Treatment Of Chronic Patellar Tendinopathy Research Articles

High-volume image-guided injection in the chronic recalcitrant non-insertional patellar tendinopathy: a retrospective case series

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.

Results of Arthroscopic Treatment of Chronic Patellar Tendinopathy.

The surgical treatment of chronic patellar tendinopathy could be open or arthroscopic. A general agreement on the best surgical treatment option is still lacking. The aim of our study was to evaluate the clinical results after a minimally invasive arthroscopic treatment of chronic patellar tendinopathy including a resection of the lower patellar pole. The study included 14 patients with a mean age of 26 years and chronic patellar tendinopathy refractory to non-operative treatment of more than 6 months. All patients underwent arthroscopic debridement of the adipose tissue of the Hoffa's body posterior to the patellar tendon, debridement of abnormal patellar tendon and resection of the lower patellar pole. Preoperative and postoperative evaluation was undertaken using clinical examination, magnetic resonance imaging (MRI) and the Lysholm and Victorian Institute of Sport Assessment-Patella (VISA-P) scores. Return to sports and postoperative complications were also assessed. The mean follow-up was 12.2 ± 0.9 months. All 14 patients continued with sport activities, but only 12 of them (85.7%) achieved their presymptom sporting level. The median time to return to preinjury level of activity was 3.9 ± 0.8 months. Patients showed a major improvement in the mean Lysholm score from 51.1 ± 3.8 to 93.4 ± 4.2 (p=0.001) and in the mean VISA-P score from 42.1 ± 3.5 to 86.7 ± 8.4 (p=0.001) There were no postoperative complications. We found that this arthroscopic technique gives reduced morbidity and satisfactory outcome resulting in significantly faster recovery and return to sports in patients with chronic patellar tendinopathy.

Arthroscopic Treatment of Chronic Patellar Tendinopathy "Jumper's Knee”

Arthroscopic Treatment of Chronic Patellar Tendinopathy "Jumper's Knee”

Effectiveness of percutaneus needle electrolysis and eccentric exercise in chronic patellar tendinopathy

Abstract Aims The aim of this study was to evaluate the effect of percutaneous needle electrolysis together with exercise with eccentric loading for the treatment of chronic patellar tendinopathy. Material and Methods An experimental study was performed including eight subjects medically diagnosed with chronic patellar tendinopathy. The sample included subjects with a mean age of 40 years old (SD:10), a sample of 10 tendons was obtained with over four months' evolution. Functionality was assessed using the VISA-P scale, pain was evaluated using the Visual Analog Scale (VAS), the tendon structure was evaluated by analyzing of ultrasound images which evaluated the AP diameter, perimeter and echogenicity. All study subjects belonged to the same group and were applied the same treatment. This consisted of three sessions of percutaneous needle electrolysis, following the protocol defined by Valera &amp; Minaya with a dosage of 3:3:3, with 3 mA of intensity for 3 seconds and 3 current applications, together with a program of eccentric overloading which was developed in nine exercise sessions, which consisted of three series of 12 repetitions single-legged semi squats with maximum patient load on a decline board. A 48-hour window was left between the clinical session and sports practice with eccentric overloading. Results In the initial assessment, a VISA-P score of 40.90 was obtained (SD:10.55), together with a VAS a score of 7.3 (SD:1.01), on the ultrasound exam all patients presented changes compatible with a degenerative process. After four weeks, the values of the VISA-P scale increased 35.8% at four weeks, VAS decreased 55.4% and slight changes were appreciated in ultrasound values in 42.4% of patients. Conclusion Percutaneous needle electrolysis, together with eccentric overload exercise, represent a treatment which may be effective for most cases of chronic patellar tendinopathy.

Platelet-rich plasma as a treatment for chronic patellar tendinopathy: comparison of a single versus two consecutive injections

Platelet-rich plasma as a treatment for chronic patellar tendinopathy: comparison of a single versus two consecutive injections

Refractory patellar tendinopathy treated by arthroscopic decortication of the inferior patellar pole in athletes: Mid-term outcomes

