Endoscopic Resection of Lipoma of the Patellar Tendon

Abstract

Synovial lipoma of the patellar tendon is a very rare entity. It can be associated with rupture of the patellar tendon. We present a case of synovial lipoma that was successfully resected endoscopically. The other indications for patellar tendoscopy include chronic patellar tendinitis and tendinosis, recalcitrant bursitis around the tendon, Osgood-Schlatter disease, and jumper's knee. The major potential danger of this endoscopic procedure is iatrogenic damage to the patellar insertion during endoscopic debridement in patients with jumper's knee or the tibial insertion during endoscopic debridement in patients with Osgood-Schlatter disease.

Endoscopic Resection of Prepatellar Bursa

“…If knee arthroscopy, patellar tendoscopy, or endoscopy of the Hoffa fat pad is needed, the standard anterolateral and anteromedial portals can be used for the bursoscopy, arthroscopy, tendoscopy, and endoscopy. [15][16][17] We consider septic bursitis as a relative contraindication of the endoscopic bursectomy. If one wants to perform endoscopic resection of an infected prepatellar bursa, precautions should be taken to prevent spreading of bacteria, such as avoidance of use of an Arthropump, adequate antibiotic cover, and insertion of a suction drain.…”

Endoscopic Resection of Gouty Tophus of the Patellar Tendon

“…Debridement of the superficial and deep surfaces of the patellar tendon can be performed through the same portals. 22 The main contraindication to use of the described technique is diffuse involvement of the patellar tendon with extensive tendinopathic change. Tophaceous deposition at the tibial insertion is a relative contraindication because the debridement may weaken the tendon insertion and result in tendon rupture (Table 1).…”

“…15 Patellar tendoscopy has been used to treat chronic patellar tendinitis and tendinosis, 16,17 recalcitrant bursitis around the tendon, 18 Osgood-Schlatter disease, 19 jumper's knee, 20,21 and synovial lipoma of the tendon. 22 Endoscopic resection of a gouty tophus and tophaceous deposits of the patellar tendon through small incisions away from the lesion and tendon can minimize the risk of wound dehiscence and persistent tophaceous discharge. The portal incisions away from the tendon and tibial tuberosity can minimize the risk of a painful surgical scar especially during kneeling.…”

Endoscopic Resection of Avulsed Fragment of Tibial Tuberosity and Endoscopic-Assisted Repair of Patellar Tendon

“…19 Our endoscopic technique follows the same surgical principles of debridement, bone resection, and tendon repair as in an open procedure. It is indicated in the case of an avulsion fracture of the tibial tuberosity or partial rupture of the patellar tendon with involvement of less than one-third of the tendon.…”

“…Debridement of the tophaceous deposition at the tibial tuberosity should be performed with caution because debridement of the adjacent tendon may weaken the tendon insertion and result in tendon rupture. 19 However, in the case of an avulsion fracture of the tibial tuberosity with gouty deposition, debridement of the tophus is considered essential to reduce the risk of invasion of the adjacent bone and tendon leading to a further avulsion fracture or tendon rupture. The major limitation of our technique is that it is technically demanding and should be reserved for the experienced Preoperative magnetic resonance imaging is essential for surgical planning.…”