C0058 Ultrasound-guide percutaneous electrolysis (EPE®), dry needling and eccentric exercises for chronic calcification in patellar tendon of a professional soccer player: a case report

Abstract

Background Patellar tendinopathy is highly prevalent in soccer. Chronic patellar tendinopathy can lead to calcific deposits in the tendon which will turn in a disabling situation. This case report shows the long-term outcomes of a professional soccer player presenting with intractable calcification in the patellar tendon receiving ultrasound-guide percutaneous electrolysis (EPE), dry needling and eccentric exercise. Methods A professional soccer player (male, 30 years) presented with pain in the left knee from 4 years ago. The clinical history revealed repetitive patellar tendinopathies in the knee. He reported complete impairment for playing soccer from 2 years ago. The day of appointment the patient reported severe pain on the patellar bone at rest and during any activity. Clinical examination revealed an exquisite local pain on palpation of the patellar tendon. Radiographs revealed the presence of a calcification in the upper insertion of the patellar tendon. The ultrasound examination confirmed the presence of a bone calcification of 1.24 cm in the tendon. The patient received 4 sessions, one each 2 weeks of EPE and dry needling on the affected tendon. Further, a high load eccentric exercise program of the quadriceps musculature was also applied during the month. Outcomes including pain intensity (NPRS, 0–10), self-perceived recovery on a 7-point Likert Scale (GROC, 0–7) and related-disability with the Victorian Institute of Sport Assessment-Patella (VISA-P) were assessed at baseline, and 1 week, 1 month, 3 months and 12 months follow-up after the last session. Results At baseline, pain intensity was 8/10 and VISA-P was 58. After the third treatment session, the patient returned for soccer playing after two years inactive. He reported slightly pain (NPRS, 2/10) during the soccer game. After the last fourth session, NPRS was 1/10 and VISA-P was 71 and GROC+5. Outcomes during the follow-ups were: 1 month (NPRS 2/10, VISA-P 90, GROC+5), 3 months (NPRS 1/10 VISA-P 95, GROC+7), 6–12 months (NPRS 0/10, VISA-P 100, GROC+7). Ultrasound examination showed no changes in calcification: 1.24 cm. at 12 months; however, the patellar tendon was visually more homogeneous. Conclusions The application of EPE, dry needling and high-load eccentric exercise program was clinically effective at long-term for treating recalcitrant chronic calcification in the patellar tendon in a professional soccer player. No structural changes in the calcification were observed.