Summary

Patients who undergo arthroscopy for refractory patellar tendinopathy after 23 months of symptoms have slightly lower reported success rates and earlier referral for arthroscopic surgical intervention may improve patient outcomes.

Abstract

Purpose

To compare surgical outcomes based on operative and perioperative variables for the arthroscopic treatment of patellar tendinopathy refractory to conservative management.

Methods

A keyword search was performed in PubMed, Embase, CINAHL, Scopus, and Cochrane databases for prospective articles published from 2000-present that studied arthroscopic intervention for refractory patellar tendinopathy. 1788 articles were screened using PRISMA guidelines against inclusion criteria. Outcomes assessed included subjective measures of Success and Return to Sport (RTS) data and patient reported outcomes measures (PROMs). The primary variables studied included operative techniques, pre-operative duration of symptoms (DOS), and post-operative rehabilitation. Data was analyzed descriptively without meta-analysis due to heterogeneity of surgical techniques.

Results

8 prospective arthroscopic studies were identified and included in analysis, with mean follow-up ranging 12-79 months. Average success and RTS rates were 89.5% and 89.0%, respectively. One study reported complications (failed tendon release). Patients who underwent surgery after less than 16 months of symptoms reported similar Lysholm score improvement (43.2 vs 42.3), while having higher subjective success rate (91.7% vs 86.7%) and a longer time to RTS time (4.5 vs 2.2mo) compared to those who received arthroscopy after 2 years of symptoms.
A comparison between studies that performed patellar bony work (PBW) and those that didn’t showed similar weighted mean RTS time (3.9 vs 3.9 mo), RTS rate (92.0% vs 88.5%), Lysholm score improvement (42.4 vs 43.3), and slightly lower subjective success rate (83.7% vs 90.1%). Patients who received PBW demonstrated a higher mean improvement in VISA-P scores (45.6 vs 39.3). Studies that did Hoffa’s Debridement (HFPD) showed similarities regarding RTS rate (88.1% vs 89.6%), Lysholm score improvement (42.4 vs 43.3) and subjective success rate (87.1% vs 91.2%) compared to those who did not. HFPD patients showed a 15% higher mean VISA-P improvement compared to non-HFPD patients (43.3 vs 37.6) as well as a slightly faster RTS time (3.6 vs 4.2 mo). Patients that were immobilized post-op had similar RTS time (3.9 vs 3.9 mo), RTS rate (92.0% vs 88.5%), and Lysholm improvement (42.4 vs 43.3), and greater improvements in VISA-P scores (45.0 vs 39.3) with lower subjective success rate (83.7% vs 90.1%) compared to those that weren’t.

Conclusions

Patients who undergo arthroscopy for refractory patellar tendinopathy after 23 months of symptoms have slightly lower reported success rates. PBW, HFPD, or post-op immobilization may lead to improved VISA-P scores and similar or decreased subjective success but have minimal impact on RTS rates or time to RTS.

Clinical Relevance: Earlier referral for arthroscopic surgical intervention may improve patient outcomes in patients with refractory patellar tendinopathy. Operative interventions such as PBW or HFPD have variable effects on outcomes and are dependent on surgeon preference.