title: The fate of patellar tendon and infrapatellar fat pad after arthroscopy via central portal.
abstract: Central patellar (CP) portal is an accessory portal in arthroscopic knee surgery, which generally is considered to be safe. In this cross sectional study, we aimed to delineate the clinical and radiological outcome of patellar tendon (PT) and Hoffa's fat pad after the use of this approach. From our hospital records, patients who underwent arthroscopy via CP portal were identified and were invited for the study. There were16 men and 4 women with a mean age of 32 years. Mean follow-up time was 28 months. Meniscectomy had been performed for irreparable bucket-handle type medial meniscal tears in all patients. At the latest follow-up, no patients had anterior knee pain and physical examination was normal. Mean PT thickness of operated knees measured with Ultrasonography was 5.63+/-1.56, while it was 3.76+/-0.46 mm in contralateral knees and the difference was significant. Contour irregularity of PT and focal hypoechoic areas were found in 17 patients, two of which also had hyperechogenic calcification focuses. Abnormal signal intensity of PT was also found in 17 patients with Magnetic Resonance Imaging (MRI). Eleven of these had decreased signal intensity within the tendon which was interpreted as fibrosis. In six patients, increased signal intensity, radiologically similar to chronic tendinitis, was detected. Four patients had decreased signal intensity in the Hoffa's fat pad. Local fibrous tissues in patellar tendon might cause weakness in the tendon. This study showed that although CP portal did not cause any clinical problems in a low demand group of patients, it leads to a significant radiological sequela in the tendon, biomechanical significance of which needs to be clarified.
authors.affiliation: Department of Orthopaedics and Traumatology, Faculty of Medicine, Zonguldak Karaelmas University, 67600, Kozlu, Zonguldak, Turkey. bayarahmet@yahoo.com
authors.forename: Ahmet
authors.initials: A
authors.lastname: Bayar
authors.forename: Egemen
authors.initials: E
authors.lastname: Turhan
authors.forename: Tülay
authors.initials: T
authors.lastname: Ozer
authors.forename: Selçuk
authors.initials: S
authors.lastname: Keser
authors.forename: Ahmet
authors.initials: A
authors.lastname: Ege
authors.forename: Zuhal
authors.initials: Z
authors.lastname: Erdem
mesh_terms: D000328:Adult; D001182:Arthroscopy / Q000009:adverse effects*; D003430:Cross-Sectional Studies; D005260:Female; D005355:Fibrosis / Q000209:etiology / Q000473:pathology; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008592:Menisci, Tibial / Q000601:surgery*; D010329:Patella / Q000473:pathology* / Q000601:surgery; D052256:Tendinopathy / Q000209:etiology / Q000473:pathology; D000070600:Tibial Meniscus Injuries; D055815:Young Adult
references.citation: Orthop Clin North Am. 1986 Apr;17(2):263-8
references.pmid: 3714209
references.citation: Acta Chir Scand. 1976;142(2):123-30
references.pmid: 936935
references.citation: Radiology. 1995 Dec;197(3):843-8
references.pmid: 7480766
references.citation: Arthroscopy. 2007 Mar;23(3):325.e1-5
references.pmid: 17349482
references.citation: Arthroscopy. 2001 Mar;17(3):333-337
references.pmid: 11239359
references.citation: Arthroscopy. 1993;9(3):265-71
references.pmid: 8323610
references.citation: Radiat Med. 2000 Jan-Feb;18(1):1-5
references.pmid: 10852649
references.citation: Orthop Clin North Am. 1982 Apr;13(2):349-62
references.pmid: 7088520
references.citation: Am J Sports Med. 1999 May-Jun;27(3):345-9
references.pmid: 10352771
references.citation: Scand J Med Sci Sports. 2001 Dec;11(6):321-7
references.pmid: 11782263
references.citation: Am J Sports Med. 1980 Mar-Apr;8(2):103-5
references.pmid: 7361973
references.citation: AJR Am J Roentgenol. 1995 Jul;165(1):115-8
references.pmid: 7785569
references.citation: Radiology. 1996 Sep;200(3):821-7
references.pmid: 8756939
references.citation: Arthroscopy. 1987;3(2):123-6
references.pmid: 3606767
references.citation: Clin Orthop Relat Res. 1984 Apr;(184):133-6
references.pmid: 6546708
references.citation: Orthop Clin North Am. 1979 Jul;10(3):545-7
references.pmid: 460830