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Return-to-Play Guidelines After Patellar Instability Surgery Requiring Bony Realignment: A Systematic Review
Rishi Chatterji1, Alex E White2, Christopher J Hadley3
1Ascension Providence-MSU, Southfield, Michigan, USA.
Orthopaedic Journal of Sports Medicine
|January 6, 2021
Summary
Postoperative guidelines for bony procedures in patellar instability are insufficient. Further research is needed to establish clear return-to-play criteria and timelines after tibial tubercle transfer surgery.
Area of Science:
- Orthopedic Surgery
- Sports Medicine
- Rehabilitation Science
Background:
- Recurrent patellar instability often necessitates surgical intervention, with bony realignment procedures like tibial tubercle osteotomies or transfers being crucial for specific patient groups.
- While soft tissue reconstruction is common, bony procedures address underlying structural issues for enhanced patellar stabilization.
Purpose of the Study:
- To systematically review and evaluate existing postoperative guidelines for return to play and rehabilitation following bony procedures involving the tibial tubercle for patellar instability.
- To identify common criteria and timelines used in current literature for patient recovery and return to athletic activity.
Main Methods:
- A systematic review of studies published between 1997 and 2019 was conducted, focusing on bony realignment procedures for patellar instability.
- Studies involving tibial tubercle osteotomies or transfers were included, excluding those with patients under 18, animal studies, or basic science research.
- Included studies were assessed for return-to-play criteria, rehabilitation protocols, and potential bias.
Main Results:
- The review analyzed 39 studies encompassing 1477 patients (1598 knees), with mean ages ranging from 17.5 to 34.0 years.
- While all studies detailed rehabilitation, only 16 specified return-to-play criteria, predominantly quadriceps strength (62.5%), followed by range of motion (50.0%).
- Subjective criteria like pain and confidence were reported in 25.0% of studies, and return-to-play timelines varied widely from 2 to 6 months.
Conclusions:
- Existing literature demonstrates a significant lack of standardized and adequate return-to-play guidelines following tibial tubercle procedures for patellar instability.
- The variability in reported timelines and criteria highlights the need for more clearly defined, evidence-based guidelines to optimize patient outcomes and safe return to sport.
