JOA - 2026-09-01 - Journal Article; Systematic Review; Meta-Analysis; Comparative Study
Excision Versus Preservation of the Infrapatellar Fat Pad During Total Knee Arthroplasty: A Systematic Review and Meta-Analysis.
Skaik K, Oulousian S, Lameire DL, Abbas A, Khalik HA, Al-Obaedi O, Ravi B
Topics
Key Takeaway
Infrapatellar fat pad preservation in TKA reduces early complications by 76% (RR=0.24) and patellar tendon shortening is 2.68 mm greater with resection at 12 months, though functional scores do not differ.
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Summary
This systematic review and meta-analysis compared IPFP preservation versus resection in primary TKA across 21 comparative studies. IPFP preservation reduced early complications (RR=0.24, P<0.01) and anterior knee pain at 3 months (RR=0.12, P=0.04), but neither effect persisted beyond 6 months. Resection produced 2.68 mm greater patellar tendon shortening and 2.92° less knee flexion at 12 months, with no difference in Knee Society Score or operative time.
Key Limitation
Early complication and anterior knee pain benefits do not persist beyond 6 months, and the absence of long-term follow-up data (beyond 12 months) leaves the durability of the patellar tendon shortening effect and its functional consequences unresolved.
Original Abstract
BACKGROUND
This study aimed to evaluate whether preservation versus resection of the infrapatellar fat pad (IPFP) during total knee arthroplasty (TKA) affects clinical outcomes.
METHODS
A systematic review and meta-analysis, searching multiple databases up to November 2024 for comparative studies of infrapatellar fat pad-preservation (IPFP-P) versus resection in primary TKA, was conducted. Outcomes assessed included rates of complications, visual analog scale for pain, and the rate of anterior knee pain, Knee Society Score, patellar tendon length, range of motion, and operative time. Data were pooled using random-effects meta-analysis. There were 21 studies (3,573 patients, 4,107 TKAs: 2,298 preserved, and 1,809 resected IPFP) included.
RESULTS
The IPFP-P had a 76% reduction in the rate of complications within six weeks (relative risk = 0.24, 95% confidence interval [CI]: 0.12 to 0.48, P < 0.01), but not at later follow-up. The visual analog scale pain scores did not differ significantly between groups at any time point. The IPFP-P reduced the risk of anterior knee pain at three months (relative risk = 0.12, 95% CI: 0.02 to 0.94, P = 0.04), but this was not sustained at later follow-up. There were no significant differences found for operative time and Knee Society Score. However, infrapatellar fat pad-resection resulted in greater patellar tendon shortening at six and 12 months (mean difference = 2.68 mm at 12 months, P < 0.01), with a significant reduction in knee flexion at 12 months (mean difference = 2.92°, 95% CI: 0.52 to 5.33, P = 0.02).
CONCLUSIONS
The IPFP-P during TKA reduces early postoperative complications and short-term anterior knee pain compared to resection, without affecting operative time or long-term pain. Complete resection is associated with patellar tendon shortening and a slight decrease in flexion at 12 months but does not impact overall functional scores. These findings support IPFP-P as the preferred approach in TKA over complete resection.