Athletes With Partial Extensor Mechanism Tears of the Knee Achieve Variable Return-to-Sport Rates Following Operative Versus Nonoperative Management: A Systematic Review

Abstract

Purpose

(1) To systematically review treatments for partial extensor mechanism tendon tears in professional and amateur athletes and (2) to report outcomes for patients undergoing operative versus nonoperative management.

Methods

PubMed, Cochrane, Scopus, Google Scholar, and Web of Science were queried in August 2023 using the following Boolean search: (quadriceps OR patella) AND (partial) AND (tear). Articles were included if they reported outcomes of operative or nonoperative management of partial extensor mechanism tears of the knee in athletes. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses criteria. Each study was queried for demographics, tendon injured, sport and level of athlete, prior treatments, final treatment modality, and return to sport (RTS) outcomes of that treatment. A qualitative subanalysis was performed for professional athletes.

Results

Ten studies met inclusion criteria and included 191 partial patellar or quadriceps tendon tears. Of the patients, 81.6% were male and 18.4% were female, with average age ranging from 21 to 28 years; 97% of patients underwent initial nonoperative management. Ultimately, 111 patients (58.1%) were maintained on nonoperative management, and 80 (41.9%) progressed to surgery. Of surgeries, 39 (48.8%) were tendon debridements, 36 (45.0%) were repairs, and 5 (6.3%) were not specified. RTS rates ranged from 33% to 93% after surgery and 70% to 89% following conservative management. Of professional athletes, 23 (33%) underwent surgery, and 46 (67%) underwent ultimate conservative management. RTS rates ranged from 33% to 67% after surgery and were 89% for the applicable study of conservative management.

Conclusions

Nearly all patients with partial extensor mechanism tears underwent initial nonoperative management. RTS rates were high but somewhat variable among both patients treated with final nonoperative versus surgical management. Even among professional athletes, most injuries were treated with initial nonoperative management and did not progress to surgery.

Level of Evidence

Level V, systematic review of Level IV and V studies.