title: Prognostic value of MRI in arthroscopic treatment of chronic patellar tendinopathy: a prospective cohort study.
abstract: To date, prognostic outcome factors for patients undergoing arthroscopic treatment due to chronic patellar tendinopathy (PT) are lacking. The purpose of this study was to investigate whether preoperatively assessed MRI parameters might be of prognostic value for prediction of functional outcome and return to sports in arthroscopic treatment of chronic PT.
  
  
  
  A prospective cohort study was conducted including 30 cases (4 female and 24 male competitive athletes) undergoing arthroscopic patellar release (APR) due to chronic PT. The mean age was 28.2 years (range, 18-49 years) at the time of surgery, and the mean follow-up period was 4.2 years (range, 2.2-10.4 years). Preoperatively assessed MRI parameters included bone marrow edema (BME) of the inferior patellar pole, patellar tendon thickening, infrapatellar fat pad (IFP) edema, and infrapatellar bursitis. Prevalences of preoperative MRI findings were correlated to functional outcome scores in order to determine statistically significant predictors.
  
  
  
  All athletes regained their preinjury sports levels. Athletes featuring preoperative IFP edema showed significantly inferior modified Blazina score (0.6 ± 0.7 vs. 0.2 ± 0.5), single assessment numeric evaluation (SANE; 86.0 ± 8.8 vs. 94.3 ± 7.5), and Visual Analogue Scale (VAS; 1.0 ± 1.2 vs. 0.3 ± 0.8) compared to subjects without IFP edema (p < 0.05). Return to sports required a mean of 4 ± 3.2 months. On average, patients with IFP edema needed significantly more time to return to sports than subjects without IFP edema (6.5 vs 2.8 months; p < 0.05). The simultaneous presence of BME and IFP edema was associated with significantly inferior outcomes by means of the Victorian Institute of Sport Assessment questionnaire for patients with patellar tendinopathy (VISA-P; 88.1 ± 11.9 vs. 98.6 ± 4.2), SANE (84.3 ± 10.2 vs. 93.1 ± 8.3), and VAS (1.3 ± 1.4 vs. 0.3 ± 0.9) compared to an isolated BME or isolated IFP edema.
  
  
  
  This is the first study identifying prognostic outcome factors in arthroscopic treatment of chronic PT. Preoperative IFP edema alone or simultaneous BME and IFP edema on preoperative MRI were associated with inferior functional outcome and delayed return to sports. Knowledge of these predictive factors might improve risk stratification, individualize treatment and postoperative rehabilitation, and contribute to improve clinical outcome. Moreover, current findings offer the potential for novel therapeutic approaches.
authors.affiliation: Center of Orthopedic Sports Medicine, Breisacher Strasse 84, 79110, Freiburg, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Ogon
authors.affiliation: Department of Orthopedics and Trauma Surgery, Medical Center - Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany.
authors.forename: Kaywan
authors.initials: K
authors.lastname: Izadpanah
authors.affiliation: Department of Orthopedics and Trauma Surgery, Medical Center - Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany.
authors.forename: Helge
authors.initials: H
authors.lastname: Eberbach
authors.affiliation: Department of Orthopedics and Trauma Surgery, Medical Center - Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany.
authors.forename: Gernot
authors.initials: G
authors.lastname: Lang
authors.affiliation: Department of Orthopedics and Trauma Surgery, Medical Center - Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany.
authors.forename: Norbert P
authors.initials: NP
authors.lastname: Südkamp
authors.affiliation: Department of Orthopedics and Trauma Surgery, Medical Center - Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany. dirk.maier@uniklinik-freiburg.de.
authors.forename: Dirk
authors.identifier: 0000-0002-9740-6474
authors.initials: D
authors.lastname: Maier
mesh_terms: D000273:Adipose Tissue / Q000000981:diagnostic imaging / Q000473:pathology; D000293:Adolescent; D000328:Adult; D001182:Arthroscopy; D001853:Bone Marrow / Q000000981:diagnostic imaging / Q000473:pathology; D001855:Bone Marrow Diseases / Q000000981:diagnostic imaging / Q000209:etiology; D002908:Chronic Disease; D004487:Edema / Q000000981:diagnostic imaging / Q000209:etiology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D017847:Patellar Ligament / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D011446:Prospective Studies; D000068958:Return to Sport; D052256:Tendinopathy / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D055815:Young Adult
keywords: Jumper’s knee; MRI; Outcome; Patellar tendinitis; Prognosis; Return to sports