Diagnosis and treatment of the infrapatellar fat pad disorders: A systematic mapping review.

Abstract

Infrapatellar fat pad (IFP) conditions represent a significant cause of anterior knee pain, yet evidence-based recommendations for their diagnosis and treatment remain fragmented and underexplored. Despite their clinical relevance, no comprehensive synthesis currently exists of the diagnostic and therapeutic approaches used in these conditions. This review aimed to synthesize existing data on clinical and imaging diagnostics, as well as conservative and surgical treatments for IFP conditions. A comprehensive literature search was conducted in PubMed, Physiotherapy Evidence Database (PEDro), ProQuest, Scopus, and SPORTDiscus databases from their inception to January 2024. Peer-reviewed studies in English focusing on the diagnosis or treatment of IFP conditions in patients with anterior knee pain were identified and screened independently by two reviewers. Diagnostic and treatments methods for IFP conditions, including clinical manifestations and evidence levels, were synthesized. The occurrence rates of each diagnostic and treatment method were identified and their correlation illustrated with evidence levels using a bubble plot. This systematic mapping review analyzed 137 studies from 1272 identified articles, aiming to clarify current diagnostic practices and treatment modalities. IFP conditions were most commonly associated with anterior knee pain (52%), typically aggravated by physical activity. Clinical assessments predominantly relied on evaluations of range of motion and pain (25.5% and 24.2%), and magnetic resonance imaging emerged as the diagnostic gold standard, reported in 40.6% of studies. Radiography, ultrasound, and histopathology also played a role in selected cases. The most frequently reported IFP conditions included masses (55.7%) and impingement syndromes (21.6%), followed by scars or postoperative changes (7.2%) and synovial abnormalities (3%). Conservative treatments were reported in approximately one-third of the studies, with medications used in 37% and active modalities in 33.3% of cases. However, surgical interventions, particularly mass resections, were the most frequently reported therapeutic option, reported in 38.4% of the literature. Diagnosing IFP conditions with magnetic resonance imaging is standard, supported by clinical exams. Conservative approaches are prioritized for mild cases, with surgery considered if needed. Limited metrological validation and lack of standardized protocols limit generalizability. Future research should focus on diagnostic accuracy and treatment optimization.