Eight case series were included (174 patients who had undergone 186 medial patellofemoral ligament reconstructions). The sample size ranged from 12 to 43 patients.
Methodological problems included: lack of a defined research question; lack of description of patient characteristics and selection methods; lack of adjustment for confounding factors; lack of reporting of statistical differences between patients at baseline; lack of clear reporting of the use of valid and reliable outcome measures; reporting of results without measures of variance; small sample size; lack of description of the full rehabilitation programme (none of the studies described their full rehabilitation programme); and use of additional knee surgery. All of the studies did, however, follow-up patients for an adequate time period. In six studies the follow-up rates were over 80%.
1. What is the optimal post-operative weight-bearing status for medial patellofemoral ligament reconstruction patients?
There appeared to be no marked differences in patellar apprehension, recurrence of dislocation or subluxation, Kujala score or radiological outcomes between studies that allowed immediate full weight-bearing (two studies) compared with non weight-bearing (five studies) or partial weight-bearing (one study).
2. Should rehabilitation for medial patellofemoral ligament reconstruction patients include knee braces?
There appeared to be no marked differences in clinical and radiological outcomes between studies that used knee braces post-operatively (seven studies) and the one study that did not use a knee brace, or between studies that did not use knee braces (one study) or used them for a relatively short time period (one study immobilised knees using a knee brace for three days then changed to patellar brace) compared with studies that immobilised knees using knee braces for a longer period (five studies).
3. When should post-operative exercise start and what type of exercise should be advised?
There appeared to be no marked differences between: studies that used immediate post-operative exercises (five studies) compared with delayed exercises (three studies started exercises at five days to three weeks post-operatively); studies that used continuous passive movement (three studies) compared with those that did not; or studies that included quadriceps exercises in early rehabilitation (three studies included quadriceps exercises/ straight leg raising immediately post-operatively) and those that did not (three studies).