- Design
- Single-centre retrospective cohort
- Population
- 97 adolescents after MPFL reconstruction, 27 with tibial tubercle osteotomy
- Primary outcome
- Return to sport
- Effect
- 78.3% returned; ACL-RSI ≥59.2 OR 3.56 (95% CI 1.10 to 11.51), AUC 0.70
A single-centre cohort reviewed 97 adolescents aged 10 to 19 who had medial patellofemoral ligament reconstruction, 27 with a tibial tubercle osteotomy, between 2020 and 2024. All were active in sport beforehand and completed the ACL-RSI, a psychological readiness questionnaire developed for ACL reconstruction, during rehabilitation.
Overall, 78.3% returned to sport. Higher ACL-RSI scores, isolated reconstruction and male sex were each associated with return on simple analysis. After adjusting for sex, only an ACL-RSI score of 59.2 or more remained a significant predictor (OR 3.56, 95% CI 1.10 to 11.51). The cut-off discriminated only moderately (AUC 0.70).
The message for rehabilitation teams is that fear of reinjury and confidence matter after patellar surgery, as they do after ACL reconstruction, and they can be measured cheaply. A low score is a prompt for targeted work on confidence rather than a reason to hold a young athlete back indefinitely.
- Consider using the ACL-RSI questionnaire during rehabilitation after patellar stabilisation surgery.
- A score below about 59 flags adolescents less likely to return to sport and worth extra support.
- Address fear of reinjury explicitly with the patient and family, not only strength and range of movement.
- About four in five adolescents returned to sport after stabilisation in this cohort.
Why it matters
Physical recovery alone did not explain who returned to sport; confidence did.
Don't overread it
This retrospective single-centre cutoff has not been validated elsewhere, and the wide confidence interval means the effect size is uncertain.
The statistics, in plain English
An odds ratio of 3.56 sounds large, but the interval running from 1.10 to 11.51 means the true effect could be small. An AUC of 0.70 is moderate discrimination.
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