Can Psychological Readiness Predict Successful Return to Sports After Patellar Stabilization Surgery in Adolescent Patients? A Retrospective Cohort Study

Background: While many metrics are used to subjectively assess a patient’s knee function with patellofemoral instability (PFI), psychological readiness to return to sport (RTS) after patellar stabilization surgery is not well established in this population. The Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) scale assesses psychological readiness to RTS after anterior cruciate ligament reconstruction and may be similarly beneficial in understanding this domain in those with PFI. Hypothesis: Higher ACL-RSI scores in patients with PFI are associated with an increased likelihood of RTS after patellar stabilization surgery. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review was conducted of adolescent patients (10-19 years old) treated surgically for PFI (medial patellofemoral ligament reconstruction [MPFLR] with or without tibial tubercle osteotomy) at a single institution from January 2020 to October 2024. Patients actively participating in sports at their first orthopaedic visit who completed the ACL-RSI during postoperative rehabilitation were included. Patient demographics, injury characteristics, surgical procedure, ACL-RSI scores, and RTS status were recorded. Descriptive statistics and bivariate analysis were performed. Based on the euclidean distance, the optimal ACL-RSI cutoff score for predicting successful RTS was determined, and diagnostic accuracy was evaluated with a receiver operating curve. A multivariate logistic regression, adjusted for sex, was used to identify predictors of RTS. Results: Study criteria identified 97 patients with a median (IQR) age of 15.6 years (14.2-16.4). Seventy underwent isolated MPFLR and 27 underwent MPFLR with tibial tubercle osteotomy. Successful RTS was achieved in 78.3% (n = 76). RTS was associated with higher ACL-RSI scores ( P = .012), isolated MPFLR ( P = .011), and male sex ( P = .03). An ACL-RSI score ≥59.2 was identified as being indicative of successful RTS (area under the curve, 0.70; 95% CI, 0.56-0.83). While procedure type and ACL-RSI scores were both associated with RTS in univariate analysis, the multivariable analysis adjusting for sex revealed that the ACL-RSI cutoff remained the only significant predictor of RTS (odds ratio, 3.56; 95% CI, 1.10-11.51; P = .033). Conclusion: ACL-RSI scores ≥59.2 are associated with an increased likelihood of successful RTS after surgical treatment for PFI in adolescents. Patient demographics and the studied injury characteristics do not appear to influence the likelihood of successful RTS.