Surgical treatment of patellofemoral instability: rehabilitation, outcomes, and return to sports

The rehabilitative treatment following medial patellofemoral ligament (MPFL) reconstruction focuses on the biological requirements of the new ligament and the reactivation of the active stabilizers of the knee. Returning to sport activity after MPFL reconstruction involves a rehabilitation protocol that can be schematized into four successive phases of progressive recovery in terms of the Range of Movement (ROM) and quadriceps reactivation. Return to sport, after isolated MPFL reconstruction is estimated around 7 months. Approximately 90% of the athletes are able to return to sport activity. However, 30% of these are not capable of reaching the pre-injury level of competition. MPFL reconstruction surgery complications include residual instability and recurrent dislocation. The rate of recurrence is around 30%, but needs to be addressed on a multifactorial risk basis, taking into consideration anatomical factors such as patella alta, trochlear dysplasia and rotational deformities (TT-TG, femoral anteversion, tibial rotation) in addition to demographic characteristics such as age, skeletal immaturity and history of contralateral patellar dislocation. Another complication that, unfortunately, is associated with MPFL reconstruction is patellofemoral osteoarthritis (PFOA). Many studies have highlighted the importance of surgical treatment in preventing recurrent patellar dislocation, however at the cost of a higher risk of PFOA. MPFL reconstruction and associated procedures are effective procedures with high RTS and at pre-injury level rate.