With an ongoing increase in total knee arthroplasty (TKA) procedural volume, there is an increased demand to improve surgical techniques to achieve ideal outcomes. Considerations of how to improve post-operative outcomes have included preservation of the infrapatellar fat pad (IPFP). Although this structure is commonly resected during TKA procedures, there is inconsistency in the literature and among surgeons regarding whether resection or preservation of the IPFP should be achieved. Additionally, information about how surgical handling of the IPFP influences outcomes is variable. Therefore, the purpose of this systematic review was to evaluate the influence of IPFP resection and preservation on post-operative flexion, pain, Insall-Salvati Ratio (ISR), Knee Society Score (KSS), patellar tendon length (PTL), and satisfaction in primary TKA. A systematic literature search was performed to retrieve all reports that evaluated IPFP resection or preservation during total knee arthroplasty (TKA). The following databases were queried: PubMed, EBSCO host, and SCOPUS, resulting in 488 unique reports. Two reviewers independently reviewed the studies for eligibility based on pre-established inclusion and exclusion criteria. A total of 11 studies were identified for final analysis. Patient demographics, type of surgical intervention, follow-up duration, and clinical outcome measures were collected and further analyzed. This systematic review reported on 11,996 total cases. Complete resection was implemented in 3,723 cases (31%), partial resection in 5,458 cases (45.5%), and preservation of the IPFP occurred in 2,815 cases (23.5%). Clinical outcome measures included patellar tendon length (PTL) (5 studies), knee flexion (4 studies), pain (6 studies), Knee Society Score (KSS) (3 studies), Insall-Salvati Ratio (ISR) (3 studies), and patient satisfaction (1 study).Introduction
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