High volume ultrasound guided injections at the interface between the patellar tendon and Hoffa's body are effective in chronic patellar tendinopathy: A pilot study.

Abstract

PURPOSE:

To evaluate a novel conservative management modality for patellar tendinopathy.

METHODS:

We recruited nine patients with patellar tendinopathy who had failed conservative management and showed evidence of neovascularisation on power Doppler scanning. A high volume ultrasound guided injection at the interface between the patellar tendon and Hoffa's body. The injection contained 10 ml 0.5% Bupivacaine, 25 mg Hydrocortisone, and between 12 and 40 ml normosaline. 100 mm visual analogue scales (VAS) for pain and for function, and Victorian Institute of Sport Assessment - Patellar tendon (VISA-P) questionnaires at an average of 9 months from the injection.

RESULTS:

All but one patient (whose pain was unchanged) improved (p = 0.028). The mean improvement in function 2 weeks after injection was 58 mm on VAS (interquartile range 27 - 88, p = 0.018). The mean improvement in pain 2 weeks after injection was 56 mm on a VAS scale (interquartile range 32 - 80, p = 0.018). At a mean follow up of 9 months, an improvement of 22 points from a baseline score of 46 on the VISA-P questionnaire (100 being normal) was established.

CONCLUSION:

High volume injections to mechanically disrupt the neovascularisation in patellar tendinopathy are helpful in the management of this condition. Controlled trials would be warranted to investigate in a more conclusive fashion this management modality.

• Authors: Tom Crisp, Faisal Khan, Nat Padhiar, Dylan Morrissey, John King, Rosy Jalan, Nicola Maffulli, Otto Chan Frcr
• Journal: Disability and rehabilitation (Disabil Rehabil) Vol. 30 Issue 20-22 Pg. 1625-34 ( 2008) ISSN: 0963-8288 [Print] England
• PMID: 18608403 (Publication Type: Journal Article)

Chemical References

• Anesthetics, Local
• Anti-Inflammatory Agents
• Hydrocortisone
• Bupivacaine

Topics

• Adolescent
• Adult
• Anesthetics, Local (therapeutic use)
• Anti-Inflammatory Agents (therapeutic use)
• Bupivacaine (therapeutic use)
• Chronic Disease
• Follow-Up Studies
• Humans
• Hydrocortisone (therapeutic use)
• Injections, Intra-Articular
• Middle Aged
• Pain Measurement
• Patellar Ligament (diagnostic imaging)
• Pilot Projects
• Severity of Illness Index
• Tendinopathy (diagnostic imaging, drug therapy)
• Ultrasonography, Interventional
• Young Adult