Knee Bracing after Medial Patellofemoral Ligament Reconstruction: A Systematic Review of Protocols and Postoperative Outcomes.

Abstract

Abstract: Medial patellofemoral ligament reconstruction (MPFLr) is the most common procedure performed for recurrent patellar instability. Although the benefits of MPFLr are well-established, postoperative bracing protocols remain highly variable and poorly characterized in the current literature. The purpose of this study was to evaluate the use of bracing by sports medicine surgeons for patients following MPFLr. Randomized controlled trials, prospective, and retrospective studies of patellar instability treated with MPFLr were identified across three databases: EMBASE (Elsevier), Medline (OVID), and SportDiscus with Full Text (EBSCOHost). Study quality was assessed using established risk of bias tools; several studies demonstrated moderate risk of bias due to nonrandom selection of intervention groups and variability in rehabilitation. Data collected included functional outcomes and rates of redislocation or subluxation. Of 521 studies identified, 112 duplicates were removed. Abstracts of 409 studies were reviewed, with 348 excluded for relevance. Full-text review of 61 studies yielded seven meeting inclusion criteria, all of which included postoperative rehabilitation protocols. Five studies (71.4%) used knee braces postoperatively, and two (28.6%) compared postoperative bracing to no bracing. Four studies (57.1%) reported using a hinged knee brace and two (28.6%) used a knee immobilizer. Six of seven studies (85.7%) braced patients for up to 6 weeks postoperatively. Postoperative instability events were reported in six studies (85.7%), collectively encompassing 650 knees. Bracing was applied to 533 knees, of which 25 (4.7%) experienced at least one instability event, compared with 1 of 117 nonbraced knees (0.9%). There was no statistically significant difference in instability events between groups (χ² [1, N = 650] = 3.68, p = 0.055). Most sports medicine surgeons brace patients for up to 6 weeks following MPFLr. Bracing protocols are widely variable, and current studies exhibit marked heterogeneity in reporting of postoperative outcomes. Further research is needed to determine the optimal postoperative rehabilitation protocol, including the use of a hinged knee brace, following MPFLr.