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

Abstract

Purpose Open surgery for patellar tendinopathy allows patients with unilateral and bilateral tendinopathy to return to high levels of physical activity. Materials Two groups of 23 athletes each underwent open surgical exploration for management of patellar tendinopathy. One group suffered from unilateral patellar tendinopathy (unilateral group), and the other group had bilateral (bilateral group) patellar tendinopathy. Maximum voluntary isometric contraction and anthropometric measures were assessed pre-operatively and at an average follow-up of seven years. The Victorian Institute of Sport Assessment (VISA)-P scoring system was also administered; functional outcomes were classified from excellent to poor according to a modification of Kelly's criteria. Results At the final follow-up, in both groups, VISA-P scores were significantly improved compared with preoperative values, with no intergroup differences. Clinical results were excellent or good in 21 patients in the unilateral and 19 in the bilateral group. Twenty of 23 patients in the unilateral group and 17 of 23 in the bilateral group were still active in sports (p=0.2). In the unilateral group, at the last follow-up, thigh volume and strength were significantly improved compared with baseline, with significant difference between operated and nonoperated limbs. In the bilateral group, there were no significant differences in thigh volume and strength between the dominant and nondominant limbs both before and after the index procedure. Conclusions This procedure is not technically demanding and provides a high rate of good and excellent outcomes in the long term.

Association between patella spurs and quadriceps tendon ruptures

“…Early diagnosis and prompt surgical repair have been shown to have good outcomes in QT ruptures, aided in part by the technical simplicity of the operation 11,12 . Patellar tendinopathy and ruptures have been studied in more detail and it is believed that eccentric exercises and even surgical interventions may be beneficial in tendinopathies which may avoid their progression and subsequent tendon ruptures [13][14][15] . Clinical features of QT ruptures include the triad of pain, loss of extension and a suprapatellar gap.…”

Arthroscopic patellar release for treatment of chronic symptomatic patellar tendinopathy: long-term outcome and influential factors in an athletic population

“…However, if athletes continue to exercise, as often observed in professional athletes, consecutive inflammation of the patellar tendon can lead to degenerative alterations affecting the inferior patellar pole [ 21 , 22 ]. Once patients remain symptomatic, conservative treatment approaches may fail resulting in 10% of athletes choosing to undergo surgery [ 6 , 18 ]. Both, open and arthroscopic surgical modalities proved to be effective for the treatment of chronic-refractory PT and the majority of patients are able to return to sports [ 20 ].…”

“…Pascarella et al performed an arthroscopic debridement of the Hoffa’s body posterior to the patellar tendon and excision of the lower patellar pole and showed a failure rate after 3 years follow-up of 9.6% but still good and excellent results after a follow up of 5 and 10 years [ 19 ]. Maffulli et al performed an open resection of tendinopathic tissue and analyzed clinical outcome at 7 years follow-up yielding in excellent results in more than 80% of cases [ 18 ]. Nevertheless, arthroscopic techniques are currently favored by the majorities of surgeons due to less approach-related morbidity and faster rehabilitation [ 21 – 23 ].…”

Management of Achilles and patellar tendinopathy: what we know, what we can do

“…The tissues excised can be fixed in 10% buffered formalin and sent for histology analysis [132,133]. Maffulli et al [131] evaluated the return to sport activity using open technique in two group of patients, one with unilateral and the other with bilateral tendinopathy. At the final follow-up, in both group, the VISA-P scores [126] were significantly improved compared to preoperative values, with no intergroup differences, concluding that A recent systematic review reported an average success rate of 87% for the open treatment and of 91% for the arthroscopic surgery, with an average rate of return to sport of 78% after open surgery and 82% after arthroscopic surgery.…”