BackgroundThis study aimed to evaluate the clinical outcomes of arthroscopic decortication of the inferior patellar pole in athletes with refractory chronic patellar tendinopathy. MethodsThirty-seven athletes in whom conservative management for at least six months failed underwent arthroscopic patellar tendon debridement and decortication of the inferior pole of the patella. Clinical outcomes were evaluated using subjective knee scores and isokinetic muscle strength tests. The average duration taken and sports participation level were also assessed. ResultsThe mean follow-up period was 51.3 ± 14.8 months. At the last follow-up, all improvements in subjective knee scores including Lysholm score, International Knee Documentation Committee (IKDC) subjective score, Victorian Institute of Sport Assessment -Patella (VISA-P) score, and Kujala score were statistically significant (p<.001). Tegner activity scale improved from 6.5±1.0 to 8.9±0.8 (p<.001). Limb symmetry index for extensor peak torque improved from 71.4±19.6% to 92.7±21.7% (p<.001). Thirty-two (86.5 %) athletes were able to return to full sports activities in a mean 3.5±1.7months, and 27 (73%) athletes maintained their previous sports activity level at the last follow-up. Symptoms recurred in two (5.2%). ConclusionsArthroscopic decortication of the inferior pole of the patella showed satisfactory clinical results and high rates of return to sports at mid-term follow-up in professional athletes with refractory chronic patellar tendinopathy. This technique could be an invasive, safe, and effective treatment for chronic patellar tendinopathy in professional athletes who want a faster return to sports. Level of evidenceLevel IV, case series.

Treatment of chronic patellar tendinopathy using an exercise program consisting of eccentric training and static stretching exercises combined with high intensity light therapy. A pilot study

Treatment of chronic patellar tendinopathy using an exercise program consisting of eccentric training and static stretching exercises combined with high intensity light therapy. A pilot study

Nonsurgical Treatments of Patellar Tendinopathy: Multiple Injections of Platelet-Rich Plasma Are a Suitable Option: A Systematic Review and Meta-analysis

Background: Patellar tendinopathy is a condition characterized by anterior knee activity–related pain. It has a high incidence among athletes engaged in jumping sports and may become a chronic condition. Nonoperative management is the first choice in these patients, and several nonsurgical treatment options have been proposed. Nonetheless, clear indications on the most effective approach to address patellar tendinopathy are still lacking. Purpose: To analyze the evidence on nonoperative options to treat chronic patellar tendinopathy through a systematic review of the literature and to perform a meta-analysis to identify the most effective nonsurgical option. Study Design: Systematic review and meta-analysis. Methods: The search was conducted with the PubMed and Cochrane databases on January 4, 2017. All clinical English-language reports of any level of evidence on nonsurgical treatment of patellar tendinopathy were included. The quality of each article was assessed by use of the Coleman score. A meta-analysis was performed on all articles reporting the Victorian Institute of Sport Assessment scale for patellar tendinopathy to evaluate the results of the most described treatments. Results: A total of 70 studies involving 2530 patients were included in the qualitative data synthesis. The Coleman score showed an overall poor study quality. The most described treatment groups that could be included in the meta-analysis were reported in 22 studies on eccentric exercise, extracorporeal shockwave therapy (ESWT), and platelet-rich plasma (PRP). Single and multiple PRP injections were evaluated separately. Eccentric exercise therapies obtained the best results (P < .05) at short-term (<6 months, mean 2.7 ± 0.7 months). However, multiple injections of PRP obtained the best results (P < .05), followed by ESWT and eccentric exercise, at long-term follow-up (≥6 months, mean 15.1 ± 11.3 months). Conclusion: The literature documents several nonsurgical approaches for the treatment of chronic patellar tendinopathy with important limitations in terms of study quality. The available evidence showed an overall positive outcome, but some differences have been highlighted. Eccentric exercises may seem the strategy of choice in the short-term, but multiple PRP injections may offer more satisfactory results at long-term follow-up and can be therefore considered a suitable option for the treatment of patellar tendinopathy.

Prognostic value of MRI in arthroscopic treatment of chronic patellar tendinopathy: a prospective cohort study

