Sports Medicine

, Volume 42, Issue 1, pp 51–67 | Cite as

Evaluation and Treatment of Disorders of the Infrapatellar Fat Pad

  • Jason L. Dragoo
  • Christina Johnson
  • Jenny McConnell
Review Article Evaluation and Treatment of IFP Disorders

Abstract

The infrapatellar fat pad (IFP), also known as Hoffa’s fat pad, is an intracapsular, extrasynovial structure that fills the anterior knee compartment, and is richly vascularized and innervated. Its degree of innervation, the proportion of substance-P-containing fibres and close relationship to its posterior synovial lining implicates IFP pathologies as a source of infrapatellar knee pain. Though the precise function of the IFP is unknown, studies have shown that it may play a role in the biomechanics of the knee or act as a store for reparative cells after injury.

Inflammation and fibrosis within the IFP, caused by trauma and/or surgery can lead to a variety of arthrofibrotic lesions including Hoffa’s disease, anterior interval scarring and infrapatellar contracture syndrome. Lesions or mass-like abnormalities rarely occur within the IFP, but their classification can be narrowed down by radiographical appearance.

Clinically, patients with IFP pathology present with burning or aching infrapatellar anterior knee pain that can often be reproduced on physical exam with manoeuvres designed to produce impingement. Sagittal MRI is the most common imaging technique used to assess IFP pathology including fibrosis, inflammation, oedema, and mass-like lesions.

IFP pathology is often successfully managed with physical therapy. Passive taping is used to unload or shorten an inflamed IFP, and closed chain quadriceps exercises can improve lower limb control and patellar congruence. Training of the gluteus medius and stretching the anterior hip may help to decrease internal rotation of the hip and valgus force at the knee. Gait training and avoiding hyperextension can also be used for long-term management. Injections within the IFP of local anaesthetic plus corticosteroids and IFP ablation with ultrasound guided alcohol injections have been successfully explored as treatments for IFP pain.

IFP pathology refractory to physical therapy can be approached through a variety of operative treatments. Arthroscopic partial resection for IFP impingement and Hoffa’s disease has showed favourable results; however, total excision of the IFP performed concomitantly with total knee arthroplasty (TKA) resulted in worse results when compared with TKA alone. Arthroscopic debridement of IFP fibrosis has been successfully used to treat extension block following anterior cruciate ligament reconstruction, and arthroscopic anterior interval release has been an effective treatment for pain associated with anterior interval scarring. Arthroscopic resection of infrapatellar plicae and denervation of the inferior pole of the patella have also been shown to be effective treatments for refractory infrapatellar pain.

