Surgery for patellar tendinopathy (jumper's knee)

Area of Science:

• Orthopedics
• Sports Medicine
• Evidence-Based Medicine

Background:

• Patellar tendinopathy is a prevalent overuse injury in athletes, often managed with conservative therapies.
• Surgical intervention is typically considered when non-operative treatments prove ineffective.
• Current surgical approaches for patellar tendinopathy exhibit considerable variability.

Purpose of the Study:

• To systematically evaluate the benefits and harms associated with surgical treatments for adult patellar tendinopathy.
• To compare surgical interventions against non-operative management strategies, including exercise and injections.

Main Methods:

• A comprehensive literature search was conducted across major databases (e.g., Cochrane CENTRAL, MEDLINE, Embase) up to July 2018.
• Included were randomized controlled trials (RCTs) comparing surgical techniques (open or arthroscopic) with non-operative treatments in adults with patellar tendinopathy.
• Key outcomes assessed included pain, function, quality of life, participant-reported success, and adverse events.

Main Results:

• Low-certainty evidence suggests open surgical excision offers no significant clinical benefit over eccentric exercises for knee pain or function.
• Arthroscopic surgery may provide pain reduction and improved participant-reported success compared to sclerosing injections, though evidence is limited.
• Two trials with 92 participants were included; findings were limited by small sample sizes, potential bias, and lack of reported adverse events.

Conclusions:

• The evidence is insufficient to definitively conclude on the benefits of surgery for patellar tendinopathy compared to eccentric exercises or injections.
• Further high-quality research is required to ascertain the true efficacy and safety profile of surgical interventions.
• Current clinical practice may rely on surgical intervention for advanced cases due to lack of alternatives rather than robust evidence of superiority.