BackgroundTo date, prognostic outcome factors for patients undergoing arthroscopic treatment due to chronic patellar tendinopathy (PT) are lacking. The purpose of this study was to investigate whether preoperatively assessed MRI parameters might be of prognostic value for prediction of functional outcome and return to sports in arthroscopic treatment of chronic PT.MethodsA prospective cohort study was conducted including 30 cases (4 female and 24 male competitive athletes) undergoing arthroscopic patellar release (APR) due to chronic PT. The mean age was 28.2 years (range, 18–49 years) at the time of surgery, and the mean follow-up period was 4.2 years (range, 2.2–10.4 years). Preoperatively assessed MRI parameters included bone marrow edema (BME) of the inferior patellar pole, patellar tendon thickening, infrapatellar fat pad (IFP) edema, and infrapatellar bursitis. Prevalences of preoperative MRI findings were correlated to functional outcome scores in order to determine statistically significant predictors.ResultsAll athletes regained their preinjury sports levels. Athletes featuring preoperative IFP edema showed significantly inferior modified Blazina score (0.6 ± 0.7 vs. 0.2 ± 0.5), single assessment numeric evaluation (SANE; 86.0 ± 8.8 vs. 94.3 ± 7.5), and Visual Analogue Scale (VAS; 1.0 ± 1.2 vs. 0.3 ± 0.8) compared to subjects without IFP edema (p < 0.05). Return to sports required a mean of 4 ± 3.2 months. On average, patients with IFP edema needed significantly more time to return to sports than subjects without IFP edema (6.5 vs 2.8 months; p < 0.05). The simultaneous presence of BME and IFP edema was associated with significantly inferior outcomes by means of the Victorian Institute of Sport Assessment questionnaire for patients with patellar tendinopathy (VISA-P; 88.1 ± 11.9 vs. 98.6 ± 4.2), SANE (84.3 ± 10.2 vs. 93.1 ± 8.3), and VAS (1.3 ± 1.4 vs. 0.3 ± 0.9) compared to an isolated BME or isolated IFP edema.ConclusionsThis is the first study identifying prognostic outcome factors in arthroscopic treatment of chronic PT. Preoperative IFP edema alone or simultaneous BME and IFP edema on preoperative MRI were associated with inferior functional outcome and delayed return to sports. Knowledge of these predictive factors might improve risk stratification, individualize treatment and postoperative rehabilitation, and contribute to improve clinical outcome. Moreover, current findings offer the potential for novel therapeutic approaches.

Platelet-rich plasma as a treatment for chronic patellar tendinopathy: comparison of a single versus two consecutive injections

platelet-rich-plasma is increasingly used in chronic patellar tendinopathy. Ideal number of PRP injections needed is not yet established. This study compares the clinical outcomes of a single versus two consecutive PRP injections. between December 2009 and January 2012, 40 athletes with proximal patellar tendinopathy were treated by PRP injection. Patients received single (20 patients) or two PRP injections 2 weeks apart (20 patients). All patients underwent prospective clinical evaluation, including Victorian Institute of Sport Assessment-Patella (VISA-P) score, visual analog scale (VAS) for pain, and Tegner scale before PRP and after a minimum of 2 year follow-up. 9 patients failed PRP treatment and needed surgery. 1 patient was lost to follow-up. For the remaining patients, the VISA-P, VAS, and Tegner scores all significantly improved from 35.2 to 78.5 (p = 0.0001), 6.6 to 2.4 (p = 0.0001), and 4.8 to 6.9 (p = 0.0003). Patients who received two injections had better scores than those who received single injection with VAS of 1.07 versus 3.7 (p = 0.0005), Tegner score of 8.1 versus 5.9 (p = 0.0003) and VISA-P of 93.2 versus 65.7 (p = 0.0001). two consecutive PRP injections in chronic patellar tendinopathy showed better improvement in outcomes when compared to single injection. randomized prospective consecutive series, Level 2.

Are Multiple Platelet-Rich Plasma Injections Useful for Treatment of Chronic Patellar Tendinopathy in Athletes?