References

  1. 1.
    Biedert RM, Sanchis-Alfonso V. Sources of anterior knee pain. Clin Sports Med 2002; 21 (3): 335–47PubMedCrossRefGoogle Scholar
  2. 2.
    Bohnsack M, Wilharm A, Hurschler C, et al. Biomechanical and kinematic influences of a total infrapatellar fat pad resection on the knee. Am J Sports Med 2004; 32 (8): 1873–80PubMedCrossRefGoogle Scholar
  3. 3.
    Gallagher J, Tierney P, Murray P, et al. The infrapatellar fat pad: anatomy and clinical correlations. Knee Surg Sports Traumatol Arthrosc 2005; 13 (4): 268–72PubMedCrossRefGoogle Scholar
  4. 4.
    Brooker B, Morris H, Brukner P, et al. The macroscopic arthroscopic anatomy of the infrapatellar fat pad. Arthroscopy 2009; 25 (8): 839–45PubMedCrossRefGoogle Scholar
  5. 5.
    Jacobson JA, Lenchik L, Ruhoy MK, et al. MR imaging of the infrapatellar fat pad of hoffa. Radiographics 1997; 17 (3): 675–91PubMedGoogle Scholar
  6. 6.
    Patel SJ, Kaplan PA, Dussault RG, et al. Anatomy and clinical significance of the horizontal cleft in the infrapatellar fat pad of the knee: MR imaging. AJR Am J Roentgenol 1998; 170 (6): 1551–5PubMedCrossRefGoogle Scholar
  7. 7.
    Steadman JR, Dragoo JL, Hines SL, et al. Arthroscopic release for symptomatic scarring of the anterior interval of the knee. Am J Sports Med 2008; 36 (9): 1763–9PubMedCrossRefGoogle Scholar
  8. 8.
    Paulos LE, Wnorowski DC, Greenwald AE. Infrapatellar contracture syndrome: diagnosis, treatment, and long-term followup. Am J Sports Med 1994; 22 (4): 440–9PubMedCrossRefGoogle Scholar
  9. 9.
    Duri Z, Aichroth P, Dowd G, et al. The fat pad and its relationship to anterior knee pain. Knee 1997; 4 (4): 227–36CrossRefGoogle Scholar
  10. 10.
    Bohnsack M, Hurschler C, Demirtas T, et al. Infrapatellar fat pad pressure and Vol. changes of the anterior compartment during knee motion: possible clinical consequences to the anterior knee pain syndrome. Knee Surg Sports Traumatol Arthrosc 2005; 13 (2): 135–41PubMedCrossRefGoogle Scholar
  11. 11.
    Kohn D, Deiler S, Rudert M. Arterial blood supply of the infrapatellar fat pad: anatomy and clinical consequences. Arch Orthop Trauma Surg 1995; 114 (2): 72–5PubMedCrossRefGoogle Scholar
  12. 12.
    Scapinelli R. Vascular anatomy of the human cruciate ligaments and surrounding structures. Clin Anat 1997; 10 (3): 151–62PubMedCrossRefGoogle Scholar
  13. 13.
    Dye SF, Vaupel GL, Dye CC. Conscious neurosensory mapping of the internal structures of the human knee without intraarticular anesthesia. Am J Sports Med 1998; 26 (6): 773–7PubMedGoogle Scholar
  14. 14.
    Bohnsack M, Meier F, Walter GF, et al. Distribution of substance-P nerves inside the infrapatellar fat pad and the adjacent synovial tissue: a neurohistological approach to anterior knee pain syndrome. Arch Orthop Trauma Surg 2005; 125 (9): 592–7PubMedCrossRefGoogle Scholar
  15. 15.
    Witonski D, Wagrowska-Danielewicz M. Distribution of substance-P nerve fibers in the knee joint in patients with anterior knee pain syndrome: a preliminary report. Knee Surg Sports Traumatol Arthrosc 1999; 7 (3): 177–83PubMedCrossRefGoogle Scholar
  16. 16.
    Kennedy JC, Alexander IJ, Hayes KC. Nerve supply of the human knee and its functional importance. Am J Sports Med 1982; 10 (6): 329–35PubMedCrossRefGoogle Scholar
  17. 17.
    Wojtys EM, Beaman DN, Glover RA, et al. Innervation of the human knee joint by substance-P fibers. Arthroscopy 1990; 6 (4): 254–63PubMedCrossRefGoogle Scholar
  18. 18.
    Lehner B, Koeck FX, Capellino S, et al. Preponderance of sensory versus sympathetic nerve fibers and increased cellularity in the infrapatellar fat pad in anterior knee pain patients after primary arthroplasty. J Orthop Res 2008; 26 (3): 342–50PubMedCrossRefGoogle Scholar
  19. 19.
