Rehabilitation variability following medial patellofemoral ligament reconstruction

ABSTRACT

Background: Medial patellofemoral ligament (MPFL) reconstruction is an increasingly utilized surgical option for recurrent patellar instability. Recent studies have highlighted the potential benefits of accelerated functional rehabilitation; however, no validated MPFL rehabilitation guidelines currently exist.

Objective: To assess the variability of MPFL reconstruction rehabilitation protocols published online by academic orthopaedic programs.

Methods: Online MPFL rehabilitation protocols from U.S. teaching orthopaedic programs were reviewed. A comprehensive scoring rubric was developed to assess each protocol for both the presence of various rehabilitation components and the timing of their introduction.

Results: Thirty-one protocols (20%) were identified from 155 U.S. academic orthopaedic programs. Thirty protocols (97%) recommended immediate postoperative knee bracing. Twenty protocols (65%) allowed for weight-bearing as tolerated using crutches immediately postoperatively, whereas seven protocols (23%) recommended partial weight-bearing and four protocols (13%) recommended toe-touch weight-bearing. For those protocols advising partial and toe-touch weight-bearing, advancement to full weight-bearing was achieved at averages of 4.7 (range, 3–8) weeks and 6.3 (range, 6–7) weeks, respectively. There was considerable variation in range of motion (ROM) goals; however, most protocols (97%) recommended achieving 90 degrees of knee flexion at an average of 1.4 (range, 0–6) weeks. Significant diversity was found in the inclusion and timing of strengthening, stretching, proprioception, and basic cardiovascular exercises. Twenty-five protocols (81%) recommended return to training after completing specific athletic criteria.

Conclusions: A minority of U.S. teaching orthopaedic institutions publish MPFL reconstruction rehabilitation protocols online. Furthermore, there is a high degree of variability in both the composition and timing of rehabilitation modalities across these protocols.

KEYWORDS:

• Patellofemoral joint
• joint instability
• rehabilitation
• physical therapy

Acknowledgments

None reported.

Declaration of interest

Christopher Ahmad has received IP royalties and research support from Arthrex, Inc. and is also a paid consultant for the company. He has stock options in At Peak; has received research support from Major League Baseball and Stryker; and has received publishing royalties and financial support from Lead Player. He is also the editor of and on the governing board of Orthopedics Today. The other authors have disclosed that they have no significant relationships with or financial interests in any commercial companies related to this study or article. Peer reviewers on this manuscript have received an honorarium from The Physician and Sportsmedicine for their review work, but have no other relevant financial relationships to disclose.

Additional information

Funding

This manuscript was not funded.