Background: Chronic patellar tendinopathy (PT) is one of the most common overuse knee disorders. Platelet-rich plasma (PRP) appears to be a reliable nonoperative therapy for chronic PT. Purpose: To evaluate clinical and radiological outcomes of 3 consecutive ultrasound (US)–guided PRP injections for the treatment of chronic PT in athletes. Study Design: Case series; Level of evidence, 4. Methods: A total of 28 athletes (17 professional, 11 semiprofessional) with chronic PT refractory to nonoperative management were prospectively included for US-guided pure PRP injections into the site of the tendinopathy. The same treating physician at a single institution performed 3 consecutive injections 1 week apart, with the same PRP preparation used. All patients underwent clinical evaluation, including the Victorian Institute of Sport Assessment–Patella (VISA-P) score, visual analog scales (VAS) for pain, and Lysholm knee scale before surgery and after return to practice sports. Tendon healing was assessed with MRI at 1 and 3 months after the procedure. Results: The VISA-P, VAS, and Lysholm scores all significantly improved at the 2-year follow-up. The average preprocedure VISA-P, VAS, and Lysholm scores improved from 39 to 94 (P < .001), 7 to 0.8 (P < .0001), and 60 to 96 (P < .001), respectively, at the 2-year follow-up. Twenty-one of the 28 athletes returned to their presymptom sporting level at 3 months (range, 2-6 months) after the procedure. Follow-up MRI assessment showed improved structural integrity of the tendon at 3 months after the procedure and complete return to normal structural integrity of the tendon in 16 patients (57%). Seven patients did not recover their presymptom sporting level (among them, 6 were considered treatment failures): 3 patients returned to sport at a lesser level, 1 patient changed his sport activity (for other reasons), and 3 needed surgical intervention. Conclusion: In this study, application of 3 consecutive US-guided PRP injections significantly improved symptoms and function in athletes with chronic PT and allowed fast recovery to their presymptom sporting level. The PRP treatment permitted a return to a normal architecture of the tendon as assessed by MRI.

Low Energy Radial Extracorporeal Shock Wave Therapy as a Treatment for Chronic Patella Tendinopathy

A single application of radial SWT is a safe and effective treatment for chronic patellar tendinopathy Extracorporeal shock wave therapy (SWT) is effective for the management of chronic recalcitrant tendinopathy. The objective of the current study was to assess if SWT is effective for treatment of chronic patellar tendinopathy. Thirty-three patients with chronic patellar tendinopathy received low-energy SWT. Thirty-three patients with chronic patellar tendinopathy received additional forms of non-operative therapy (control group). Evaluation was by change in visual analog score (VAS), Victoria Institute of Sport Assessment Score for patellar tendinopathy (VISA - P) score and by Roles and Maudsley score. Mean pre-treatment VAS scores for the control and SWT groups were 7.5 and 7.8 respectively. One month, 3 months, and 12 months after treatment, the mean VAS for the control and SWT groups were 6.7 and 4.3 (p<0.001), 5.9 and 3.5 (p<0.001), and 5.1 and 2.7 (p<0.001) respectively. One month, 3 months, and 12 months after treatment, the mean VISA for the control and SWT groups were 50.7 and 65.5 (p<.001), 52.1 and 71 (p<0.001), and 54.9 and 74.5 (p<0.001) respectively. At final follow-up, the number of excellent, good, fair, and poor results for the SWT and control groups were 8 and 3 (p<0.001), 17 and 10 (p<0.001), 5 and 16 (p<0.001), and 3 and 4 (p<0.001) respectively. The percentage of patients with excellent (“1”) or good (“2”) Roles and Maudsley scores (i.e. successful results) 12 months after treatment was statistically greater in the SWT group compared to the control group (p<0.001). A single application of radial SWT is an effective treatment for chronic patellar tendinopathy.

Topical glyceryl trinitrate treatment of chronic patellar tendinopathy: a randomised, double-blind, placebo-controlled clinical trial

ObjectivesTo assess if continuous topical glyceryl trinitrate (GTN) treatment improves outcome in patients with chronic patellar tendinopathy when compared with eccentric training alone.MethodsRandomised double-blind, placebo-controlled clinical trial comparing a 12-week...

A single application of low-energy radial extracorporeal shock wave therapy is effective for the management of chronic patellar tendinopathy

Extracorporeal shock wave therapy (SWT) is effective for the management of chronic recalcitrant tendinopathy. The objective of the current study was to assess whether a standardized, single treatment SWT is effective for the management of chronic patellar tendinopathy Thirty-three patients with chronic patellar tendinopathy received low-energy SWT. Thirty-three patients with chronic patellar tendinopathy received other forms of non-operative therapy (control group). Evaluation was by change in Visual Analogue Scale (VAS), Victoria Institute of Sport Assessment score for patellar tendinopathy (VISA-P) score and by Roles and Maudsley Score. Mean pre-treatment VAS scores for the control and SWT groups were 7.5 and 7.8, respectively. Onemonth, 3months, and 12months after treatment, the mean VAS for the control and SWT groups were 6.7 and 4.3 (p<0.001), 5.9 and 3.5 (p<0.001), and 5.1 and 2.7 (p<0.001), respectively. One month, 3months, and 12months after treatment, the mean VISA for the control and SWT groups were 50.7 and 65.5 (p<0.001), 52.1 and 71 (p<0.001), and 54.9 and 74.5 (p<0.001), respectively. At final follow-up, the number of excellent, good, fair, and poor results for the SWT and control groups were 8 and 3 (p<0.001), 17 and 10 (p<0.001), 5 and 16 (p<0.001), and 3 and 4 (p<0.001), respectively. The percentage of patients with excellent ("1") or good ("2") Roles and Maudsley Scores (i.e. successful results) 12months after treatment was statistically greater in the SWT group compared to the control group (p<0.001). A single application of radial SWT is an effective treatment for chronic patellar tendinopathy. III.

