Excision Versus Preservation of the Infrapatellar Fat Pad During Total Knee Arthroplasty: A Systematic Review and Meta-Analysis
Bibliographic record
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.012 | 0.024 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.017 | 0.035 |
| Bibliometrics | 0.005 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".