Arthroscopic Patellar Tendon Debridement and Distal Pole Osteoplasty for Recalcitrant Patellar Tendinopathy

2022 ◽  
Vol 2 (1) ◽  
pp. 263502542110548
Author(s):  
Arya Amirhekmat ◽  
Hayk Stepanyan ◽  
Kylie Callan ◽  
Riley Williams ◽  
Dean Wang
Keyword(s):  
Patellar Tendon ◽  
Return To Sport ◽  
Dorsal Surface ◽  
Arthroscopic Treatment ◽  
Direct Access ◽  
Infrapatellar Fat Pad ◽  
Patellar Tendinopathy ◽  
Distal Pole ◽  
And Function ◽  
Diseased Portion

Background: Chronic patellar tendinosis is an overuse injury of the patellar tendon that commonly afflicts jumping athletes. Indications: For patients with refractory symptoms that do not respond to extensive physical therapy and rest, surgical management may be considered. Although both open and arthroscopic treatments have been described, arthroscopic treatment allows for more direct access to the diseased dorsal portion of the tendon and allows for faster return to activities and sport. Technique Description: Arthroscopic treatment involves debridement of the diseased portion of the patella tendon and osteoplasty of the distal pole of the patella. The infrapatellar fat pad is first debrided using an arthroscopic shaver and radiofrequency ablation device to the level of the dorsal surface of the patellar tendon. Under direct arthroscopic visualization and corresponding to the location of edema noted on the magnetic resonance image, the diseased portion of the patellar tendon is gently debrided with an arthroscopic shaver. Next, an osteoplasty of the distal pole of the patella is performed to facilitate bleeding and healing of the diseased tendon as well as eliminate any mechanical impingement. Any calcifications within the enthesis can be removed using an arthroscopic biter and resector. An arthroscopic resector is then used to decorticate and smoothen the distal pole of the patella to the level of healthy, bleeding cancellous bone. Results: Significant improvements in pain and function have been reported with arthroscopic treatment for chronic patellar tendinosis. Patients can expect a 90% return to sport rate following the procedure, with return to preinjury function as soon as 3 to 5 months. This procedure is well tolerated with minimal complications reported. Discussion: Arthroscopic patellar tendon debridement and distal pole osteoplasty can be used to treat chronic patellar tendinosis refractory to nonoperative treatment. Improvements in pain and function have been reported with this technique, along with a faster return to sport compared with traditional open techniques.

scholarly journals Results of Arthroscopic Treatment of Chronic Patellar Tendinopathy

PRILOZI ◽  
2020 ◽  
Vol 41 (2) ◽  
pp. 71-79
Author(s):  
Alan Andonovski ◽  
Biljana Andonovska ◽  
Simon Trpeski
Keyword(s):  
Surgical Treatment ◽  
Postoperative Complications ◽  
Patellar Tendon ◽  
Clinical Results ◽  
Arthroscopic Treatment ◽  
Patellar Tendinopathy ◽  
Return To Sports ◽  
Satisfactory Outcome ◽  
Sport Activities ◽  
The Mean

AbstractBackground: The surgical treatment of chronic patellar tendinopathy could be open or arthroscopic. A general agreement on the best surgical treatment option is still lacking.Purpose: The aim of our study was to evaluate the clinical results after a minimally invasive arthroscopic treatment of chronic patellar tendinopathy including a resection of the lower patellar pole.Methods: The study included 14 patients with a mean age of 26 years and chronic patellar tendinopathy refractory to non-operative treatment of more than 6 months. All patients underwent arthroscopic debridement of the adipose tissue of the Hoffa’s body posterior to the patellar tendon, debridement of abnormal patellar tendon and resection of the lower patellar pole. Preoperative and postoperative evaluation was undertaken using clinical examination, magnetic resonance imaging (MRI) and the Lysholm and Victorian Institute of Sport Assessment-Patella (VISA-P) scores. Return to sports and postoperative complications were also assessed. The mean follow-up was 12.2 ± 0.9 months.Results: All 14 patients continued with sport activities, but only 12 of them (85.7%) achieved their presymptom sporting level. The median time to return to preinjury level of activity was 3.9 ± 0.8 months. Patients showed a major improvement in the mean Lysholm score from 51.1 ± 3.8 to 93.4 ± 4.2 (p=0.001) and in the mean VISA-P score from 42.1 ± 3.5 to 86.7 ± 8.4 (p=0.001) There were no postoperative complications.Conclusion: We found that this arthroscopic technique gives reduced morbidity and satisfactory outcome resulting in significantly faster recovery and return to sports in patients with chronic patellar tendinopathy.

