Flexibility of infrapatellar fat pad affecting anterior knee pain 6 months after anterior cruciate ligament reconstruction with hamstring autograft

Kitagawa, Takashi; Nakase, Junsuke; Takata, Yoshinobu; Shimozaki, Kengo; Asai, Kazuki; Yoshimizu, Rikuto; Kimura, Mitsuhiro; Tsuchiya, Hiroyuki

doi:10.1038/s41598-020-78406-y

Cited by 9 publications

(12 citation statements)

References 30 publications

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“…Moreover, AKP is also often explained by the PT graft site morbidity. In case of HT procedure, the Kujala score and the Cincinnati Knee score are low, but these scores are used to identify only AKP defined as femoro-patellar pain [ 21 , 22 ]. The AMI recovery after ACLR seems to be delayed in patients with AKP compared to those without AKP [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

Consequences of anterior knee pain after anterior cruciate ligament reconstruction: A 2015–2020 cohort study

Chantrelle

Crenn

et al. 2023

PLoS ONE

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Anterior cruciate ligament reconstruction (ACLR) using hamstring tendon (HT) graft aims to stabilise the knee, but it may bring some complications like anterior knee (AKP) pain that can have consequences on the functional aspect of this surgery. The aim of this study was to compare isokinetic knee strength and functional outcomes between patients with and without AKP following an ACLR using HT graft during the first-year post-surgery. Three hundred and thirty subjects operated by ACLR using hamstring tendon graft were included in our retrospective cohort and divided into two groups: a group with AKP (AKP+ group) and one without AKP (AKP–group). In our population, 14.8% of the patients had AKP. At 4 post-operative months, subjects with pain had lower isokinetic strength limb symmetry index (LSI) for knee flexors and extensors, and a lower Lysholm score than subjects without pain (p < 0.0001). These differences did not persist at 7 post-operative months, and there was no difference in the one-leg hop test. After multivariate analysis, we highlighted the impact of time on the evolution of these parameters. Yet, the exact definition of AKP after ACLR remains to be clearly defined since an imprecise diagnosis may lead to inappropriate management. Pre-operative information about this type of complication, which evolves favourably with time, could be useful for patients. Indeed, AKP can occur after ACLR, even if a HT graft has been used, compared to other surgical procedures using the knee extensor apparatus as patellar tendon graft (AKP is associated with the donor site morbidity). In case of AKP after ACLR, monitoring the muscle inhibition by isokinetic tests may enable clinicians to adapt the retraining and the return to sport.

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Section: Introductionmentioning

confidence: 99%

Consequences of anterior knee pain after anterior cruciate ligament reconstruction: A 2015–2020 cohort study

Chantrelle

Crenn

et al. 2023

PLoS ONE

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“…We think it may be the reason that branches of the femoral, saphenous, obturator, and sciatic nerves pass through IPFP so that IPFP plays an important role in pain perception 26 . Moreover, in the present study, the IPFP of patients in the resection group was partially resected, and a decrease in the threshold of pain sensation may result from an increase in free nerve endings 13 . In addition, previous animal model studies have confirmed that when the rat experienced ACLR, trauma or patellar tendinopathy, free nerve endings in the IPFP used to be accompanied by fibrosis, vascularity, and other histopathological changes 27 , 28 .…”

Section: Discussionmentioning

confidence: 58%

“…Recently, one study suggested that partial resection of the IPFP during ACLR did not affect clinical outcomes including anterior knee pain 12 . However, the other study showed that after ACLR, a decrease in the thickness change ratio of the fat pad appeared to affect post-operative anterior knee pain 13 . Moreover, numerous studies have shown that the preservation of IPFP had a better postoperative outcome during total knee arthroplasty 14 – 17 .…”

Section: Introductionmentioning

confidence: 89%

Outcome analysis of infrapatellar fat pad partial resection or preservation in patients with anterior cruciate ligament reconstruction