    Biedert RM, Stauffer E, Friederich NF. Occurrence of free nerve endings in the soft tissue of the knee joint: a histologic investigation. Am J Sports Med 1992; 20 (4): 430–3PubMedCrossRefGoogle Scholar
  20. 20.
    Ushiyama T, Chano T, Inoue K, et al. Cytokine production in the infrapatellar fat pad: another source of cytokines in knee synovial fluids. Ann Rheum Dis 2003 Feb; 62 (2): 108–12PubMedCrossRefGoogle Scholar
  21. 21.
    Clockaerts S, Bastiaansen-Jenniskens YM, Runhaar J, et al. The infrapatellar fat pad should be considered as an active osteoarthritic joint tissue: a narrative review. Osteoarthr Cartil 2010; 18 (7): 876–82PubMedCrossRefGoogle Scholar
  22. 22.
    Murakami S, Muneta T, Furuya K, et al. Immunohistologic analysis of synovium in infrapatellar fat pad after anterior cruciate ligament injury. Am J Sports Med 1995; 23 (6): 763–8PubMedCrossRefGoogle Scholar
  23. 23.
    Hodges PW, Mellor R, Crossley K, et al. Pain induced by injection of hypertonic saline into the infrapatellar fat pad and effect on coordination of the quadriceps muscles. Arthritis Rheum 2009; 61 (1): 70–7PubMedCrossRefGoogle Scholar
  24. 24.
    Bennell K, Hodges P, Mellor R, et al. The nature of anterior knee pain following injection of hypertonic saline into the infrapatellar fat pad. J Orthop Res 2004; 22 (1): 116–21PubMedCrossRefGoogle Scholar
  25. 25.
    Chew HF, Evans NA, Stanish WD. Patient-controlled bupivacaine infusion into the infrapatellar fat pad after anterior cruciate ligament reconstruction. Arthroscopy 2003; 19 (5): 500–5PubMedCrossRefGoogle Scholar
  26. 26.
    Lemon M, Packham I, Narang K, et al. Patellar tendon length after knee arthroplasty with and without preservation of the infrapatellar fat pad. J Arthroplasty 2007; 22 (4): 574–80PubMedCrossRefGoogle Scholar
  27. 27.
    Tanaka N, Sakahashi H, Sato E, et al. Influence of the infrapatellar fat pad resection in a synovectomy during total knee arthroplasty in patients with rheumatoid arthritis. J Arthroplasty 2003; 18 (7): 897–902PubMedCrossRefGoogle Scholar
  28. 28.
    Dragoo JL, Phillips C, Schmidt JD, et al. Mechanics of the anterior interval of the knee using open dynamic MRI. Clin Biomech 2010; 25 (5): 433–7CrossRefGoogle Scholar
  29. 29.
    Donell ST. The synovial folds of the patellofemoral joint: a dynamic study. Clin Anat 1992; 5 (2): 107–12CrossRefGoogle Scholar
  30. 30.
    Takatoku K, Sekiya H, Hayashi M, et al. Influence of fat pad removal on patellar tendon length during growth. Knee Surg Sports Traumatol Arthrosc 2005; 13 (8): 706–13PubMedCrossRefGoogle Scholar
  31. 31.
    Dragoo JL, Samimi B, Zhu M, et al. Tissue-engineered cartilage and bone using stem cells from human infrapatellar fat pads. J Bone Joint Surg Br 2003; 85 (5): 740–7PubMedGoogle Scholar
  32. 32.
    English A, Jones EA, Corscadden D, et al. A comparative assessment of cartilage and joint fat pad as a potential source of cells for autologous therapy development in knee osteoarthritis. Rheumatology 2007 November; 46 (11): 1676–83PubMedCrossRefGoogle Scholar
  33. 33.
    Wickham MQ, Erickson GR, Gimble JM, et al. Multipotent stromal cells derived from the infrapatellar fat pad of the knee. Clin Orthop Rel Res 2003; 412: 196–212CrossRefGoogle Scholar
  34. 34.
    Post WR. Anterior knee pain: Diagnosis and treatment. J Am Acad Orthop Surg 2005 Dec; 13 (8): 534–43PubMedGoogle Scholar
  35. 35.
    Kumar D, Alvand A, Beacon JP. Impingement of infrapatellar fat pad (Hoffa’s disease): results of high-portal arthroscopic resection. Arthroscopy 2007; 23 (11): 118011860Google Scholar
  36. 36.
    McConnell J. The physical therapist’s approach to patellofemoral disorders. Clin Sports Med 2002; 21 (3): 363–87PubMedCrossRefGoogle Scholar
  37. 37.
    Metheny JA, Mayor MA. Hoffa disease: chronic impingement of the infrapatellar fat pad. Am J Knee Surg 1988; 1: 134–9Google Scholar
