Explore the scholarly record.

Abstract

Abstract Background Selective resection of the infrapatellar fat pad (IPFP) is often used during anterior cruciate ligament reconstruction (ACLR) when the tissue obstructs arthroscopic visualization or instrument passage. We implemented an IPFP-preserving strategy using optimized portal placement and temporary polydioxanone (PDS) suture retraction. This study evaluated postoperative fibrosis and early clinical outcomes before and after implementation of this strategy. Methods This retrospective before-and-after cohort included 58 patients undergoing primary ACLR between September 2021 and September 2024. During the earlier period, 36 patients underwent conventional ACLR with selective, non-standardized IPFP resection when required for exposure. After implementation of the preservation strategy, 22 patients underwent ACLR using PDS suture retraction without IPFP resection. Outcomes included Kujala, International Knee Documentation Committee (IKDC), visual analog scale (VAS), and Lysholm scores, range of motion (ROM), operative time, and 6-month MRI-assessed IPFP fibrosis. Results At 3 months, the preservation group had a higher Kujala score (90.5 ± 16.76 vs 80.7 ± 12.30; P=.013), lower VAS score (0.9 ± 0.43 vs 2.2 ± 0.56; P<.001), and higher Lysholm score (89.2 ± 7.97 vs 76.9 ± 17.49; P=.003); IKDC scores did not differ significantly (P=.459). By 6 months, Lysholm scores and ROM were similar between groups. Moderate-to-severe IPFP fibrosis (grades II-III) occurred in 18.2% (4/22) of the preservation group and 83.3% (30/36) of the conventional group (risk ratio 0.22, 95% CI 0.09–0.54). Operative time did not differ significantly. Conclusions Implementation of PDS suture retraction for IPFP preservation during ACLR was associated with less severe MRI-detected IPFP fibrosis and more favorable early pain and functional outcomes. Because treatment strategy was chronologically allocated, these findings are associative and require prospective confirmation.