Abstract
Background:
Non-operative treatment is the standard of care for patellar tendinitis (PaT), with focal surgical debridement of the affected tissue and tendon repair considered only for refractory cases. While favorable outcomes have been shown for this procedure in adults, it has not been well studied in adolescent and younger adult populations.
Objectives:
It was hypothesized that >75% of adolescents and young adults would demonstrate resolution of symptoms at a minimum of 1 year following patellar tendon debridement/repair.
Methods:
Records of patients 10-35 years-old with pre-operative MRI-confirmed proximal patellar tendonitis (Figure 1) who underwent tendon debridement/repair at the study institution between 7/1/2007 and 9/30/2024 were reviewed. Operative details, MRI findings, and patient survey results regarding ongoing knee pain, functional limitations, return-to-sport (RTS), IKDC scores, and Pedi-FABS scores were analyzed.
Results:
Twenty patients (21 knees) were included, of which 8 (40%) were adolescent (10-19 years) males. All patients had experienced symptoms for >1 year (mean 3.2 years) despite physical therapy. The majority had trialed additional nonoperative modalities (Table 1). Most patients underwent concomitant interventions at the time of open patellar tendon debridement/repair, including arthroscopic procedures in 16 (76%) and drilling of the inferior pole of the patella to stimulate healing in 14 (67%).
Documented clinical follow-up averaged 2.2 years and revealed persistent anterior knee pain >6 months post-operatively requiring additional interventions in 5 patients (24%). This included 1 case of revision patellar tendon debridement and 4 cases of post-operative extracorporeal pulse activation technology (EPAT).
Of the 9 completed post-operative patient surveys (mean 6.8 years post-operative, mean age 30.4 years at survey), only 4 (44%) achieved RTS at the same level. Five patients (56%) reported persistent anterior knee pain with running. Mean IKDC was 64.4±14.8, and mean pedi-FABS was 11.6±9.5. Four patients (44%) reported that they would not do the surgery again.
Fusing clinical and functional follow up data, mean total follow-up was 4.6 years. Eleven patients (52%) demonstrated suboptimal outcomes, defined as 1 or more criteria: 1) revision surgery, 2) persistent anterior knee pain, 3) reporting they would not do the surgery again, or 4) final IKDC score <60.
Conclusion:
The current series demonstrates mixed outcomes for open debridement/repair for PaT in adolescent and young adult athletes. Although surgery represents a viable option for those who have failed prolonged nonoperative treatment, patients considering surgery should be counseled that – contrary to the study hypothesis – approximately half of patients may have a suboptimal result.
