Management of the Infrapatellar Fat Pad in Total Knee Arthroplasty: A Comprehensive Review of Recent Evidence

TL;DR

This paper reviews recent evidence on whether to remove or preserve the infrapatellar fat pad during knee replacement surgery, finding that both approaches lead to similar long-term outcomes.

Contribution

The study provides updated insights into the short- and long-term effects of infrapatellar fat pad management in total knee arthroplasty based on recent randomized trials and meta-analyses.

Findings

Excision of the infrapatellar fat pad causes modest patellar tendon shortening but does not significantly affect long-term pain or function.

Preservation of the fat pad may offer small early recovery benefits but does not improve long-term outcomes compared to excision.

Surgical decisions should consider the balance between exposure needs and potential early benefits of preservation.

Abstract

Surgical management of the infrapatellar fat pad (IPFP) during total knee arthroplasty remains debated: excision may improve exposure but risks tendon changes and pain, while preservation protects soft tissues yet limits visualisation. This review synthesises randomised trials and meta-analyses (2020-2025) comparing IPFP excision versus preservation. Outcomes, including anterior knee pain, functional scores such as Knee Society Score (KSS) and the Knee Injury and Osteoarthritis Outcome Score-Quality of Life subscale (KOOS-QoL), range of motion (ROM), patellar tendon length, and Insall-Salvati ratio (ISR), were evaluated at less than or equal to three months and 6-12 months. Evidence shows modest tendon shortening after excision without lasting differences in pain, function, or mobility. Preservation may offer small early recovery benefits, but long-term outcomes are equivalent. Intraoperative decisions should balance exposure needs with potential early advantages of preservation.

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