Return-to-Sport Testing After Medial Patellofemoral Ligament Reconstruction in Adolescent Athletes

Background: Return to sport (RTS) after patellar stabilization surgery involves the return of strength and dynamic knee stability, which can be assessed using isometric strength and functional performance testing. Purpose: To investigate the results of isometric strength and functional RTS testing between the surgical and uninvolved limbs in adolescent patients who underwent medial patellofemoral ligament (MPFL) reconstruction for patellar instability. Study Design: Case series; Level of evidence, 4. Methods: A retrospective review of adolescent patients who underwent MPFL reconstruction identified 28 patients (20 female, 8 male) who also underwent isometric and functional RTS testing. Data were compared with the uninvolved limb. The recovery of muscle strength was defined by a limb symmetry index (LSI) >= 90%. Differences in peak torque were compared using the Wilcoxon signed-rank test. Correlations were examined between dependent and independent variables using the Spearman correlation. Results: The mean age of the patients was 14.9 years (range, 12-16 years). Reconstruction was performed with a hamstring autograft in 17 (60.7%) patients. Concomitant tibial tubercle osteotomy was performed in 10 (35.7%) patients. Testing was performed at a mean 7.4 months (range, 5.5-11.9 months) postoperatively. The mean LSIs for quadriceps and hamstring strength were 85.3% and 95.1%, respectively. For knee extension, there was a statistically significant difference between isometric peak torque measured in the surgical and uninvolved limbs (P = .001). Only 32.0% of patients passed all 4 hop tests. Also, 63.0% of patients achieved an anterior reach asymmetry of <4 cm on the Lower Quarter Y-Balance Test (YBT-LQ). There were no statistically significant differences in isometric strength testing, hop tests, or the YBT-LQ based on graft type or concomitant procedures. There was no correlation between isometric strength and performance on the YBT-LQ or hop tests. Conclusion: Adolescent athletes undergoing MPFL reconstruction may need prolonged rehabilitation programs beyond 8 months to allow the adequate recovery of muscle strength for safe RTS. There is a significant deficit in isometric quadriceps strength in the surgical limb after surgery. Further investigation is needed to determine safe RTS criteria after MPFL reconstruction in the pediatric and adolescent population.