Introduction
Patellar tendinopathy is a common overuse condition that causes anterior knee pain in elite-level athletes, most frequently basketball and volleyball. There is currently no consensus regarding the optimal treatment for patellar tendinopathy. Although physical therapy (PT) represents the mainstay of initial management, athletes whose symptoms fail to resolve despite conservative modalities may be indicated for arthroscopic patellar tendon debridement. The authors are not aware of any prior study that has directly compared the clinical outcomes of physical therapy and arthroscopic surgery for the treatment of patellar tendinopathy.
Methods
A systematic review of original research articles was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. To qualify for study inclusion, articles were required to be published in English, Level 4 evidence or higher, and had to examine either arthroscopic surgery or physical therapy in patients with patellar tendinopathy. No restrictions were made regarding publication date and methodological quality. Baseline and final outcome scores were extracted from the included articles, then aggregated and compared between the two treatment groups.
Results
Fifty-two articles including 1,177 patients with patellar tendinopathy were identified. 775 patients were treated with physical therapy and 402 patients were treated with arthroscopic surgery. Mean VAS scores were not significantly different between groups at baseline (5.17 ± 2.15 vs. 5.37 ± 2.50, p = 0.50). However, mean VAS scores at final follow-up were significantly lower in the surgically treated patients (1.45 ± 4.40) compared to those treated with PT (3.28 ± 2.94) (p < 0.001). Mean VISA-P scores at baseline were significantly lower in the arthroscopic surgery group (47.89 ± 8.76) compared to the PT group (55.20 ± 12.34) (p < 0.001). By contrast, mean VISA-P scores at final follow-up were significantly higher in the arthroscopically treated group (88.21 ± 9.86) compared to the PT group (74.25 ± 14.10) (p < 0.001).
Discussion And Conclusion
Although patellar tendinopathy patients treated with arthroscopic debridement had equivalent (VAS) or worse (VISA-P) outcome scores at baseline compared to those treated with PT, the surgically treated patients demonstrated significantly better scores at final follow-up. The findings of this systematic review suggest that arthroscopic treatment of patellar tendinopathy may be associated with improved outcomes compared to PT, particularly in the setting of severe or recalcitrant disease.