  38. 38.
    Smith BW, Green GA. Acute knee injuries. Part I: history and physical examination. Am Fam Phys 1995; 51 (3): 615–21Google Scholar
  39. 39.
    Akseki D, Pinar H, Karaoglan O. The accuracy of the clinical diagnosis of meniscal tears with or without associated anterior cruciate ligament tears. Acta Orthop Traumatol Turc 2003; 37 (3): 193–8PubMedGoogle Scholar
  40. 40.
    McConnell J. Fat pad irritation: a mistaken patellar tendonitis. Sport Health 1991; 9 (4): 7–9Google Scholar
  41. 41.
    Richmond JC, al Assal M. Arthroscopic management of arthrofibrosis of the knee, including infrapatellar contraction syndrome. Arthroscopy 1991; 7 (2): 144–7PubMedCrossRefGoogle Scholar
  42. 42.
    Crossley KM, Thancanamootoo K, Metcalf BR, et al. Clinical features of patellar tendinopathy and their implications for rehabilitation. J Orthop Res 2007; 25 (9): 1164–75PubMedCrossRefGoogle Scholar
  43. 43.
    Saddik D, McNally EG, Richardson M. MRI of Hoffa’s fat pad. Skeletal Radiol 2004; 33 (8): 433–44PubMedCrossRefGoogle Scholar
  44. 44.
    Tang G, Niitsu M, Ikeda K, et al. Fibrous scar in the infrapatellar fat pad after arthroscopy: MR imaging. Radiat Med 2000; 18 (1): 1–5PubMedGoogle Scholar
  45. 45.
    House CV, Connell DA. Therapeutic ablation of the infrapatellar fat pad under ultrasound guidance: a pilot study. Clin Radiol 2007; 62 (12): 1198–201PubMedCrossRefGoogle Scholar
  46. 46.
    Apostolaki E, Cassar-Pullicino VN, Tyrrell PN, et al. MRI appearances of the infrapatellar fat pad in occult traumatic patellar dislocation. Clin Radiol 1999; 54 (11): 743–7PubMedCrossRefGoogle Scholar
  47. 47.
    Llopis E, Padron M. Anterior knee pain. Eur J Radiol 2007; 62 (1): 27–43PubMedCrossRefGoogle Scholar
  48. 48.
    Hoffa A. The influence of the adipose tissue with regard to the pathology of the knee joint. JAMA 1904; 43: 795–6CrossRefGoogle Scholar
  49. 49.
    Ogilvie-Harris DJ, Giddens J. Hoffa’s disease: arthroscopic resection of the infrapatellar fat pad. Arthroscopy 1994; 10 (2): 184–7PubMedCrossRefGoogle Scholar
  50. 50.
    von Engelhardt LV, Tokmakidis E, Lahner M, et al. Hoffa’s fat pad impingement treated arthroscopically: related findings on preoperative MRI in a case series of 62 patients. Arch Orthop Trauma Surg 2010; 130 (8): 1041–51CrossRefGoogle Scholar
  51. 51.
    Chung CB, Skaf A, Roger B, et al. Patellar tendon-lateral femoral condyle friction syndrome: MR imaging in 42 patients. Skeletal Radiol 2001; 30 (12): 694–7PubMedCrossRefGoogle Scholar
  52. 52.
    Abreu MR, Chung CB, Trudell D, et al. Hoffa’s fat pad injuries and their relationship with anterior cruciate ligament tears: new observations based on MR imaging in patients and MR imaging and anatomic correlation in cadavers. Skeletal Radiol 2008; 37 (4): 301–6PubMedCrossRefGoogle Scholar
  53. 53.
    Ahmad CS, Kwak SD, Ateshian GA, et al. Effects of patellar tendon adhesion to the anterior tibia on knee mechanics. Am J Sports Med 1998; 26 (5): 715–24PubMedGoogle Scholar
  54. 54.
    Bayar A, Turhan E, Ozer T, et al. The fate of patellar tendon and infrapatellar fat pad after arthroscopy via central portal. Knee Surg Sports Traumat Arthrosc 2008; 16 (12): 1114–20CrossRefGoogle Scholar
  55. 55.
    Bulmer JH. Torsion of the infrapatellar fat pad. Br Med J 1966; 2 (5514): 628PubMedCrossRefGoogle Scholar
  56. 56.
    Ellen MI, Jackson HB, DiBiase SJ. Uncommon causes of anterior knee pain: a case report of infrapatellar contracture syndrome1. Am J Physical Med Rehab 1999; 78 (4): 376–80CrossRefGoogle Scholar
  57. 57.
    Fisher SE, Shelbourne KD. Arthroscopic treatment of symptomatic extension block complicating anterior cruciate ligament reconstruction. Am J Sports Med 1993; 21 (4): 558–64PubMedCrossRefGoogle Scholar
  58. 58.