Treatment of Chronic Patellar Tendinopathy with Autologous Bone Marrow Stem Cells: A 5-Year-Followup

The purpose of this study is to determine if patients with chronic patellar tendinopathy will improve clinically after the inoculation of bone marrow mononuclear cells (BM-MNCs). Eight patients with chronic patellar tendinopathy were included. Patients averaged 24 years old (range 14–35). All patients were refractory to conservative treatment for at least 6 months before the procedure. BM-MNCs were harvested from the iliac bone crest and inoculated under ultrasound guide in the patellar tendon lesion. Improvement was assessed through established clinical scores and ultrasound. At 5-year followup, statistically significant improvement was seen for most clinical scores. Seven of eight patients said they would have the procedure again if they had the same problem in the opposite knee and were completely satisfied with the procedure. Seven of 8 patients thought that the results of the procedure were excellent. According to our results, inoculation of BM-MNCs could be considered as a potential therapy for those patients with chronic patellar tendinopathy refractory to nonoperative treatments.

Can Arthroscopically Assisted Treatment of Chronic Patellar Tendinopathy Reduce Pain and Restore Function?

Patellar tendinopathy is a common source of pain in athletes, especially those involved in sports with a high incidence of jumping and cutting. Changes in training programs and exercises based on eccentric quadriceps contractions often relieve patients' symptoms. For athletes unresponsive to this treatment, some authors suggest open and arthroscopic procedures débriding either the tendon alone, or the tendon and bone. We asked whether an arthroscopically assisted approach to débride not only the tendon, bone, but also the peritenon could relieve pain and allow athletes to return to their former activities. We retrospectively reviewed 23 patients with a history of at least 6 months of painful patellar tendinopathy unresponsive to nonoperative treatment treated with an arthroscopic technique that débrided the tendon, inferior pole of the patella, and peritenon: 22 males and one female. Mean age was 29 years. Patients were evaluated using the anterior knee pain score of Kujala et al. The minimum followup was 12 months (mean, 58 months; range, 12-121 months). Twelve patients scored 100, one 99, one 98, five 97, two 94, one 90, and one 64. The Kujala et al. mean score was 96 (range, 64-100). All but four patients returned to their former sports activities. We observed no complications. Arthroscopic treatment can relieve the pain of refractory chronic patellar tendinopathy. Our observations were comparable with those previously reported for open techniques and a high percentage of patients returned to their previous activity level. Level IV, observational study. See Guidelines for Authors for a complete description of levels of evidence.

Extracorporeal Shockwave for Chronic Patellar Tendinopathy

Background Chronic patellar tendinopathy is an overuse syndrome with pathologic changes similar to tendinopathies of the shoulder, elbow, and heel. Extracorporeal shockwave was shown effective in many tendinopathies. Hypothesis Extracorporeal shockwave therapy may be more effective than conservative treatment for chronic patellar tendinopathy. Study Design Randomized controlled clinical trial; Level of evidence, 2. Methods This study consisted of 27 patients (30 knees) in the study group and 23 patients (24 knees) in the control group. In the study group, patients were treated with 1500 impulses of extracorporeal shockwave at 14 KV (equivalent to 0.18 mJ/mm 2 energy flux density) to the affected knee at a single session. Patients in the control group were treated with conservative treatments including nonsteroidal anti-inflammatory drugs, physiotherapy, exercise program, and the use of a knee strap. The evaluation parameters included pain score, Victorian Institute of Sports Assessment score, and ultrasonographic examination at 1, 3, 6, and 12 months and then once a year. Results At the 2- to 3-year follow-up, the overall results for the study group were 43% excellent, 47% good, 10% fair, and none poor. For the control group, the results were none excellent, 50% good, 25% fair, and 25% poor. The mean Victorian Institute of Sports Assessment scores were 42.57 ± 10.22 and 39.25 ± 10.85, respectively, before treatment (P = .129) and 92.0 ± 10.17 and 41.04 ± 10.96, respectively, after treatment (P < .001). Satisfactory results were observed in 90% of the study group versus 50% of the control group (P < .001). Recurrence of symptoms occurred in 13% of the study group and 50% of the control group (P = .014). Ultrasonographic examination showed a significant increase in the vascularity of the patellar tendon and a trend of reduction in the patellar tendon thickness after shockwave treatment compared with conservative treatments. However, no significant difference in the appearance, arrangement, and homogeneity of tendon fibers was noted between the 2 groups. There were no systemic or local complications or device-related problems. Conclusion Extracorporeal shockwave therapy appeared to be more effective and safer than traditional conservative treatments in the management of patients with chronic patellar tendinopathy.

