Infrapatellar fat pad resection or preservation during total knee arthroplasty: a meta-analysis of randomized controlled trials
Abstract Background The infrapatellar fat pad (IPFP) or Hoffa’s fat pad is often resected during total knee arthroplasty in order to improve visibility. However, the management of the IPFP during total knee arthroplasty (TKA) is the subject of an ongoing debate that has no clear consensus. The purpo...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2020-08-01
|
| Series: | Journal of Orthopaedic Surgery and Research |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13018-020-01823-2 |
| _version_ | 1818002036780695552 |
|---|---|
| author | Changjiao Sun Xiaofei Zhang Woo Guan Lee Yan Tu Huimin Li Xu Cai Huadong Yang |
| author_facet | Changjiao Sun Xiaofei Zhang Woo Guan Lee Yan Tu Huimin Li Xu Cai Huadong Yang |
| author_sort | Changjiao Sun |
| collection | DOAJ |
| description | Abstract Background The infrapatellar fat pad (IPFP) or Hoffa’s fat pad is often resected during total knee arthroplasty in order to improve visibility. However, the management of the IPFP during total knee arthroplasty (TKA) is the subject of an ongoing debate that has no clear consensus. The purpose of this review was to appraise if resection of the IPFP affects clinical outcomes. Methods We conducted a meta-analysis to identify relevant randomized controlled trials involving infrapatellar fat pad resection and infrapatellar fat pad preservation during total knee arthroplasty in electronic databases, including Web of Science, Embase, PubMed, Cochrane Controlled Trials Register, Cochrane Library, Highwire, CBM, CNKI, VIP, and Wanfang database, up to March 2020. Results Nine randomized controlled trials, involving 783 TKAs (722 patients), were included in the systematic review. Outcome measures included patellar tendon length (PTL), Insall-Salvati ratio (ISR), rate of anterior knee pain, Knee Society Scores (KSS), and knee range of motion. The meta-analysis identified a trend toward the shortening of the patellar tendon with IPFP resection at 6 months (P = 0.0001) and 1 year (P = 0.001). We found no statistical difference in ISR (P = 0.87), rate of anterior knee pain within 6 months (p = 0.45) and 1 year (p = 0.38), KSS at 1 year (p = 0.77), and knee range of motion within 6 months (p = 0.61) and 1 year (0.46). Conclusion Based on the available level I evidence, we were unable to conclude that one surgical technique of IPFP can definitively be considered superior over the other. More adequately powered and better-designed randomized controlled trial (RCT) studies with long-term follow-up are required to produce evidence-based guidelines regarding IPFP resection. |
| first_indexed | 2024-04-14T03:41:39Z |
| format | Article |
| id | doaj.art-b7e356f560e4481089fcbb714fbae5ec |
| institution | Directory Open Access Journal |
| issn | 1749-799X |
| language | English |
| last_indexed | 2024-04-14T03:41:39Z |
| publishDate | 2020-08-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj.art-b7e356f560e4481089fcbb714fbae5ec2022-12-22T02:14:31ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2020-08-011511910.1186/s13018-020-01823-2Infrapatellar fat pad resection or preservation during total knee arthroplasty: a meta-analysis of randomized controlled trialsChangjiao Sun0Xiaofei Zhang1Woo Guan Lee2Yan Tu3Huimin Li4Xu Cai5Huadong Yang6Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua UniversityDepartment of Clinical Epidemiology and Biostatistics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua UniversityDepartment of Orthopedic, Kuching Specialist HospitalDepartment of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua UniversityDepartment of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua UniversityDepartment of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua UniversityDepartment of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua UniversityAbstract Background The infrapatellar fat pad (IPFP) or Hoffa’s fat pad is often resected during total knee arthroplasty in order to improve visibility. However, the