title: Open Patellar Tendon Debridement for Treatment of Recalcitrant Patellar Tendinopathy: Indications, Technique, and Clinical Outcomes After a 2-Year Minimum Follow-up.
abstract: BACKGROUND
  Patellar tendinopathy can be treated surgically for patients that have failed at least 1 year of nonoperative treatment who continue to have debilitating symptoms. Patellar tendinopathy can cause significant functional deficits, yet little has been reported about the operative treatment of patellar tendinopathy.
  
  
  OBJECTIVE
  A combined arthroscopic and open surgical technique for the treatment of recalcitrant patellar tendinopathy results in an improvement in function and pain at a minimum 2-year follow-up. The purpose of this study was to present the indications, combined surgical technique, rehabilitation protocol, and the 2-year minimum follow-up results of the operative treatment of recalcitrant patellar tendinopathy.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  A retrospective review was performed of all patients who underwent a surgical primary patellar tendon debridement for recalcitrant patellar tendinopathy by a single surgeon between July 1999 and December 2005. Every patient failed at least 1 year of nonoperative treatment. Patients were excluded from the study if they had previous open knee surgery. Validated patient-reported outcome scores were used to assess function and pain levels pre- and postoperatively (Lysholm, International Knee Documentation Committee, Tegner activity, and visual analog pain score).
  
  
  RESULTS
  Thirty-four consecutive patients (37 consecutive cases) with mean follow-up 3.8 ± 1.6 years (range, 2-7.6 years) underwent the procedure with no complications. The mean age at surgery was 29 years (range, 14-51 years). Postoperatively, the visual analog score decreased by an mean of 6 points (range, 1 to -10, P < 0.001), and patients were able to return to their preinjury Tegner activity level. When asked if they were satisfied by the overall outcome of their surgery, 28 patients (82%) were completely or mostly satisfied with their surgical outcome on a particular knee; 6 (18%) were somewhat satisfied; and 2 (6%) were dissatisfied. Twenty-seven patients (79%) said they would have the surgery again.
  
  
  CONCLUSIONS
  The combined arthroscopic and open surgical technique described for chronic recalcitrant patellar tendinopathy successfully reduces knee pain and allows return to preinjury level of activity.
authors.affiliation: Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Gill
authors.affiliation: Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Kaitlin M
authors.initials: KM
authors.lastname: Carroll
authors.affiliation: Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Sonaz
authors.initials: S
authors.lastname: Hariri
keywords: clinical outcomes; fenestration; microfracture; patellar tendinopathy