Failed Surgery for Patellar Tendinopathy in Athletes: Midterm Results of Further Surgical Management

Abstract

Background: Tendon injuries are commonly seen in sports medicine practice. Many elite players involved in high-impact activities develop patellar tendinopathy (PT) symptoms. Of them, a small percentage will develop refractory PT and need to undergo surgery. In some of these patients, surgery does not resolve these symptoms. Purpose: To report the clinical results in a cohort of athletes who underwent further surgery after failure of primary surgery for PT. Study Design: Case series; Level of evidence, 4. Methods: A total of 22 athletes who had undergone revision surgery for failed surgical management of PT were enrolled in the present study. Symptom severity was assessed through the Victorian Institute of Sport Assessment Scale for Patellar Tendinopathy (VISA-P) upon admission and at the final follow-up. Time to return to training, time to return to competition, and complications were also recorded. Results: The mean age of the athletes was 25.4 years, and the mean symptom duration from the index intervention was 15.3 months. At a mean follow-up of 30.0 ± 4.9 months, the VISA-P score improved 27.8 points ( P < .0001). The patients returned to training within a mean of 9.2 months. Fifteen patients (68.2%) returned to competition within a mean of 11.6 months. Of these 15 patients, a further 2 had decreased their performance, and 2 more had abandoned sports participation by the final follow-up. The overall rate of complications was 18.2%. One patient (4.5%) had a further revision procedure. Conclusion: Revision surgery was feasible and effective in patients in whom PT symptoms persisted after previous surgery for PT, achieving a statistically significant and clinically relevant improvement of the VISA-P score as well as an acceptable rate of return to sport at a follow-up of 30 months.

Current Concepts in Patellar Tendinopathy

“…In cases where conservative measures and primary surgery have failed, revision surgery remains an option. Maffulli et al reported a 68.2% success rate in returning to competition in less than 1 year, with an 18% complication rate, based on a recent publication involving 22 athletes who underwent revision surgery after a failed previous intervention 70 .…”

“…Given that most patients with PT can be effectively managed nonoperatively, there is limited literature available on surgical options after a failed prior surgery. Surgical failure, as defined by Maffuli et al, is characterized by persistent pain and inability to RTS after at least 1 year postsurgery 70 .…”

Computed Tomography (Ct) Image in Repairing Tendon Injury in Athletes

“…Surgical exploration is difficult for patients to accept due to high cost, large investment and large trauma. [7][8]…”

Safety and Efficacy of Bone Marrow–Derived Mesenchymal Stem Cells for Chronic Patellar Tendinopathy (With Gap >3 mm) in Patients: 12-Month Follow-up Results of a Phase 1/2 Clinical Trial

“…In addition, failure after surgery means that this option can bring about a poor prognosis. 3,16 Regenerative medicine with autologous expanded bone marrow-derived mesenchymal stem cell (BM-MSC) therapy has recently been introduced in the management of tendon pathology. 6 In 2021, we published the 6-month follow-up results of a prospective, double-blind, randomized, 2-arm, parallel, active-controlled, phase 1/2, singlecenter clinical study investigating the effects of ultrasound-guided intratendinous and peritendinous injections of BM-MSCs or leukocyte-poor PRP (Lp-PRP) on clinical outcomes in younger patients (age, 18-48 years) with patellar tendinopathy.…”

“…In patellar tendinopathy, elite and nonelite running and jumping athletes 9 , 14 experience anterior knee pain and reduced function, often for prolonged periods. 16 Although modification of training and implementation of load management programs may be effective, 5 it is still unclear what the optimal strategies are. 17 In addition, the results of nonoperative management are unpredictable, and returning to sport is not certain despite rigorous adherence to rehabilitation programs.…”