Arthroscopic Management of Chronic Patellar Tendinopathy

Abstract

Arthroscopic surgery for patients with patellar tendinopathy, refractory to nonoperative management, appears to provide significant improvements in symptoms and function, with improvements maintained for at least 3 years. These results suggest that some patients may not be able to achieve their presymptom sporting level; or if they do, they may participate in sports with some degree of residual symptoms. Limited data show that these improvements are maintained for up to 10 years. Early return to sports may also be achieved.

Surgery for unilateral and bilateral patellar tendinopathy: a seven year comparative study

“…Return to full sporting activity was on average by 8.5 months for patients undergoing unilateral surgery and 10.1 months (p = 0.04) for those in the bilateral group. Pascarella et al [7] emphasised that arthroscopic technique allows early rehabilitation and return to sport. Shorter recovery times, ranging from four [26] to six [27] months, have been observed after open surgery.…”

“…The first approach is conservative [1][2][3][4], with encouraging results in almost 90 % of patients mildly symptomatic. In unresponsive patients, surgery is indicated [5,6]: both open and arthroscopic procedures have been successfully proposed, but the best treatment is still unknown [5,7]. This was a seven year follow-up study comparing clinical, functional and anthropometric outcomes of athletes who had undergone unilateral (unilateral group) vs bilateral (bilateral group) open exploration and multiple tenotomies for management of patellar tendinopathy.…”

Open Patellar Tendon Tenotomy, Debridement, and Repair Technique Augmented With Platelet-Rich Plasma for Recalcitrant Patellar Tendinopathy

“…[2][3][4] Histologically, patellar tendinopathy has been described as microscopic tears in combination with evidence of a failed healing response. This is more evident at the distal aspect of the patella, although it can be seen at any location of the tendon.…”

“…A combination of conservative methods is used, including activity modification, relative rest (which is preferred over immobilization, given that inactivity may lead to further tendon and muscle atrophy), 9 nonsteroidal anti-inflammatory drugs, eccentric exercises, and cryotherapy. 3 Recently, biological approaches have been described as coadjuvant or sole treatments, including prolotherapy, 10 platelet-rich plasma (PRP), [11][12][13] and progenitor Fig 1. A midline skin incision is performed in a left knee centered at the patellar tendon and extending to the tibial tubercle to perform the patellar tendon debridement. The subcutaneous layer is sharply dissected medially and laterally to expose the whole patellar tendon.…”

“…However, no consensus currently exists on the preferred approach. 3 Arthroscopically, debridement of the retropatellar tissues at the site of the attachment of the patellar tendon and partial resection of the distal pole of the patella can be performed. 15 Previously described open surgical techniques include partial removal of the affected patellar tendon; opening of the paratenon; drilling of the distal patellar pole; and tenotomy, debridement, and repair.…”