    Murakami S, Muneta T, Ezura Y, et al. Quantitative analysis of synovial fibrosis in the infrapatellar fat pad before and after anterior cruciate ligament reconstruction. Am J Sports Med 1997; 25 (1): 29–34PubMedCrossRefGoogle Scholar
  59. 59.
    Rosenberg TD, Franklin JL, Baldwin GN, et al. Extensor mechanism function after patellar tendon graft harvest for anterior cruciate ligament reconstruction. Am J Sports Med 1992; 20 (5): 519–25; discussion 525-6PubMedCrossRefGoogle Scholar
  60. 60.
    McMahon MS, Scuderi GR, Glashow JL, et al. Scintigraphic determination of patellar viability after excision of infrapatellar fat pad and/or lateral retinacular release in total knee arthroplasty. Clin Orthop Relat Res 1990; (260): 10/6/2012Google Scholar
  61. 61.
    Tsirbas A, Paterson RS, Keene GCR. Fat pad impingement: a missed cause of patello-femoral pain. Aust J Sci Med Sport 1991; 23: 246Google Scholar
  62. 62.
    Boyd CR, Eakin C, Matheson GO. Infrapatellar plica as a cause of anterior knee pain. Clin J Sport Med 2005; 15 (2): 98–103PubMedCrossRefGoogle Scholar
  63. 63.
    Chin KR, Barr SJ, Winalski C, et al. Treatment of advanced primary and recurrent diffuse pigmented villonodular synovitis of the knee. J Bone Joint Surg Am 2002; 84-A (12): 2192–202PubMedGoogle Scholar
  64. 64.
    Chin KR Brick GW. Extraarticular pigmented villonodular synovitis: a cause for failed knee arthroscopy. Clin Orthop Rel Res 2002 (404): 330–8CrossRefGoogle Scholar
  65. 65.
    Cothran RL, McGuire PM, Helms CA, et al. MRimaging of infrapatellar plica injury. AJR Am J Roentgenol 2003; 180 (5): 1443–7PubMedCrossRefGoogle Scholar
  66. 66.
    Delcogliano A, Galli M, Menghi A, et al. Localized pigmented villonodular synovitis of the knee: report of two cases of fat pad involvement. Arthroscopy 1998; 14 (5): 527–31PubMedCrossRefGoogle Scholar
  67. 67.
    Demirag B, Ozturk C, Karakayali M. Symptomatic infrapatellar plica. Knee Surg Sports Traumatol Arthrosc 2006; 14 (2): 156–60PubMedCrossRefGoogle Scholar
  68. 68.
    Hill CL, Hunter DJ, Niu J, et al. Synovitis detected on magnetic resonance imaging and its relation to pain and cartilage loss in knee osteoarthritis. Ann Rheum Dis 2007; 66 (12): 1599–603PubMedCrossRefGoogle Scholar
  69. 69.
    Huang GS, Lee CH, Chan WP, et al. Localized nodular synovitis of the knee: MR imaging appearance and clinical correlates in 21 patients. AJR Am J Roentgenol 2003; 181 (2): 539–43PubMedCrossRefGoogle Scholar
  70. 70.
    Jerosch J, Schroder M. Clinical symptoms caused by intraarticular fibrous plicae after knee replacement, arthroscopic diagnosis and therapy. Arch Orthop Trauma Surg 1996; 115 (3-4): 195–8PubMedCrossRefGoogle Scholar
  71. 71.
    Lowenstein MB, Smith JR, Cole S. Infrapatellar pigmented villonodular synovitis: arthrographic detection. AJR Am J Roentgenol 1980; 135 (2): 279–82PubMedCrossRefGoogle Scholar
  72. 72.
    Palumbo RC, Matthews LS, Reuben JM. Localized pigmented villonodular synovitis of the patellar fat pad: a report of two cases. Arthroscopy 1994; 10 (4): 400–3PubMedCrossRefGoogle Scholar
  73. 73.
    Kosarek FJ, Helms CA. The MR appearance of the infrapatellar plica. AJR Am J Roentgenol 1999; 172 (2): 481–4PubMedCrossRefGoogle Scholar
  74. 74.
    Helpert C, Davies AM, Evans N, et al. Differential diagnosis of tumours and tumour-like lesions of the infrapatellar (Hoffa’s) fat pad: pictorial review with an emphasis onMR imaging. Eur Radiol 2004; 14 (12): 2337–46PubMedCrossRefGoogle Scholar
  75. 75.
    Azzouz D, Tekaya R, Hamdi W, et al. Lipoma arborescens of the knee. J Clin Rheumatol 2008; 14 (6): 370–2PubMedCrossRefGoogle Scholar
  76. 76.
    Hardy P, Muller GP, Got C, et al. Glomus tumor of the fat pad. Arthroscopy 1998; 14 (3): 325–8PubMedCrossRefGoogle Scholar
  77. 77.
