Ward, Gavin H

Purpose To evaluate objective return‐to‐sport (RTS) outcomes and limb symmetry index (LSI) data after primary medial patellofemoral ligament reconstruction (MPFLR) in patients with patellar instability. Methods A systematic search of Scopus, PubMed, CINAHL, and Embase (2000‐2024) identified studies reporting RTS outcomes and LSI‐based performance testing in patients undergoing primary MPFLR. Clinical and observational studies reporting objective metrics such as isokinetic strength and hop testing were included. Results Six studies including 243 patients (64% women, mean age 19.4 years) undergoing primary MPFLR were included. Several studies included patients undergoing concomitant bone procedures (41%), such as tibial tubercle osteotomy or trochleoplasty. Objective RTS testing commonly included isokinetic strength (4 studies), hop testing (3 studies), and Y‐Balance testing (2 studies). Follow‐up testing ranged from 6 to 8 months postoperatively. Reported LSI values ranged from 83% to 94% for isokinetic flexion, 70% to 96% for isokinetic extension, 85% to 93% for single hop, and 90% to 97% for triple hop. Time to RTS ranged from 6.1 to 8.1 months across studies, with RTS rates from 85% to 100%. However, only 14% to 40% of patients met all study‐specific RTS criteria when reported. Testing protocols and thresholds varied across studies, contributing to heterogeneity in outcomes. Conclusions Few studies reporting RTS outcomes after MPFLR incorporate LSI measures as part of RTS assessment, and only a minority define explicit RTS criteria based on objective testing. Among studies that reported LSI, quadriceps strength frequently remained below 90% LSI at the time of RTS. Despite high reported RTS rates, substantial variability exists in RTS assessment after MPFLR. Level of Evidence Level IV, systematic review of Level III to IV studies.

Purpose To evaluate the agreement between a simple magnetic resonance imaging‐based measurement method for determining the patellar tendon‐to‐lateral trochlear ridge (PT‐LTR) distance using an external adhesive marker and a previously validated conventional measurement technique. Methods Patients diagnosed with patellofemoral instability before undergoing primary patellar stabilization surgery at a single institution between 2020 and 2024 were eligible for inclusion. PT‐LTR distances were measured in a blinded fashion by 2 musculoskeletal‐trained radiologists using the conventional technique and by an orthopaedic group using the simple technique. Interrater reliability between the musculoskeletal‐trained radiologists and between the orthopaedic groups was calculated using intraclass correlation coefficients (ICCs) and concordance correlation coefficients (CCCs) and subsequently intermethod reliability between the 2 groups. The measurements were plotted on concordance correlation graphs. Results One hundred knees (38 right, 62 left) from 97 patients (37 men, 60 women; mean age 22 ± 9 years) were included. The average distance for PT‐LTR measured by the radiologists using the conventional technique was 10.9 ± 7.5 mm and by the orthopaedic group using the simple technique was 9.3 ± 6.8 mm. Excellent interobserver agreement was noted for the radiologist group (ICC 0.941, 95% confidence interval [CI], 0.914‐0.960; CCC 0.941, 95% CI, 0.915‐0.959) and orthopaedic group (ICC 0.976, 95% CI, 0.964‐0.985; CCC 0.976, 95% CI, 0.965‐0.984). Excellent intermethod agreement was noted between the 2 techniques (ICC 0.903, 95% CI, 0.775‐0.942; CCC 0.902, 95% CI, 0.861‐0.932). Conclusions There was excellent interobserver reliability for measuring PT‐LTR distance using both the conventional radiologist‐based technique and the external adhesive marker technique. Excellent intermethod agreement was also shown between the 2 techniques, with comparable mean measurements between groups; thus, the simple technique can be used as a reproducible alternative for PT‐LTR distance. Level of Evidence Level III, retrospective comparative study.