Current Evidence Regarding the Safety and Effectiveness of Early Weightbearing and Accelerated Rehabilitation Following Patellar Instability Surgery: A Scoping Review

Postoperative rehabilitation following patellar instability surgery, particularly medial patellofemoral ligament reconstruction (MPFLR) with or without tibial tubercle osteotomy (TTO), remains highly variable.Increasing interest in accelerated rehabilitation strategies raises the question of whether earlier functional recovery can be promoted without compromising stability and safety.A scoping review was conducted in accordance with the PRISMA extension for Scoping Reviews (ScR) guidelines.PubMed, Embase, and Cochrane Library databases were searched from January 2010 to September 2026 using prespecified, database-specific search strings.Studies evaluating early or accelerated postoperative weightbearing, range of motion (ROM), or activity following MPFLR and/or TTO were included.Early or accelerated rehabilitation was defined as the advancement of at least one of four domains, relative to a conventional protocol: weightbearing, ROM, the discontinuation of bracing, or strengthening and return to activity.Two independent reviewers screened articles and extracted data on study characteristics, rehabilitation protocols, and clinical outcomes, with disagreements resolved by consensus.The search identified 252 records, 175 of which remained after duplicates were removed and were screened.Six studies comprising 474 patients met inclusion criteria.Accelerated rehabilitation protocols commonly involved early ROM progression, immediate or early weightbearing as tolerated, and the reduced use of postoperative bracing.Across studies, early rehabilitation was not associated with increased rates of recurrent patellar instability, graft failure, or major complications.Several studies reported earlier return to activity and improved shortterm functional outcomes compared with more restrictive protocols, while long-term patient-reported outcomes were comparable between rehabilitation strategies.Current evidence suggests that early weightbearing and accelerated rehabilitation following patellar instability surgery appear feasible in appropriately selected patients and were not associated with increased rates of recurrent instability, graft failure, or major complications in the included studies.Since the evidence base is small, heterogeneous, and predominantly non-randomized and because no formal quality appraisal was performed, these findings should be regarded as preliminary and hypothesis-generating rather than as evidence of equivalence or superiority.Further high-quality comparative studies are needed to establish optimal rehabilitation parameters.