Response to: ‘Infrapatellar fat pad resection during total knee replacement: yet another reason?’ by Ryan

We thank Ryan1 for the interest in our original paper2 and response3 regarding to the associations between infrapatellar fat pad (IPFP) maximal area and knee osteoarthritic measures including symptoms and structural changes. Our previous studies revealed that IPFP maximal area and volume were associated with reduced knee pain, decreased loss of cartilage volume and reduced risks of cartilage defect progression, indicating a beneficial effect of IPFP size.2 4 On the other hand, our further investigation demonstrated that IPFP signal intensity alteration was negatively associated with maximum area of IPFP and, moreover, associated with increased knee cartilage defects, subchondral bone marrow lesions and knee pain, suggesting IPFP with abnormal quality may play a detrimental role in knee osteoarthritis (OA).5 Based on these findings, we proposed that IPFP with normal qualities, rather than abnormal …