Surgical Management of Patellar Tendinopathy Results in Improved Outcomes and High Rates of Return to Sport: A Systematic Review
- 26 September 2022
- journal article
- review article
- Published by Georg Thieme Verlag KG in The Journal of Knee Surgery
- Vol. 36 (11), 1171-1190
- https://doi.org/10.1055/s-0042-1757701
Abstract
Although the majority of patients with patellar tendinopathy (PT) can be treated nonoperatively, operative management may be indicated for recalcitrant cases. While several surgical techniques have been described, there is limited understanding of postoperative outcomes and expectations regarding return to activity and sport. The purpose of this study was to characterize the clinical outcomes associated with the surgical management of PT with an emphasis on return to sport (RTS) rates. We hypothesized that surgical management would lead to clinically important improvements in patient-reported outcomes (PROs) with high rates of RTS and RTS at the same level. A comprehensive search of the PubMed, Medline, and Embase databases was performed in December 2020. Level of evidence studies I through IV, investigating results of surgical management for PT (PRO, functional outcomes, pain, and/or RTS), were included. The search was performed in accordance with the Preferred Reported Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Forty clinical studies reporting on surgery for PT satisfied inclusion criteria, with 1,238 total knees undergoing surgery for PT. A comparison of pre- and postoperative Victorian Institute of Sport Assessment, patellar tendon (VISA-P) scores (mean difference: 41.89, p < 0.00001), Lysholm scores (mean difference: 41.52, p < 0.00001), and visual analogue scale (VAS) pain scores (mean difference: 5, p < 0.00001) demonstrated clinically and statistically significant improvements after surgery. The overall RTS rate following operative management was 89.8% (95% confidence interval [CI]: 86.4–92.8, I 2 = 56.5%) with 76.1% (95% CI: 69.7.5–81.9, I 2 = 76.4%) of athletes returning to the same level of activity. Surgery for PT provides meaningful improvement in patient reported outcomes and pain while allowing athletes to RTS at high rates with levels of participation similar to that of preinjury. Comparative studies of open and/or arthroscopic surgery are still limited but current evidence suggests better rates of RTS for arthroscopic surgery compared with open surgery. This is a systematic review of level-I to -IV studies. Received: 15 November 2021 Accepted: 26 April 2022 Article published online: 26 September 2022 © 2022. Thieme. All rights reserved. Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USAKeywords
This publication has 65 references indexed in Scilit:
- Can Arthroscopically Assisted Treatment of Chronic Patellar Tendinopathy Reduce Pain and Restore Function?Clinical Orthopaedics and Related Research, 2012
- Arthroscopic Management of Chronic Patellar TendinopathyThe American Journal of Sports Medicine, 2011
- Sclerosing polidocanol injections or arthroscopic shaving to treat patellar tendinopathy/jumper's knee? A randomised controlled studyBritish Journal of Sports Medicine, 2011
- Risk factors for patellar tendinopathy: a systematic review of the literatureBritish Journal of Sports Medicine, 2011
- Effect of Immunoglobulin Therapy on the Rate of Infections in Multiple Myeloma Patients Undergoing Autologous Stem Cell Transplantation and or treated with immunomodulatory agentsMediterranean Journal of Hematology and Infectious Diseases, 2010
- Minimal clinically important improvement/difference (MCII/MCID) and patient acceptable symptom state (PASS): what do these concepts mean?Annals Of The Rheumatic Diseases, 2007
- Surgical Treatment of Chronic Patellar TendinosisClinical Orthopaedics and Related Research, 2007
- Quantifying heterogeneity in a meta-analysisStatistics in Medicine, 2002
- Histopathology of Common TendinopathiesSports Medicine, 1999
- Surgical treatment of patellar tendon pain in athletes.British Journal of Sports Medicine, 1986