Delayed return to sport after fat pad debridement: A surgical effect or a load-tolerance signal?

This Letter responds to the meta‑analysis entitled 'Fat pad debridement prolongs return-to-sport: A meta-analysis and meta-regression of surgical interventions for chronic patellar tendinopathy' by Jolly et al., which examined surgical interventions for chronic patellar tendinopathy. We contend that the observed delay should not be attributed solely to the surgical procedure. Fat pad debridement may serve as a marker of a more irritable anterior-knee pain phenotype, given that fat pad pathology frequently coexists with impingement, fibrosis and peritendinous irritation. Furthermore, time to return to sport (RTS) is an incomplete recovery surrogate; meaningful restoration depends on rebuilding tendon load tolerance rather than meeting a single chronological milestone. We therefore advise interpreting the association as a composite signal of procedural, phenotypic and rehabilitative factors. Future prospective studies should document preoperative fat pad status, extent of debridement and criterion-based RTS progression, so as to determine whether fat pad preservation truly accelerates recovery or whether delayed RTS simply identifies athletes needing more individualized load management.