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

  • Alex E. White
  • Rishi Chatterji
  • Saif U. Zaman
  • Christopher J. Hadley
  • Steven B. Cohen
  • Kevin B. Freedman
  • Christopher C. DodsonEmail author



To date, there is no consensus for the appropriate timing or functional evaluation for safe return to play following patellar instability surgery. The purpose of this study is to develop a consensus-based return to play checklist following patellar stabilization surgery using the Delphi method.


A 3-part survey series was conducted following the systematic guidelines of the Delphi technique for gathering consensus from experts in the management of patellofemoral instability. All surveys were completed between July and November of 2017. A literature search was performed in SCOPUS and PubMed to identify existing sources on return to play following patellar instability surgery and determining patellofemoral joint strength in athletes, which served as the basis for the surveys.


12 of the 19 selected participants (63%) completed the first-round survey, 11 of those 12 participants (92%) completed the second-round survey, and 10 of these 11 participants (91%) completed the final survey. Of the final ten participants, there was representation from seven different states in the USA. Nine of the ten (90%) respondents endorsed the final checklist. The final checklist included eight overarching domains with defined and reproducible objective criteria.


The standardized list of objective and reproducible criteria for rehabilitation outlined below should help practitioners focus more on patient-centred factors and less on arbitrary timelines. No prior study has gathered consensus from experts on this topic; therefore, this study should serve as a benchmark to help guide patients back to sport safely.

Level of evidence



Return to play Patellofemoral instability surgery Checklist 



Funding was not acquired for this study.

Compliance with ethical standards

Conflict of interest

Each author certifies that he or she has no commercial associations (e.g. consultancies, stock ownership, equity interest, patent/licensing arrangements) that might pose a conflict of interest in connection with the submitted article.

Ethical approval

IRB approval was not required for this study.

Supplementary material

167_2019_5510_MOESM1_ESM.pdf (320 kb)
Supplementary file1 (PDF 320 kb)
167_2019_5510_MOESM2_ESM.pdf (1.1 mb)
Supplementary file2 (PDF 1175 kb)
167_2019_5510_MOESM3_ESM.pdf (118 kb)
Supplementary file3 (PDF 118 kb)


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  • Alex E. White
    • 1
  • Rishi Chatterji
    • 1
  • Saif U. Zaman
    • 2
  • Christopher J. Hadley
    • 2
  • Steven B. Cohen
    • 2
  • Kevin B. Freedman
    • 2
  • Christopher C. Dodson
    • 2
    Email author
  1. 1.Sidney Kimmel Medical College at Thomas Jefferson UniversityPhiladelphiaUSA
  2. 2.Rothman InstitutePhiladelphiaUSA

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