Wen

Xing

Liu

et al. 2023

Sci Rep

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The infrapatellar fat pad (IPFP) is one of the structures surrounding the knee joint that obscures exposure in minimally arthroscopy anterior cruciate ligament reconstruction (ACLR). Most surgeons excise the partial fat pad for better exposure of the knee. However, whether removal of IPFP in ACLR remained inconclusive. The purpose of this study was to investigate clinical outcomes of IPFP preservation or resection in patients with primary hamstring-graft ACLR. A total of 104 patients were assigned to receive either IPFP-R (n = 55) or IPFP-P (n = 49). There were no significant preoperative differences between the two groups. The anterior knee pain (AKP) and the Knee Injury and Osteoarthritis Outcome Score (KOOS) in the two groups both recovered compared with those at baseline, but the IPFP-P group recovered more significantly at 3-, 6-, 12-month, and 3-, 6-month of follow-up, respectively. When assessing the KOOS subclasses using minimum perceptible clinical improvement (MPCI), patients with IPFP-R failed to make significant improvement at 3 months in the symptoms, pain and sports subsets of the KOOS. Knee-related complications were not significantly different between the two groups, while the resection group had a higher incidence. These results suggested that ACLR with primary hamstring grafts can achieve good effects whether performed with IPFP resection or preservation; however, the improvements in anterior knee pain and knee joint functions are better for the patients with IPFP preservation. Therefore, surgeons should avoid the resection of IPFP as much as possible while fully exposing the wild view to ensure the ACLR.

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“…In patients with knee joint diseases, such as anterior cruciate ligament injury, the IPFP shows reduced flexibility [ 5 ]. Decreased flexibility of the IPFP is also associated with clinical symptoms, such as limited range of motion and anterior pain in the knee joint [ 6 , 7 ]. Therefore, it is clinically important to maintain normal flexibility of the IPFP or recover the movement once it is reduced.…”

Section: Introductionmentioning

confidence: 99%

“…To date, there have been few reports on conservative clinical treatments for improving flexibility and lesions of the IPFP, which are associated with anterior knee pain [ 7 ]. Conservative treatment, such as physical therapy, is an option for anterior knee pain [ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

Effect of physical therapy on the flexibility of the infrapatellar fat pad: A single-blind randomised controlled trial

2022

Self Cite

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The infrapatellar fat pad plays a biomechanical role in the knee joint. After knee injury or surgery, its dynamics decrease because of an inflammatory response. Physical therapy might be one of the valuable treatments for the recovery of knee joint mobility. This study aimed to evaluate the immediate effect of physical therapy on the dynamics of the infrapatellar fat pad in healthy participants using ultrasonography. In this prospective, single-blind, randomised controlled trial, 64 healthy young participants were enrolled and randomly assigned to one of the following three interventions: manual therapy, hot pack treatment, and control. Ultrasound images of the infrapatellar fat pad were obtained before and after the intervention. The thickness change ratio of the infrapatellar fat pad was calculated to compare the changes between and within groups before and after the intervention. No significant inter-group differences were observed. The effect sizes were relatively small. Manual therapy or hot pack intervention might not have an immediate effect on infrapatellar fat pad flexibility in healthy participants. Thus, it is necessary to consider more intensive treatments to change the dynamics of the infrapatellar fat pad.

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Flexibility of infrapatellar fat pad affecting anterior knee pain 6 months after anterior cruciate ligament reconstruction with hamstring autograft

Cited by 9 publications

References 30 publications

Consequences of anterior knee pain after anterior cruciate ligament reconstruction: A 2015–2020 cohort study

Consequences of anterior knee pain after anterior cruciate ligament reconstruction: A 2015–2020 cohort study

Outcome analysis of infrapatellar fat pad partial resection or preservation in patients with anterior cruciate ligament reconstruction

Effect of physical therapy on the flexibility of the infrapatellar fat pad: A single-blind randomised controlled trial

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