Eight case series were included (n=174 patients who had undergone 186 MPFL 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 6 studies the follow-up rates were over 80%.
1. What is the optimal post-operative weight-bearing status for MPFL 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 (2 studies) compared with non weight-bearing (5 studies) or partial weight-bearing (1 study).
2. Should rehabilitation for MPFL 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 (7 studies) and the one study that did not use a knee brace, or between studies that did not use knee braces (1 study) or used them for a relatively short time period (1 study immobilised knees using a knee brace for 3 days then changed to patellar brace) compared with studies that immobilised knees using knee braces for a longer period (5 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 (5 studies) compared with delayed exercises (3 studies started exercises at 5 days to 3 weeks post-operatively); studies that used continuous passive movement (3 studies) compared with those that did not; or studies that included quadriceps exercises in early rehabilitation (3 studies included quadriceps exercises/ straight leg raising immediately post-operatively) and those that did not (3 studies).