Distalising tibial tubercle osteotomy decreases patellar tendon force — A treatment rationale for recalcitrant patellar tendinopathy

The Knee ◽  
2020 ◽  
Vol 27 (3) ◽  
pp. 871-877 ◽  
Author(s):  
Michael J. Dan ◽  
Joseph Cadman ◽  
James McMahon ◽  
William C.H. Parr ◽  
David Broe ◽  
...  
Keyword(s):  
Patellar Tendon ◽  
Patellar Tendinopathy ◽  
Tibial Tubercle ◽  
Tibial Tubercle Osteotomy ◽  
Tendon Force

scholarly journals Surgical Technique: Jumper's Knee—Arthroscopic Treatment of Chronic Tendinosis of the Patellar Tendon

2016 ◽  
Vol 5 (6) ◽  
pp. e1419-e1424 ◽  
Author(s):  
Matthias Brockmeyer ◽  
Alexander Haupert ◽  
Dieter Kohn ◽  
Olaf Lorbach
Keyword(s):  
Surgical Technique ◽  
Patellar Tendon ◽  
Arthroscopic Treatment ◽  
Jumper’S Knee

scholarly journals Histopathological study of the infrapatellar fat pad in a rat patellar tendinopathy model

2018 ◽  
Vol 13 ◽  
pp. 11-12
Author(s):  
Takashi Kitagawa ◽  
Junsuke Nakase ◽  
Yasushi Takata ◽  
Kengo Shimozaki ◽  
Kazuki Asai ◽  
...  
Keyword(s):  
Infrapatellar Fat Pad ◽  
Patellar Tendinopathy ◽  
Histopathological Study ◽  
Fat Pad

scholarly journals Morpho-textural changes of the patellar tendon in professional volleyball players: a six month longitudinal study

2019 ◽  
Vol 02 (02) ◽  
pp. 126-126
Author(s):  
de Groot Ferrando A.
Keyword(s):  
Patellar Tendon ◽  
Effect Size ◽  
Repeated Measures ◽  
Structural Changes ◽  
Patellar Tendinopathy ◽  
Average Effect ◽  
Average Effect Size ◽  
Significant Difference ◽  
Volleyball Players ◽  
Textural Changes

Abstract Introduction Tendinopathy is a term used to describe a clinical presentation of pain and dysfunction, which, at times, is accompanied by pathologic structural changes in the tendon matrix. Jumper's knee has been studied for some time, however the etiology is still unknown. The deep fibers of the proximal region are the most affected area in tendinopathies affecting the patellar tendon. Ultrasound (US) scanning may have the greatest sensitivity for confirming clinically diagnosed patellar tendinopathy compared with other imaging techniques such as magnetic resonance. Some studies have found that a minimum of six months is required to observe significant structural changes, although other studies reveal that structural changes can be visible in a shorter period of time. Thus, sonography has been used to evaluate quantitative variables such as thickness, echogenicity, texture measures and the internal tendon matrix. Objective The purpose of this study was to evaluate the sonographic behavior of morpho-textural changes of the patellar tendon in professional male volleyball players over a one year season. Material and Methods This is an observational, longitudinal and analytical study. A sample of 66 patellar tendons from 33 volleyball players of the Spanish super league was recruited, with an average of: 28 years, 86kg and 192cm. An ultrasound scan was performed using the Sonosite Titan ultrasound system, L38, 5–10 MHz, with a cross section of 5mm from the lower pole of the patella. Two depths were analyzed: a.39mm: echogenicity, echogenicity variation, circularity, width and thickness. b.24mm: entropy and contrast. Statistical analysis and analysis of variance (ANOVA) was performed for repeated measures and, in addition, the effect size was calculated with Cohen's d. The confidence interval was 95%. SPSS Statistics software was used. Results For textural variables: contrast increased significantly with an average effect size, and entropy showed no significant difference. Circularity was significantly lower. Width was shown to be significantly greater, with an average effect size, while thickness was reduced significantly. Regarding echogenicity, no significant changes were detected and variation in echogenicity did not show significant changes. Conclusions Imaging analysis could be a potential tool to detect changes in the pattern of patellar tendons. Some morpho-textural changes were found in male volleyball players: the textural contrast variable increases significantly throughout the annual season, meaning that the tendon becomes slightly flatter and loses circularity in its transverse section. The entropy and echogenic parameters obtained from the gray-scale histogram did not reveal any significant changes.

