Minimally Invasive Intraoperative Strategies May Influence Success Rate and Return to Sport in Arthroscopic Treatment of Patellar Tendinopathy: A Systematic Review of Prospective Studies

Purpose The purpose of this study is to improve understanding of which perioperative variables may influence outcomes and return to activity after arthroscopic debridement of patellar tendinopathy. Methods A keyword search was performed in the PubMed, Embase, CINAHL, Scopus, and Cochrane databases for prospective articles published from 2000 to March, 2024 that studied arthroscopic intervention for refractory patellar tendinopathy. 1885 articles were screened using PRISMA guidelines. Outcomes included subjective Success, Return to Sport (RTS) and patient reported outcomes measures (PROMs). Variables included operative techniques of patellar bony work (PBW), Hoffa’s fat pad debridement (HFPD), peripatellar denervation (DNRV), pre-operative duration of symptoms (DOS), and post-operative immobilization (POI). Data were analyzed descriptively and plotted with I2 and 95% confidence intervals where appropriate. Results Eight prospective arthroscopic studies with a total of 260 patients were included in analysis, with mean follow-up 45.2 months (range 6-79). Average success and RTS rates were 90.2% (range 80-100%) and 90.6% (range 85.7-100%), respectively. There was a weak negative correlation between subjective success rate and DOS (R2=0.14). Studies reported RTS times ranging from 2.2 months to 4.96 months from the day of surgery. Conclusions For refractory patellar tendinopathy, arthroscopic debridement of the patellar tendon is a safe and effective procedure that allows rapid return to sport. Surgeons may elect to forgo patellar bony work and Hoffa’s fat pad debridement in favor of a conservative approach for athletes seeking to return to sport quickly. However, these decisions should always be considered in the circumstances of the individual patient and intraoperative findings.