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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.
Objective:
To assess the effectiveness of high-volume image-guided injection in the middle term in patients with recalcitrant patellar tendinopathy.
Design:
Case series study; Level of evidence, 4.
Setting:
All tertiary referrals, public, and private healthcare.
Patients:
Forty-four patients (41 men and 3 women) with diagnosis of recalcitrant patellar tendinopathy were included.
Intervention:
Tendon injection of a mixture of 10 mL of 0.5% bupivacaine hydrochloride, 62 500 international units of aprotinin, and 40 mL of normal saline solution.
Main Outcome Measures:
The Victorian Institute of Sport Assessment-patellar tendon (VISA-P), visual analogue scale, and Roles and Maudsley were assessed at baseline and at the last follow-up.
Results:
The baseline VISA-P score of 46 ± 18.2 (range, 28-75) improved to 75.3 ± 19.2 (range, 68-100) by 15 months (P = 0.003). The mean pain visual analogue scale changed from 91 mm (range, 66-92 mm) before the injection to 28 mm (2-52 mm) (P = 0.01). Of 32 physically active patients, 23 (72%) had returned to sport at the same level practiced before the onset of symptoms. Thirty-five of the 44 patients (80%) rated their condition as good or excellent.
Conclusions:
High-volume injection at the interface between the deep surface of the patellar tendon and Hoffa body improves in the short-term symptoms and function of the knee.
Clinical Relevance:
This procedure is minimally invasive, safe, and effective in the short term in athletes.
