# 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.

## Key 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.