Development of a return to play checklist following patellar instability surgery: a Delphi-based consensus

Key points

1. 01Built by expert consensus using the Delphi method, not by tracking patient outcomes
2. 02Produced eight domains of return-to-play criteria, including range of motion, strength, functional testing, kneecap apprehension and stability, swelling, patient-reported outcomes, minimum time, and sport-specific progression
3. 03The aim is to reduce reliance on arbitrary timelines and give clinicians reproducible, measurable thresholds
4. 04Final checklist was endorsed by 90% of the participating experts
5. 05This is Level V evidence (expert opinion) and the checklist still needs validation

How it was conducted

Design

Delphi-based expert consensus, following Sprague recommendations

Process

Three-part survey rounds conducted July to November 2017, informed by a SCOPUS and PubMed literature review

Panel

Expert patellofemoral surgeons with recent publications, academic affiliation, and international society participation

Outcome

A consensus return-to-play checklist with objective, reproducible criteria

What they found

• 12 of 19 invited experts completed round 1; 11 of 12 completed round 2; 10 of 11 completed the final round
• 9 of 10 experts (90%) endorsed the final checklist
• The final checklist comprises eight domains: range of motion, strength, functional testing, patellar apprehension and stability, swelling, patient-reported outcomes, time minimums, and sport-specific progression, each with defined measurable thresholds

Limitations

• Level V evidence based on expert opinion, not on patient outcome data
• Only 9 to 12 experts participated across the rounds, a small panel
• The checklist is pragmatic but has not been validated against actual return-to-play or re-injury outcomes
• Survey content was derived from existing literature that itself lacks uniform return-to-play criteria

Why it matters

For patients

It gives you concrete milestones to discuss with your care team rather than just waiting a set number of weeks before going back to sport.

For clinicians

It offers a reproducible eight-domain framework for clearing athletes after patellar stabilization surgery, though it remains expert consensus pending validation.

For readers

It highlights that return-to-play decisions after kneecap surgery have lacked standardized criteria and that this checklist is a first consensus attempt to fill that gap.