Preservation vs. resection of the infrapatellar fat pad during total knee arthroplasty part II: A systematic review of published evidence

Background: The management of the infrapatellar fat pad (IPFP) during total knee arthroplasty (TKA) is the subject of ongoing debate. In part 2 of this two part series the authors aimed to investigate if resection of the IPFP affects clinical outcomes. Methods: A systematic search of CENTRAL Cochrane library, Medline, Embase and Web-of-science databases for the past 10 years was performed. Studies of patients undergoing primary TKA comparing outcomes between IPFP resection and preservation were included. The meta-analysis was performed with Review Manager 5.3. Results: Seven studies, involving 2815 patients (3312 knees) were included in the systematic review, of which two were RCTs. Outcome measures included patellar tendon length (PTL), post-operative pain, Knee Society Scores (KSS) and Functional Scores. Meta-analysis identified a trend toward shortening of the patellar tendon with IPFP resection. Resection correlated with a lower incidence of post-operative pain at one to two months, however at three to six months pain scores were higher in this group. No statistical difference was found in KSS and Functional Scores. Conclusion: There is wide variation in practice with regard to the IPFP in TKA. The available literature with regard to resection or preservation of the IPFP is not conclusive. Implications: There is no clear consensus in the literature on the resection or preservation of the IPFP indicating a clear need for high quality studies in the future to provide meaningful answers.