The surgical treatment of anterior knee pain due to infrapatellar fat pad pathology: A systematic review.
BACKGROUND
Anterior knee pain (AKP) encompasses a range of pathologies. As a result, there are a number of therapeutic options used to treat AKP. The non-operative treatments have been analysed in a number of randomised controlled trials and systematic reviews. There is however a scarcity of such publications covering the surgical management of AKP. There are no systematic reviews that have investigated surgical interventions for AKP due to pathology of the infrapatellar fat pad (IFP). The aims of this study were to review the literature systematically, to establish which surgical procedures have been used to treat IFP disease and to determine their efficacy.


METHODS
The review was conducted in accordance with the PRISMA reporting guidelines. A search of the literature was performed on 1st January 2014 using multiple databases including CENTRAL, MEDLINE, EMBASE, PubMed, and Google Scholar. The quality of the studies was assessed using Oxford Evidence-Based Medicine Levels of Evidence guidelines and the GRADE approach.


RESULTS
Twenty-four eligible studies were found and included. The critical appraisal identified that the current evidence-base has low methodology quality. The clinical findings indicated that there is a positive trend towards the surgical management of IFP disease for AKP symptoms. Excision of IFP tumours and resection of the IFP in Hoffa's disease can lead to improvements in symptoms and function.


CONCLUSIONS
Truly robust evidence to support the surgical management of IFP pathology requires randomised controlled trials; however the expenses involved to design such trials means that they are unlikely to be undertaken for this uncommon disorder. Consequently well-designed and well-reported case series need to be undertaken to improve our current understanding that includes recording quantitative measures such as range of knee motion, VAS Pain scores and a validated scoring system.
Department of Orthopaedics, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY UK. Electronic address: aaronrooney@doctors.org.uk.
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A
Rooney
Department of Orthopaedics, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY UK.
A J
AJ
Wahba
Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, NR4 7TJ UK.
T O
TO
Smith
Department of Orthopaedics, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY UK.
S T
ST
Donell
D000273:Adipose Tissue / Q000473:pathology*; D018771:Arthralgia / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007719:Knee Joint / Q000473:pathology / Q000601:surgery*; D020370:Osteoarthritis, Knee / Q000150:complications* / Q000175:diagnosis / Q000601:surgery
Anterior knee pain; Hoffa's disease; Infrapatellar fat pad; Painful patella syndrome