title: Mid- and long-term efficacy of the arthroscopic patellar release for treatment of patellar tendinopathy unresponsive to nonoperative management.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the mid- and long-term efficacy of the arthroscopic patellar release (APR) in a representative number of competitive athletes.
  
  
  METHODS
  This prospective study included 35 competitive athletes who underwent APR for treatment of chronic refractory patellar tendinopathy. The minimum follow-up period was 24 months. Preoperatively and at follow-up, we measured the Swedish Victorian Institute of Sport Assessment for Patella (VISA-P) and modified Blazina score for assessment of functional outcome. The patients rated their subjective knee function (0% to 100%) and maximum pain during exercise on a visual analog scale (0 to 10 points). We inquired about time required for full return to sports.
  
  
  RESULTS
  Thirty athletes (27 male individuals, 3 female individuals) were available for clinical examination after a mean follow-up period of 4.4 years (σ = 3.0 years). The follow-up rate was 30 of 35 (86%). Mean age at surgery was 27.6 years (σ = 7.4). The mean VISA-P score improved from 57.3 (σ = 11.4) to 95.1 (σ = 8.2) and the mean Blazina score improved from 4.0 (σ = 0.8) to 0.3 (σ = 0.7). Average subjective knee function improved from 48.8% (σ = 18.5%) to 90.5% (σ = 9.8%). The mean pain level decreased from 5.7 (σ = 1.1) to 0.6 (σ = 1.2%). All changes were significant (P < .01). Twenty-three (76.7%) athletes were able to perform sports at previous levels without any symptoms. The mean time required for full return to sports was 4.4 months (1.5 to 12.0 months; σ = 3.3). Less pronounced symptoms recurred in 3 (10%) athletes.
  
  
  CONCLUSIONS
  After APR, 97% of patients obtained excellent or good functional outcomes with a mean follow-up of 4.4 years. Three of 4 athletes achieved asymptomatic previous sports levels, returning to full sports at an average of 4.4 months. Symptoms partially recurred in 10% of participants.
  
  
  METHODS
  Level IV: prospective therapeutic case series.
authors.affiliation: Department of Orthopedic and Trauma Surgery, University Medical Center Freiburg, Freiburg, Germany. dirk.maier@uniklinik-freiburg.de
authors.forename: Dirk
authors.initials: D
authors.lastname: Maier
authors.forename: Lutz
authors.initials: L
authors.lastname: Bornebusch
authors.forename: Gian M
authors.initials: GM
authors.lastname: Salzmann
authors.forename: Norbert P
authors.initials: NP
authors.lastname: Südkamp
authors.forename: Peter
authors.initials: P
authors.lastname: Ogon
mesh_terms: D000293:Adolescent; D000328:Adult; D018771:Arthralgia; D001265:Athletic Injuries / Q000175:diagnosis / Q000601:surgery* / Q000628:therapy; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D057913:Joint Capsule Release / Q000379:methods* / Q000534:rehabilitation; D007719:Knee Joint / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D017847:Patellar Ligament / Q000601:surgery*; D011446:Prospective Studies; D016059:Range of Motion, Articular; D012008:Recurrence; D052256:Tendinopathy / Q000175:diagnosis / Q000601:surgery* / Q000628:therapy; D016896:Treatment Outcome; D055815:Young Adult