    Turhan E, Doral MN, Atay AO, et al. A giant extrasynovial osteochondroma in the infrapatellar fat pad: end stage Hoffa’s disease. Arch Orthop Trauma Surg 2008; 128 (5): 515–9PubMedCrossRefGoogle Scholar
  78. 78.
    Roth PB. Ossifying chondroma replacing the infrapatellar pad of fat. Proc R Soc Med 1944 Apr; 37 (6): 279–80PubMedGoogle Scholar
  79. 79.
    Krebs VE, Parker RD. Arthroscopic resection of an extrasynovial ossifying chondroma of the infrapatellar fat pad: end-stage Hoffa’s disease? Arthroscopy 1994; 10 (3): 301–4PubMedCrossRefGoogle Scholar
  80. 80.
    Canizares Perez AC, Stallenberg B. Magnetic resonance imaging of the infrapatellar fat pad: correlation with patellar articular cartilage abnormalities. JBR-BTR 2005; 88 (1): 1–6PubMedGoogle Scholar
  81. 81.
    Crossley K, Bennell K, Green S, et al. Physical therapy for patellofemoral pain: A randomized, double-blinded, placebo- controlled trial. Am J Sports Med 2002; 30 (6): 857–65PubMedGoogle Scholar
  82. 82.
    Doucette SA, Child DD. The effect of open and closed chain exercise and knee joint position on patellar tracking in lateral patellar compression syndrome. J Orthop Sports Phys Ther 1996; 23 (2): 104–10PubMedGoogle Scholar
  83. 83.
    Duri ZA, Aichroth PM, Dowd G. The fat pad: clinical observations. Am J Knee Surg 1996; 9 (2): 55–66PubMedGoogle Scholar
  84. 84.
    Dragoo JL, Korotkova T, Kanwar R, et al. The effect of local anesthetics administered via pain pump on chondrocyte viability. Am J Sports Med 2008 Aug; 36 (8): 1484–8PubMedCrossRefGoogle Scholar
  85. 85.
    Chu CR, Coyle CH, Chu CT, et al. In vivo effects of single intra-articular injection of 0..5% bupivacaine on articular cartilage. J Bone Joint Surg Am 2010 Mar; 92 (3): 599–608PubMedCrossRefGoogle Scholar
  86. 86.
    Gomoll AH, Kang RW, Williams JM, et al. Chondrolysis after continuous intra-articular bupivacaine infusion: an experimental model investigating chondrotoxicity in the rabbit shoulder. Arthroscopy 2006; 22 (8): 813–9PubMedCrossRefGoogle Scholar
  87. 87.
    Fukui N, Fukuda A, Kojima K, et al. Suppression of fibrous adhesion by proteoglycan decorin. J Orthop Res 2001; 19 (3): 456–62PubMedCrossRefGoogle Scholar
  88. 88.
    Macule F, Sastre S, Lasurt S, et al. Hoffa’s fat pad resection in total knee arthroplasty. Acta Orthop Belg 2005; 71 (6): 714–7PubMedGoogle Scholar
  89. 89.
    Millett PJ, Williams 3rd RJ, Wickiewicz TL. Open debridement and soft tissue release as a salvage procedure for the severely arthrofibrotic knee. Am J Sports Med 1999; 27 (5): 552–61PubMedGoogle Scholar
  90. 90.
    Kim DH, Gill TJ, Millett PJ. Arthroscopic treatment of the arthrofibrotic knee. Arthroscopy 2004; 20 Suppl.2: 187–94PubMedGoogle Scholar
  91. 91.
    Feagin Jr JA, Steadman JR, editors. The crucial principles in care of the knee. Philadelphia (PA): Lippincott Williams & Williams, 2008Google Scholar
  92. 92.
    Dragoo JL, Miller MD, Vaughn ZD, et al. Restoration of knee Vol. using selected arthroscopic releases. Am J Sports Med 2010; 38 (1): 2288–93PubMedCrossRefGoogle Scholar
  93. 93.
    Ogon P, Maier D, Jaeger A, et al. Arthroscopic patellar release for the treatment of chronic patellar tendinopathy. Arthroscopy 2006; 22 (4): 462PubMedGoogle Scholar
  94. 94.
    Vega J, Golano P, Perez-Carro L. Electrosurgical arthroscopic patellar denervation. Arthroscopy 2006; 22 (9): 1028PubMedGoogle Scholar

Copyright information

© Adis Data Information BV 2012

Authors and Affiliations

  • Jason L. Dragoo
    • 1
  • Christina Johnson
    • 2
  • Jenny McConnell
    • 3
  1. 1.Department of Orthopaedic SurgeryStanford UniversityPalo AltoUSA
  2. 2.Tufts University School of MedicineBostonUSA
  3. 3.Department of Sports MedicineUniversity of MelbourneMelbourneAustralia

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