Grants and Contracts Details
Description
Development of a Medial Patellofemoral Ligament Reconstruction Return to Play Decision-Making Tool
Abstract
Medial patellofemoral ligament reconstruction (MPFL-R) is widely considered a successful intervention for
individuals with patellar instability. However, more than half of patients are unable to return to the same level of
competition after MPFL-R. Furthermore, many may be returning to sport despite marked strength and
functional deficiencies. At six months after surgery, only 14% of patients were able to successfully complete a
return to sport test battery and this only marginally increased to 39.6% being able to pass a test battery at a
minimum of 8 months after surgery. Results in tactical athletes and military personnel are even worse with
57.6% having postoperative activity restrictions and more than half of patients being medically separated from
the military. To date, return to play test batteries have been proposed but have largely been informed by Level
V evidence and are yet to be validated. The purpose of this study is to leverage advanced analytical
techniques to develop a clinical return to play decision-making tool. In the proposed study, a test battery will be
performed at the time that the athlete has been cleared by their treating surgeon to return to sport-specific
activities (approximately 6-8 months after surgery). Patients will also be contacted by phone or SMS text
message 12 months post-operatively to determine whether they have been able to return to play at their pre-
injury level of competition and the time required to do so. The test battery will include the MPFL-Return to
Sport Index (MPFL-RSI) as a measure of psychological readiness,6 a clinical measure of dynamic valgus
during a drop jump, grip strength as a global measure of strength, quadriceps strength assessed with a hand-
held dynamometer, and the single leg vertical jump as a measure of lower extremity power. We will use a
Conditional Inference Tree analysis which is a machine learning approach to both identify the variables that
significantly contribute to return to play but also provides threshold values that can inform clinical practice. This
approach will also allow for the creation of different models based on biological sex and/or age should
differences exist. We will also replicate these analyses with high fidelity measures to determine if performance
of the return to sport battery is meaningfully improved with the inclusion of dynamic valgus assessed with 3D
motion capture, isokinetic quadriceps strength, and/or instrumented measures of power when performing a
maximal vertical jump using a force plate. Finally, psychological factors are the most common reason for not
returning to sport more so than functional or performance measures. We will evaluate factors that contribute to
reduced MPFL-RSI scores to better inform postoperative rehabilitation.
Status | Active |
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Effective start/end date | 8/1/24 → 7/31/25 |
Funding
- Brigham and Womens Hospital: $51,769.00
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