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

Giulio Maria Marcheggiani Muccioli, Stefano Zaffagnini, Kyriakos Tsapralis, Ester Alessandrini, Tommaso Bonanzinga, Alberto Grassi, Laura Bragonzoni, Stefano della Villa, Maurilio Marcacci

Research output: Contribution to journalArticle

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.

Original languageEnglish
Pages (from-to)351-357
Number of pages7
JournalKnee Surgery, Sports Traumatology, Arthroscopy
Volume21
Issue number2
DOIs
Publication statusPublished - 2013

Fingerprint

Tendinopathy
Aptitude
Therapeutics
Sample Size
Sports
Publications
Randomized Controlled Trials
Outcome Assessment (Health Care)
Pain
Wounds and Injuries
Return to Sport

Keywords

  • Arthroscopy
  • Jumper's knee
  • Open surgery
  • Proximal patellar tendinopathy
  • Surgical treatment

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Surgery

Cite this

Open versus arthroscopic surgical treatment of chronic proximal patellar tendinopathy. A systematic review. / Marcheggiani Muccioli, Giulio Maria; Zaffagnini, Stefano; Tsapralis, Kyriakos; Alessandrini, Ester; Bonanzinga, Tommaso; Grassi, Alberto; Bragonzoni, Laura; della Villa, Stefano; Marcacci, Maurilio.

In: Knee Surgery, Sports Traumatology, Arthroscopy, Vol. 21, No. 2, 2013, p. 351-357.

Research output: Contribution to journalArticle

Marcheggiani Muccioli, GM, Zaffagnini, S, Tsapralis, K, Alessandrini, E, Bonanzinga, T, Grassi, A, Bragonzoni, L, della Villa, S & Marcacci, M 2013, 'Open versus arthroscopic surgical treatment of chronic proximal patellar tendinopathy. A systematic review', Knee Surgery, Sports Traumatology, Arthroscopy, vol. 21, no. 2, pp. 351-357. https://doi.org/10.1007/s00167-012-2100-9
Marcheggiani Muccioli, Giulio Maria ; Zaffagnini, Stefano ; Tsapralis, Kyriakos ; Alessandrini, Ester ; Bonanzinga, Tommaso ; Grassi, Alberto ; Bragonzoni, Laura ; della Villa, Stefano ; Marcacci, Maurilio. / Open versus arthroscopic surgical treatment of chronic proximal patellar tendinopathy. A systematic review. In: Knee Surgery, Sports Traumatology, Arthroscopy. 2013 ; Vol. 21, No. 2. pp. 351-357.
@article{9ec0e18eef0d44218ee01cf42f7df168,
title = "Open versus arthroscopic surgical treatment of chronic proximal patellar tendinopathy. A systematic review",
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.",
keywords = "Arthroscopy, Jumper's knee, Open surgery, Proximal patellar tendinopathy, Surgical treatment",
author = "{Marcheggiani Muccioli}, {Giulio Maria} and Stefano Zaffagnini and Kyriakos Tsapralis and Ester Alessandrini and Tommaso Bonanzinga and Alberto Grassi and Laura Bragonzoni and {della Villa}, Stefano and Maurilio Marcacci",
year = "2013",
doi = "10.1007/s00167-012-2100-9",
language = "English",
volume = "21",
pages = "351--357",
journal = "Knee Surgery, Sports Traumatology, Arthroscopy",
issn = "0942-2056",
publisher = "Springer Verlag",
number = "2",

}

TY - JOUR

T1 - Open versus arthroscopic surgical treatment of chronic proximal patellar tendinopathy. A systematic review

AU - Marcheggiani Muccioli, Giulio Maria

AU - Zaffagnini, Stefano

AU - Tsapralis, Kyriakos

AU - Alessandrini, Ester

AU - Bonanzinga, Tommaso

AU - Grassi, Alberto

AU - Bragonzoni, Laura

AU - della Villa, Stefano

AU - Marcacci, Maurilio

PY - 2013

Y1 - 2013

N2 - 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.

AB - 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.

KW - Arthroscopy

KW - Jumper's knee

KW - Open surgery

KW - Proximal patellar tendinopathy

KW - Surgical treatment

UR - http://www.scopus.com/inward/record.url?scp=84872662628&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84872662628&partnerID=8YFLogxK

U2 - 10.1007/s00167-012-2100-9

DO - 10.1007/s00167-012-2100-9

M3 - Article

C2 - 22714975

AN - SCOPUS:84872662628

VL - 21

SP - 351

EP - 357

JO - Knee Surgery, Sports Traumatology, Arthroscopy

JF - Knee Surgery, Sports Traumatology, Arthroscopy

SN - 0942-2056

IS - 2

ER -