Related Experiment Video
Updated: Apr 4, 2026
Autologous Microfractured and Purified Adipose Tissue for Arthroscopic Management of Osteochondral Lesions of the Talus
Published on: January 23, 2018
High-Volume Image-Guided Injection for Recalcitrant Patellar Tendinopathy in Athletes
Nicola Maffulli1, Angelo Del Buono, Francesco Oliva
1*Department of Musculoskeletal Disorders, University of Salerno, Salerno, Italy; †Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, London, United Kingdom; ‡Department of Orthopaedic and Trauma Surgery, Ospedale Sant'Anna, Como, Italy; §Department of Orthopaedic and Trauma Surgery, University of Rome, Rome, Italy; ¶Department of Sports Traumatology, Dynamic Center, Angri, Italy; and ‖Department of Orthopaedics and Traumatology, University of Napoli, Napoli, Italy.
High-volume image-guided injections effectively treat recalcitrant patellar tendinopathy, improving knee function and reducing pain. This minimally invasive procedure offers significant short-term benefits for athletes, with most patients returning to sport.
Area of Science:
- Orthopedic surgery
- Sports medicine
- Regenerative medicine
Background:
- Recalcitrant patellar tendinopathy significantly impacts athletes' performance and quality of life.
- Current treatment options for severe cases have limited efficacy.
- A novel high-volume injection technique aims to address these limitations.
Purpose of the Study:
- To evaluate the mid-term effectiveness of high-volume image-guided injections for recalcitrant patellar tendinopathy.
- To assess improvements in pain, function, and return to sport.
- To determine the safety and clinical relevance of the procedure.
Main Methods:
- A case series study (Level of evidence, 4) included 44 patients with recalcitrant patellar tendinopathy.
- Patients received a high-volume injection of bupivacaine hydrochloride, aprotinin, and saline solution guided by imaging.
- Outcomes were measured using the Victorian Institute of Sport Assessment-patellar tendon (VISA-P) score, visual analogue scale (VAS) for pain, and Roles and Maudsley criteria.
Main Results:
- The mean VISA-P score improved significantly from 46 to 75.3 by 15 months (P = 0.003).
- Mean VAS pain scores decreased from 91 mm to 28 mm (P = 0.01).
- 80% of patients reported good or excellent outcomes, and 72% of physically active patients returned to their previous sport level.
Conclusions:
- High-volume injection at the interface between the patellar tendon and Hoffa body provides significant short-term improvements in knee symptoms and function.
- The procedure is minimally invasive, safe, and effective for athletes with recalcitrant patellar tendinopathy.
- This technique represents a promising therapeutic option for managing this challenging condition.
