 35-cm-high box, lands on both feet, and immediately jumps as high as possible before a subsequent landing

Fig. 4

Lateral step-down test. The lateral step-down test is performed with the athlete standing on one limb at the edge of a box while performing a lateral step down to 60° of knee flexion. The athlete taps their contralateral heel to the ground and aims to match a cadence of 80 beats per minute (bpm)

Fig. 5

Lateral leap and catch. In the lateral leap and catch, the athlete hops lateral from one limb to the other at a distance of 60% of their height