Summary

While both open and arthroscopic surgical approaches for surgical intervention of patellar tendinopathy lead to high rates of success and return to sport, arthroscopic approaches may lead to quicker return to sport and greater improvements in patient-reported outcome measures than open procedures.

Abstract

Purpose

To compare outcomes between open and arthroscopic surgical interventions for patellar tendinopathy (Jumper’s Knee) refractory to conservative management.

Methods

A systematic search of PubMed, Embase, CINAHL, Scopus, and Cochrane databases was performed. Articles published 2000-present studying outcomes after surgical intervention for refractory patellar tendinopathy were included. 1788 articles were screened using PRISMA guidelines against these criteria. Outcomes assessed included Patient Reported Outcome Measures (PROM) such as Victorian Institute of Sports Assessment (VISA-P), Visual Analog Scale (VAS), modified Blazina, Lysholm, Tegner, IKDC, and SANE scores, and subjective Success and Return to Sport (RTS) rates at follow-up. Descriptive statistics were compared between groups, but no meta-analysis was performed due to heterogeneity of groups.

Results

21 studies were included for analysis that analyzed 13 arthroscopic, 8 open, and 2 combined treatment groups with follow-up ranging from 6-96 months. 2 retrospective studies directly compared open vs arthroscopic and reported earlier RTS time in arthroscopic patients (mean 5.5 vs 8.0mo) but no differences in VISA-P, overall success, or RTS rate. Open surgical patients required repeat surgery in 4 instances. Summary analysis of all data showed arthroscopic patients had earlier RTS (3.8 vs 8.7mo) and slightly higher RTS rate (88.5% vs 74.9%), but similarly high rates of overall success (89.1% vs 83.1%). Arthroscopic groups generally had higher average VISA-P and Blazina scores compared to Open groups. Combined open/arthroscopic procedures exhibited a mean success and RTS rate of 86.6% and 91.3%. Complications were reported in 3 open groups (surgical site complication, repeat surgery required, algodystrophy), 2 arthroscopic groups (failed tendon release, new-onset PFPS), and 1 combined group (repeat surgery required).

Conclusions

In patients with refractory patellar tendinopathy and varying baseline activity levels, both open and arthroscopic surgical approaches lead to high rates of success and return to sport. Arthroscopic approaches may lead to quicker return to sport and greater improvements in patient-reported outcome measures than open procedures. Combined open and arthroscopic procedures are also effective and can be utilized.

Clinical Relevance: Arthroscopic intervention may yield similar or better clinical outcomes compared to open techniques with quicker return to sport for patellar tendinopathy refractory to conservative management.