Abstract
PurposeTo evaluate if High-volume Image-guided Injection (HVIGI)-treatment for chronic Patellar tendinopathy (PT) improve function and reduce pain at 16-months follow-up.MethodsPatients with resistant PT who failed to improve after a three-month eccentric loading program were included in the study. Maximal tendon thickness was assessed with ultrasound. All patients were injected with 10 mL of 0.5% Marcaine, 0.5 mL Triamcinolonacetonid (40 mg/mL) and 40 mL of 0.9% NaCl saline solution under real-time ultrasound-guidance and high pressure. All outcome measures were recorded at baseline and at 16 months. A standardised Heavy Slow Resistance rehabilitation protocol was prescribed after HVIGI-treatment. Clinical outcome was assessed with the Victorian Institute of Sports Assessment-Patella tendon questionnaire (VISA-P) and statistically analyses were performed.ResultsThe study included 28 single treatment HVIGI procedures in PT in 23 patients (19 men, 4 women) with a mean age of 30.3 (range 19–52). The mean duration of symptoms before HVIGI was 33 months. The baseline VISA-P score of 43 ± 17 (range 15–76) improved to 76 ± 16 (range 42–95) after 16 months (p < 0.01). Of the 28 HVIGI procedures 12 patients (15 PT) were not satisfied after the initial HVIGI procedure. Of these, 5 patients (5 PT) had additional HVIGI, 2 patients (2 PT) had corticoid injection and 6 patients (8 PT) needed surgery. Of the remaining 11 patients (13 PT), 9 patients had more than a 13-point improvement in the VISA-P score after 16 months.ConclusionsIn this retrospective case-study, only 9 patients (32%) did benefit of a single HVIGI treatment at 16-months and a 33-point significant improvement was seen on the VISA-P score.
Highlights
Jumper’s knee or patellar tendinopathy (PT) is a common overuse injury among athletes
It was hypothesised that High-volume Image-guided Injection (HVIGI) would result in clinically relevant improvements of symptoms and function for chronic Patellar tendinopathy after 16 months and that most of the patients would benefit from HVIGI treatment. In this retrospective case series of 28 single HVIGI procedures followed prospectively were performed between May 2013 and October 2016
Patients were included if they had a diagnosis of tendinopathy (here defined by (1) pain localized to the inferior pole of patella and (2) neovascularisation and innervation in and around the tendon using ultrasound examination) and had failed a three-month Heavy Slow Resistance training (HSR) program [19]
Summary
Jumper’s knee or patellar tendinopathy (PT) is a common overuse injury among athletes. Overall prevalence of PT is seen in 10–14% of elite athletes. The prevalence is higher in sports with high demands on speed and power [13, 16, 20]. Lian et al presented prevalence as high as 32–45% in elite volleyball and basketball players [20]. In nonelite athletes prevalence of PT is seen in 5.8– 8.5% of athletes and again prevalence is higher in speed and power activities such as volleyball and basketball (range 11.3–14.4) [8, 24]. PT is a degenerative condition and could be characterized by a neovascularisation of the patella tendon [15, 18]. The area of degeneration generally occurs distal of the inferior pole of the patella and in the proximal portion of the patella tendon [14]
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