scholarly journals Mechanical properties of the patellar tendon in elite volleyball players with and without patellar tendinopathy

2013 ◽  
Vol 47 (13) ◽  
pp. 862-868 ◽  
Author(s):  
Christian Helland ◽  
Jens Bojsen-Møller ◽  
Truls Raastad ◽  
Olivier R Seynnes ◽  
Marie M Moltubakk ◽  
...  
Keyword(s):  
Mechanical Properties ◽  
Patellar Tendon ◽  
Patellar Tendinopathy ◽  
Volleyball Players

scholarly journals Patellar and Achilles Tendon Stiffness in Elite Soccer Players Assessed Using Myotonometric Measurements

2019 ◽  
Vol 11 (2) ◽  
pp. 157-162 ◽  
Author(s):  
Iver Cristi-Sánchez ◽  
Claudia Danes-Daetz ◽  
Alejandro Neira ◽  
Wilson Ferrada ◽  
Roberto Yáñez Díaz ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Patellar Tendon ◽  
Professional Training ◽  
Soccer Players ◽  
Patellar Tendinopathy ◽  
Control Group ◽  
Force Transmission ◽  
Level Of Evidence ◽  
Tendon Stiffness ◽  
Handheld Device

Background: Tendon overuse injuries are an issue in elite footballers (soccer players) and may affect tendon function. Achilles and patellar tendinopathy are the most frequent pathologies. Tendon stiffness, the relationship between the force applied to a tendon and the displacement exerted, may help represent tendon function. Stiffness is affected by training and pathology. Nevertheless, information regarding this mechanical property is lacking for elite soccer athletes. Hypothesis: Achilles and patellar tendon stiffness assessed using myotonometric measurements will be greater in elite soccer athletes than in control participants. Study Design: Cross-sectional study. Level of Evidence: Level 4. Methods: Forty-nine elite soccer athletes and 49 control participants were evaluated during the 2017 preseason. A handheld device was used to measure Achilles and patellar tendon stiffness. Dominant and nondominant limbs were assessed for both groups. Results: A significantly stiffer patellar tendon was found for both the dominant and the nondominant limb in the elite soccer athletes compared with the control group. Nevertheless, no differences were found in Achilles tendon stiffness between groups. When comparing between playing positions in soccer athletes, no significant differences were found for both tendons. Conclusion: Greater patellar tendon stiffness may be related to an improvement in force transmission during muscle contraction. On the other hand, it seems that after years of professional training, Achilles tendon stiffness does not change, conserving the storing-releasing function of elastic energy. The nonsignificant differences between positions may be attributable to the years of homogeneous training that the players underwent. Clinical Relevance: The present study shows another technique for measuring mechanical properties of tendons in soccer athletes that could be used in clinical settings. In the future, this technique may help clinicians choose the best exercise protocol to address impairments in tendon stiffness.