Arthroscopic Patellar Release for the Treatment of Chronic Patellar Tendinopathy

Abstract We describe an arthroscopic technique for the treatment of chronic patellar tendinopathy (jumper’s knee). Preoperatively, tendon necrosis or rupture is excluded by sonography. Diagnostic arthroscopy is performed and hypertrophic synovitis around the inferior patellar pole is removed with a bipolar cautery system. Two outside-in cannulas mark the clinically symptomatic region, mainly found between the tendon insertion site and the lateral aspects of the patellar tendon. The bipolar cautery is used for a release of the paratenon and a bone denervation at the inferior patellar pole including the tendon insertion site within the marked area. No tendon or bone material is removed or excised throughout the procedure. We treated 15 athletes with stage 3 and 4 chronic patellar tendinopathies on a modified version of the Blazina score (0-5). Patients’ mean age was 29 years and the mean follow-up period was 41 months. In 13 cases, clinical symptoms subsided completely within 3 months after surgery. The mean preoperative Blazina score was 3.7 (SD, 0.5) and the mean postoperative Blazina score was 0.4 (SD, 1.0; paired 2-tailed t test, P < .01). Ultrasound showed a reduction of tendon edema within 3 weeks and no signs of edema within a mean period of 5 weeks after surgery. The minimal surgical impact to the tendon allows early and functional rehabilitation. The technique is effective, easy to perform, and safe to apply.

Ultrasound-guided percutaneous longitudinal tenotomy for the management of patellar tendinopathy.

Thirty-eight athletes with unilateral patellar tendinopathy (17 with a tendinopathy of the main body of the tendon, and 21 with an insertional tendinopathy) underwent ultrasound-guided multiple percutaneous longitudinal tenotomy under local anaesthetic infiltration after failure of conservative management. Thirty-four patients were reviewed at least 24 months after the operation. Sixteen patients were rated excellent, nine good, eight fair, and five poor. Nine of the 13 patients with a fair or poor result had an insertional tendinopathy, and eight of them underwent a formal exploration of the patellar tendon. Before the operation, there were some areas of altered echogenicity at and around the site of involvement. These were still visible 6 wk after surgery in 70% of the patients. At the latest follow-up, in the patients with an excellent or good result, the tendon was generally isoechogenic but slightly thicker (P = 0.06) than the normal contralateral. In the patients with a fair or poor result, the tendon was significantly thicker than the contralateral (P = 0.03), and showed some areas of mixed echogenicity. In the patients in whom the procedure was successful, the thicker operated tendon did not interfere with physical training. Bilateral isokinetic peak torque (Nm), average work (Joules), and average power (Watts) were tested at 90 degrees x s(-1). Immediately before the operation, there was no significant difference in peak torque, but total work and average power were significantly lower in the limb to be operated (0.01 < P < 0.05). By the end of the study, although peak torque was, on average, within 7% of the unoperated limb, total work and average power were still significantly lower than in the unoperated limb (0.01 < P < 0.04). Percutaneous longitudinal internal tenotomy is simple, can be performed on an outpatient basis, requires minimal follow-up care, does not hinder further surgery should it be unsuccessful, and, in our experience, has produced no significant complications. In our hands, it has become the first line operative intervention in the treatment of chronic patellar tendinopathy after failure of conservative management. However, patients should be advised that, if they suffer from an tendinopathy at the attachment of the patellar tendon at the lower pole of the patella, a formal surgical exploration with stripping of the paratenon is preferable.