Impact of patellar stabilisation surgery on return to active duty in the French military population: an observational study.

Abstract

Introduction: Patellar instability is 10 times higher in the military population, even more with young recruits undergoing a rapid and significant increase in daily sports activity. Despite such prevalence, little data are available on the return to operational activities. The objective of this research was to study the return to operational active duty after patellar stabilisation and identify risk factors for military return failure.

Materials and methods: We conducted a multicentre, retrospective study, involving French soldiers who underwent patellar stabilisation in a military hospital between January 2009 and June 2022. Epidemiological, clinical, surgical data and postoperative score evaluations were collected via an online questionnaire. The main criteria of analysis were the return to operational activity. Secondary criteria were the return to physical activity and functional results. We conducted a sub-group comparison between surgeries.

Results: Among the 52 patients, 63% returned to operational activity in a mean time of 9±5.14 months. Persistent pain and flessum were significantly associated with failure (p<0.05). Average follow-up was 37.3 months. Regarding physical activity, 78% managed to return, 43% at a prior or higher level, the mean delay was 11.6±7.26 months. The mean postoperative Tegner score was 3.9±1.72. On functional results, the mean Lysholm score was 78.4±21 and the mean International Knee Documentation Committee (IKDC) score was 74±17.3. Persistent instability occurred in 4% of cases. The delay to prior physical level was significantly higher in tibial tuberosity transposition versus medial patella femoral ligament ligamentoplasty (p=0.016) CONCLUSIONS: Patellar instability represents a turning point in a military career. Despite effective stabilisation, nearly half of the patients will experience a decrease in their sports level, and 60% will fully regain their full duty activity. Clear and accurate information should be provided to military patients to prepare them for the foreseeable consequences.