scholarly journals Ultrasound Characterization of Patellar Tendon in Non-Elite Sport Players with Painful Patellar Tendinopathy: Absolute Values or Relative Ratios? A Pilot Study

Diagnostics ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. 882
Author(s):  
José L. Arias-Buría ◽  
César Fernández-de-las-Peñas ◽  
Jorge Rodríguez-Jiménez ◽  
Gustavo Plaza-Manzano ◽  
Joshua A. Cleland ◽  
...  
Keyword(s):  
Pilot Study ◽  
Patellar Tendon ◽  
Operating Characteristic ◽  
Diagnostic Value ◽  
Patellar Tendinopathy ◽  
Width Ratio ◽  
Elite Sport ◽  
Cross Sectional ◽  
Blinded Assessor

Imaging findings in patellar tendinopathy are questioned. The aim of this pilot study was to characterize ultrasound measures, by calculating ultrasound ratio and neovascularization of the patellar tendon in non-elite sport players with unilateral painful patellar tendinopathy. Cross-sectional area (CSA), width, and thickness of the patellar tendon were assessed bilaterally in 20 non-elite sport-players with unilateral painful patellar tendinopathy and 20 asymptomatic controls by a blinded assessor. Ultrasound ratios were calculated to discriminate between symptomatic and asymptomatic knees. The Ohberg score was used for characterizing neovascularization. We found that non-elite sport players with patellar tendinopathy exhibited bilateral increases in CSA, width, and thickness of the patellar tendon compared to asymptomatic controls (Cohen d > 2). The ability of ultrasound ratios to discriminate between painful and non-painful patellar tendons was excellent (receiver operating characteristic, ROC > 0.9). The best diagnostic value (sensitivity: 100% and specificity: 95%) was observed when a width ratio ≥ 1.29 between the symptomatic and asymptomatic patellar tendon was used as a cut-off. Further, neovascularization was also observed in 70% of non-elite sport players with unilateral patellar tendinopathy. A greater CSA ratio was associated with more related-disability and higher tendon neovascularization. This study reported that non-elite sport players with painful unilateral patellar tendinopathy showed structural ultrasound changes in the patellar tendon when compared with asymptomatic controls. Ultrasound ratios were able to discriminate between symptomatic and asymptomatic knees. Current results suggest that ultrasound ratios could be a useful imaging outcome for identifying changes in the patellar tendon in sport players with unilateral patellar tendinopathy.

Rethinking Patellar Tendinopathy and Partial Patellar Tendon Tears: A Novel Classification System

2020 ◽  
Vol 48 (2) ◽  
pp. 359-369 ◽  
Author(s):  
Mikhail Golman ◽  
Margaret L. Wright ◽  
Tony T. Wong ◽  
T. Sean Lynch ◽  
Christopher S. Ahmad ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Patellar Tendon ◽  
Classification System ◽  
Treatment Guidelines ◽  
Patellar Tendinopathy ◽  
Partial Tear ◽  
Partial Thickness ◽  
Tendon Thickness ◽  
Tendon Tears ◽  
The Relationship

