Multi-planar patellar hypomobility as a potential contributor to VMO-VL dyssynergy and return to sport limitations following ACL reconstruction in soccer players.

Authors

Rosario D'Onofrio, Salvatore Capotosto, Thomas Boucher, Italo Sannicandro, Vincenzo Manzi, Robert Parisien

Published in

The Journal of sports medicine and physical fitness. Nov 09, 2026. Epub Nov 09, 2026.

Abstract

Patellofemoral hypomobility (PFH) is a frequent yet underestimated complication following anterior cruciate ligament (ACL) reconstruction. PFH induces biomechanical and neuromuscular alterations that impair return to sport (RTS) and accelerate early joint degeneration. However, current evidence describes PFH primarily as an associated factor rather than a direct causal determinant of RTS failure. Therefore, the primary objective of this review is to analyze the correlation between PFH and functional complications during RTS. The study also aims to summarize the available evidence on the relationship between PFH and medium- to long-term clinical outcomes, without implying causal predictions where not supported.
A narrative review was conducted across PubMed, EMBASE, Scopus, the Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science using a Population, Intervention, Comparison, and Outcome (PICO)-structured search. No systematic review procedures or pooled quantitative analyses were performed; all numerical data derived from individual studies. Included studies involved athletes aged 18-35 undergoing primary ACL reconstruction with Bone-Patellar Tendon-Bone (BPTB) or Hamstring autografts.
The analysis reveals significant PFH (>25% compared to the contralateral side) in 15-22% of athletes at 6 months, with a peak of 28% in BPTB graft cases. Longitudinal hypomobility correlates with extension deficit, whereas transverse hypomobility is associated with increased anterior knee pain (AKP) in 34% of cases. Data indicate a 12-15% reduction in Countermovement Jump (CMJ) performance and a 3.4-fold higher risk of patellofemoral osteoarthritis (PFOA) within 5 years, although PFH was not directly measured as an independent variable in these studies. Additionally, 25% of athletes with PFH discontinue competitive activity within 36 months after RTS.
PFH emerges as an important factor associated with postoperative functional limitations. Restricted patellar glide disrupts the vastus medialis obliquus (VMO)/vastus lateralis (VL) synergy, reduces performance, and accelerates cartilage degeneration. Symmetry of patellar kinematics should be considered a relevant parameter for RTS decision-making, while acknowledging that RTS outcomes are multifactorial and not solely determined by PFH.

PMID:
43001664
Bibliographic data and abstract were imported from PubMed on 09 Nov 2026.

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