management of the IPFP during total knee arthroplasty (TKA) is the subject of an ongoing debate that has no clear consensus. The purpose of this review was to appraise if resection of the IPFP affects clinical outcomes. Methods We conducted a meta-analysis to identify relevant randomized controlled trials involving infrapatellar fat pad resection and infrapatellar fat pad preservation during total knee arthroplasty in electronic databases, including Web of Science, Embase, PubMed, Cochrane Controlled Trials Register, Cochrane Library, Highwire, CBM, CNKI, VIP, and Wanfang database, up to March 2020. Results Nine randomized controlled trials, involving 783 TKAs (722 patients), were included in the systematic review. Outcome measures included patellar tendon length (PTL), Insall-Salvati ratio (ISR), rate of anterior knee pain, Knee Society Scores (KSS), and knee range of motion. The meta-analysis identified a trend toward the shortening of the patellar tendon with IPFP resection at 6 months (P = 0.0001) and 1 year (P = 0.001). We found no statistical difference in ISR (P = 0.87), rate of anterior knee pain within 6 months (p = 0.45) and 1 year (p = 0.38), KSS at 1 year (p = 0.77), and knee range of motion within 6 months (p = 0.61) and 1 year (0.46). Conclusion Based on the available level I evidence, we were unable to conclude that one surgical technique of IPFP can definitively be considered superior over the other. More adequately powered and better-designed randomized controlled trial (RCT) studies with long-term follow-up are required to produce evidence-based guidelines regarding IPFP resection.http://link.springer.com/article/10.1186/s13018-020-01823-2Total knee arthroplastyInfrapatellar fat padHoffa’s fat padpatellar tendon lengthInsall-Salvati ratio |
| spellingShingle | Changjiao Sun Xiaofei Zhang Woo Guan Lee Yan Tu Huimin Li Xu Cai Huadong Yang Infrapatellar fat pad resection or preservation during total knee arthroplasty: a meta-analysis of randomized controlled trials Journal of Orthopaedic Surgery and Research Total knee arthroplasty Infrapatellar fat pad Hoffa’s fat pad patellar tendon length Insall-Salvati ratio |
| title | Infrapatellar fat pad resection or preservation during total knee arthroplasty: a meta-analysis of randomized controlled trials |
| title_full | Infrapatellar fat pad resection or preservation during total knee arthroplasty: a meta-analysis of randomized controlled trials |
| title_fullStr | Infrapatellar fat pad resection or preservation during total knee arthroplasty: a meta-analysis of randomized controlled trials |
| title_full_unstemmed | Infrapatellar fat pad resection or preservation during total knee arthroplasty: a meta-analysis of randomized controlled trials |
| title_short | Infrapatellar fat pad resection or preservation during total knee arthroplasty: a meta-analysis of randomized controlled trials |
| title_sort | infrapatellar fat pad resection or preservation during total knee arthroplasty a meta analysis of randomized controlled trials |
| topic | Total knee arthroplasty Infrapatellar fat pad Hoffa’s fat pad patellar tendon length Insall-Salvati ratio |
| url | http://link.springer.com/article/10.1186/s13018-020-01823-2 |
| work_keys_str_mv | AT changjiaosun infrapatellarfatpadresectionorpreservationduringtotalkneearthroplastyametaanalysisofrandomizedcontrolledtrials AT xiaofeizhang infrapatellarfatpadresectionorpreservationduringtotalkneearthroplastyametaanalysisofrandomizedcontrolledtrials AT wooguanlee infrapatellarfatpadresectionorpreservationduringtotalkneearthroplastyametaanalysisofrandomizedcontrolledtrials AT yantu infrapatellarfatpadresectionorpreservationduringtotalkneearthroplastyametaanalysisofrandomizedcontrolledtrials AT huiminli infrapatellarfatpadresectionorpreservationduringtotalkneearthroplastyametaanalysisofrandomizedcontrolledtrials AT xucai infrapatellarfatpadresectionorpreservationduringtotalkneearthroplastyametaanalysisofrandomizedcontrolledtrials AT huadongyang infrapatellarfatpadresectionorpreservationduringtotalkneearthroplastyametaanalysisofrandomizedcontrolledtrials |