Refractory patellar tendinopathy treated by arthroscopic decortication of the inferior patellar pole in athletes: Mid-term outcomes

Abstract

Background: This study aimed to evaluate the clinical outcomes of arthroscopic decortication of the inferior patellar pole in athletes with refractory chronic patellar tendinopathy.

Methods: Thirty-seven athletes in whom conservative management for at least six months failed underwent arthroscopic patellar tendon debridement and decortication of the inferior pole of the patella. Clinical outcomes were evaluated using subjective knee scores and isokinetic muscle strength tests. The average duration taken and sports participation level were also assessed.

Results: The mean follow-up period was 51.3 ± 14.8 months. At the last follow-up, all improvements in subjective knee scores including Lysholm score, International Knee Documentation Committee (IKDC) subjective score, Victorian Institute of Sport Assessment -Patella (VISA-P) score, and Kujala score were statistically significant (p<.001). Tegner activity scale improved from 6.5±1.0 to 8.9±0.8 (p<.001). Limb symmetry index for extensor peak torque improved from 71.4±19.6% to 92.7±21.7% (p<.001). Thirty-two (86.5 %) athletes were able to return to full sports activities in a mean 3.5±1.7months, and 27 (73%) athletes maintained their previous sports activity level at the last follow-up. Symptoms recurred in two (5.2%).

Conclusions: Arthroscopic decortication of the inferior pole of the patella showed satisfactory clinical results and high rates of return to sports at mid-term follow-up in professional athletes with refractory chronic patellar tendinopathy. This technique could be an invasive, safe, and effective treatment for chronic patellar tendinopathy in professional athletes who want a faster return to sports.

Level of evidence: Level IV, case series.

Keywords: Arthroscopy; Athletes; Debridement; Decortication; Patellar inferior pole; Patellar tendinopathy.