title: Does infrapatellar fat pad resection in total knee arthroplasty impair clinical outcome? A systematic review.
abstract: BACKGROUND
  The infrapatellar fat pad (IPFP) is often removed during total knee arthroplasty (TKA). No evidence based guidelines on changes in clinical outcome have yet been described. The aim of this review is to investigate whether regular removal of the IPFP during TKA should be performed.
  
  
  METHODS
  Seven databases were systematically searched. Clinical studies, in which TKA with IPFP resection was compared with IPFP preservation, were included. Risk of bias was assessed using the Cochrane collaboration tool. Studies reporting anterior knee pain, patellar tendon length, range of motion, patellar vascularisation or functional outcome were included.
  
  
  RESULTS
  The indication for TKA varied in the different studies: osteoarthritis (OA), rheumatic arthritis (RA) and multiple indications (OA, RA and osteonecrosis). After IPFP resection: 1. For OA, no differences in function, range of motion, and anterior knee pain were found. 2. In the RA study, there was a trend towards more discomfort and a decrease in function. 3. In OA and RA patients a decrease in patellar tendon length was observed. 4. One study reported no decrease in patellar vascularisation.
  
  
  CONCLUSIONS
  Limitations of this review are the high risk of bias scores of the included studies, the varying outcome measures, follow up, number and type of participants. Randomised clinical trials are required to support or refute the results, contributing to a possible future evidence based guideline on IPFP resection during TKA.
authors.affiliation: Department of Orthopaedic Surgery and Traumatology, University of Antwerp, Edegem, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: Van Beeck
authors.forename: S
authors.initials: S
authors.lastname: Clockaerts
authors.forename: J
authors.initials: J
authors.lastname: Somville
authors.forename: J H W
authors.initials: JH
authors.lastname: Van Heeswijk
authors.forename: F
authors.initials: F
authors.lastname: Van Glabbeek
authors.forename: P K
authors.initials: PK
authors.lastname: Bos
authors.forename: M
authors.initials: M
authors.lastname: Reijman
mesh_terms: D000273:Adipose Tissue / Q000601:surgery*; D018771:Arthralgia / Q000209:etiology; D001172:Arthritis, Rheumatoid / Q000601:surgery; D019645:Arthroplasty, Replacement, Knee; D006801:Humans; D020370:Osteoarthritis, Knee / Q000601:surgery; D010020:Osteonecrosis / Q000601:surgery; D017847:Patellar Ligament / Q000033:anatomy & histology; D063868:Patient Outcome Assessment; D011183:Postoperative Complications; D016059:Range of Motion, Articular