Background: Patellar tendinopathy is an overuse injury of the patellar tendon frequently affecting athletes involved in jumping sports. The tendinopathy may progress to partial patellar tendon tears (PPTTs). Current classifications of patellar tendinopathy are based on symptoms and do not provide satisfactory evidence-based treatment guidelines. Purpose: To define the relationship between PPTT characteristics and treatment guidelines, as well as to develop a magnetic resonance imaging (MRI)–based classification system for partial patellar tendon injuries. Study Design: Cohort study (prognosis); Level of evidence, 2. Methods: MRI characteristics and clinical treatment outcomes were retrospectively reviewed for 85 patients with patellar tendinopathy, as well as 86 physically active control participants who underwent MRI of the knee for other conditions. A total of 56 patients had a PPTT and underwent further evaluation for tear size and location. The relationship between tear characteristics and clinical outcome was defined with use of statistical comparisons and univariate and logistic regression models. Results: Of the 85 patients, 56 had partial-thickness patellar tendon tears. Of these tears, 91% involved the posterior and posteromedial regions of the proximal tendon. On axial MRI views, patients with a partial tear had a mean tendon thickness of 10 mm, as compared with 6.2 mm for those without ( P < .001). Eleven patients underwent surgery for their partial-thickness tear. All of these patients had a tear >50% of tendon thickness (median thickness of tear, 10.3 mm) on axial views. Logistic regression showed that tendon thickness >8.8 mm correlated with the presence of a partial tear, while tendon thickness >11.45 mm and tear thickness >55.7% predicted surgical management. Conclusion: Partial-thickness tears are located posterior or posteromedially in the proximal patellar tendon. The most sensitive predictor for detecting the presence of a partial tear was patellar tendon thickness, in which thickness >8.8 mm was strongly correlated with a tear of the tendon. Tracking thickness changes on axial MRI may predict the effectiveness of nonoperative therapy: athletes with patellar tendon thickness >11.5 mm and/or >50% tear thickness on axial MRI were less likely to improve with nonoperative treatment. A novel proposed classification system for partial tears, the Popkin-Golman classification, can be used to guide treatment decisions for these patients.

scholarly journals Surgical Treatments of Talar Osteochondral Lesion: A Long-term Follow-up of Return to Sport and Patient-Reported Outcome Measures

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0037
Author(s):  
Andrew Schwartz ◽  
Shuo Niu ◽  
Faris Mirza ◽  
Ashley Thomas ◽  
Sameh Labib
Keyword(s):  
Outcome Measures ◽  
Osteochondral Lesion ◽  
Return To Sport ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Surgical Interventions ◽  
Patient Reported ◽  
Long Term Follow Up ◽  
And Function

Category: Ankle, Arthroscopy, Sports, Trauma Introduction/Purpose: Talar osteochondral lesion (TOCL) is a common problem in the young athletic population, mostly related to trauma. TOCL surgical treatment algorithm remains controversial, though results are improving as we gain experience. The results of TOCL surgical treatment on function and return to sport are promising, but quantified return to sport metrics remain largely unknown. Methods: A total of 156 consecutive patients following TOCL chondroplasty (10/1/2000-5/31/2018) by a single practice were retrospectively reviewed and included in this study. There were 54.5% female with a mean age 38.2 years, and mean follow-up 40.2 months following the index surgery. Patients were divided into four groups according to the type of chondroplasty performed: Antegrade arthroscopic drilling and/or microfracture (antegrade, 83 patients), retrograde arthroscopic drilling (retrograde, 35 patients), osteochondral autograft transfer (OATS, 26 patients), and allograft cartilage implantation (allograft, 12 patients). VAS scores for pain and function at the final clinic visit were collected. Patient-reported outcome measures including the short form-12 (SF-12), The Foot and Ankle Disability Index Sports Module (FADI-sports), Tegner score, Marx scale, Naal’s Sports inventory are also actively being collected. Results: Nearly 75% of patients are satisfied with surgical intervention of TOCLs. Allograft transplant was the least satisfying (71.4%), while OATS was the most satisfying (90%). Each surgical intervention yielded significantly decreased pain and increased function postoperatively (all p<0.001). Currently, 57 patients (36%) provided patient-reported outcome measures, with an average follow up of 79.8 months (Table 1). All surgical interventions trended toward decreased Tegner score, though only antegrade drilling showed a significant decrease (p<0.001). Based on Naal’s sports inventory, 85.7% of surgically treated patients reported participating in sport activities, on average 3 times/week and 50.6 minutes/session. Conclusion: Traditionally, TOCLs presented a difficult problem that is marred by unsatisfactory surgical outcomes in typically active patients. As our surgical understanding has evolved, we’ve continued to improve on outcomes. Our patients demonstrated a 74.5% satisfaction rate, a statistically significant improvement in pain and function, and a high rate of return to sport with little difference between surgical interventions at a long-term follow-up.

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