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Open versus arthroscopic surgical treatment of chronic proximal patellar tendinopathy. A systematic review

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

A general agreement on the best surgical treatment option of chronic proximal patellar tendinopathy is still lacking. The purpose of this systematic review was to investigate if arthroscopically assisted procedures have been reported better results compared to open surgery and to assess the methodology of studies.

Methods

Twenty-one studies were included in the review. Surgical outcomes were defined referring to the functional classification described by Kelly et al. (Am J Sports Med 12(5):375–380, [11]): return to sport was regarded as the ability of training at the original level before injury with mild or moderate pain and success as the improvement after surgery with symptom reduction. Methodological analysis was performed by two reviewers adopting the Coleman Methodology Score (CMS) (range 0–100, best score 100).

Results

Only one randomized controlled trial (RCT) met inclusion criteria; all other included studies were case series. Median sample size 24, range 11–138, mean age at surgery 26.8 ± 3.2 years, mean follow-up 32.5 ± 18.4 (median 31, range 6–60) months. Return to sport rate: global 78.5 %, open group 76.6 % and arthroscopic group 84.2 %. Success rate: global 84.6 %, open group 87.2 % and arthroscopic group 92.4 %. Differences between groups were not statistically significant. CMSs were positively correlated with the year of publication (P < 0.05).

Conclusions

Minimally invasive arthroscopically assisted procedures have not reported better statistically significant results when compared to open surgery in the treatment of chronic proximal patellar tendinopathy. The methodology of studies in this field has improved over the past 15 years, but well-designed RCTs using validated patient-based outcome measures are still lacking.

Level of evidence

Systematic Review, Level IV.

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Acknowledgments

The authors would like to thank: Benedetta Bertozzi for writing assistance; Costanza Musiani, Emil Ferretti, Antonio Scarale, Federico Raggi, Tommaso Roberti di Sarsina and the Library’s Staff of our Institute for their technical support. No external funding was received for this study.

Conflict of interest

The authors declared that they had no conflict of interest.

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Authors and Affiliations

  1. Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Pupilli, 1, 40136, Bologna, Italy

    Giulio Maria Marcheggiani Muccioli, Stefano Zaffagnini, Ester Alessandrini, Tommaso Bonanzinga, Alberto Grassi, Laura Bragonzoni & Maurilio Marcacci

  2. Isokinetic Study Center, Via Casteldebolo, 8/4, 40132, Bologna, Italy

    Kyriakos Tsapralis & Stefano Della Villa

  3. Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via di Barbiano, 1/10, 40100, Bologna, Italy

    Stefano Zaffagnini

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  1. Giulio Maria Marcheggiani Muccioli
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Correspondence to Stefano Zaffagnini.

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Marcheggiani Muccioli, G.M., Zaffagnini, S., Tsapralis, K. et al. Open versus arthroscopic surgical treatment of chronic proximal patellar tendinopathy. A systematic review. Knee Surg Sports Traumatol Arthrosc 21, 351–357 (2013). https://doi.org/10.1007/s00167-012-2100-9

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  • DOI: https://doi.org/10.1007/s00167-012-2100-9

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