Abstract
Background:
Return to sport is a commonly utilized outcome to denote clinical success for patients who have recently undergone medial patellofemoral ligament reconstruction (MPFLR) and ACL reconstruction (ACLR). However, there is a lack of clarity whether persistent functional and patient-reported deficits are consistent among young patients who have undergone these surgical procedures.
Purpose:
To compare patient-reported function, psychological readiness for sport, and functional symmetry between age and sex-matched individuals with recent MPFLR or ACLR.
Methods:
Fifteen participants with a history of MFPLR (sex= 8 women/7 men, age= 16.6±2.7 years, BMI= 23.2±4.1 kg/m2, months since surgery= 5.3±1.5) and 15 participants with ACLR (sex= 8 women/7 men, age= 17.1±2.8 years, BMI= 23.8±3.5 kg/m2, months since surgery= 5.9±0.8) enrolled in this cross-sectional research study. Participants were enrolled at the time of their final scheduled clinical visit. All participants completed the Tegner Activity Scale, the International Knee Documentation Committee (IKDC) subjective knee evaluation form, and the ACL-RSI scale. Participants then completed knee extension-flexion isokinetic strength testing at 60°/s, isometric knee extension strength assessment at 90° of knee flexion, and a battery of single-leg hopping tasks including the single hop, triple hop, crossover hop, and single leg vertical jump from which limb symmetry indices (LSI) were calculated. Group comparisons for patient-reported outcomes, strength LSI, and single-leg hop LSI were made using independent samples t-tests and the odds of meeting ≥90% LSI, ≥90 IKDC score, or ≥64 ACL-RSI score were compared between groups using odds ratios and 95% confidence intervals.
Results:
Participants with MPFLR reported worse ACL-RSI scores (MPFL= 50.3±23.0, ACLR= 77.3±18.7, p= 0.001) and displayed worse isometric knee extension strength symmetry (MPFL= 70.5±13.4%, ACLR= 86.3±16.3%, p= 0.01) and crossover hop symmetry (MPFL= 88.6±12.0%, healthy= 98.4±9.1%, p= 0.04) when compared to participants with ACLR. The odds of a participant with ACLR achieving adequate symmetry were 1.50 (CI95%: 1.05, 2.15) times greater for isometric quadriceps strength and 5.33 times greater (1.03, 27.76) for crossover hop performance when compared to a participant with MPFLR. The odds of reporting ACL-RSI score ≥64 were 7.56 (1.50, 38.15) greater among participants with ACLR as compared to those with MPFLR.
Conclusion:
Patients with MPFL reconstruction experience worse persistent patient-reported and functional deficits during the terminal phases of rehabilitation as compared to individuals with ACLR. Specific focus on clinical focus on improving psychological readiness for sport and quadriceps strength may facilitate improved outcomes upon medical clearance for unrestricted activity among patients with MPFLR.