title: Treatment of Jumper's knee: promising short-term results in a pilot study using a new arthroscopic approach based on imaging findings.
abstract: Sclerosing injections targeting the area with neovessels and nerves on the dorsal side of the patellar tendon has been demonstrated as giving promising clinical results in patients with chronic painful Jumper's knee-patellar tendinosis (PT). However, a mean number of three treatments with 6-8 weeks in between were needed for a good clinical result. This study aimed to evaluate a more radical removal of the area with neovessels and nerves by using arthroscopic shaving. Fifteen patients (12 men and three women) with the diagnose Jumper's knee-PT in altogether 15 patellar tendons were included. All patients had a long duration of pain-symptoms (mean 27 months) from the patellar tendon, and ultrasonography (US) + colour Doppler (CD) examination showed structural tendon changes with hypo-echoic areas and a neovascularisation inside and on the dorsal side of the tendon, corresponding to the painful area. All patients were treated with arthroscopic shaving of the dorsal side of the proximal tendon. At follow-up (mean 6 months) after treatment, there was a good clinical result in 13/15 tendons (6/8 elite athletes). The satisfied patients were back to previous (before injury) sport activity level, and the amount of pain recorded on a visual analogue scale (VAS)-scale had decreased significantly (VAS from 79 to 12, P < 0.05). A telephone follow-up 13 months (mean) postoperatively showed that the same 13/15 were still satisfied and active in their sports, and that the 2/15 poor cases were still not satisfied with the treatment. Our short-term results indicate that arthroscopic shaving targeting the area with neovessels and nerves on the dorsal side of the patellar tendon has a potential to reduce the tendon pain and allow for the majority of patients to go back to full tendon loading activity within 2 months after surgery. Further studies evaluating this new technique for treating Jumper's knee-PT are in progress.
authors.affiliation: Capio Artro Clinic, Karolinska Institute, 11486, Stockholm, Sweden.
authors.forename: Lotta
authors.initials: L
authors.lastname: Willberg
authors.forename: Kerstin
authors.initials: K
authors.lastname: Sunding
authors.forename: Lars
authors.initials: L
authors.lastname: Ohberg
authors.forename: Magnus
authors.initials: M
authors.lastname: Forssblad
authors.forename: Håkan
authors.initials: H
authors.lastname: Alfredson
mesh_terms: D000328:Adult; D001182:Arthroscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D018919:Neovascularization, Physiologic; D010147:Pain Measurement; D017847:Patellar Ligament / Q000098:blood supply / Q000000981:diagnostic imaging / Q000294:innervation / Q000601:surgery*; D017060:Patient Satisfaction; D010865:Pilot Projects; D020127:Recovery of Function; D052256:Tendinopathy / Q000000981:diagnostic imaging / Q000601:surgery*; D018615:Ultrasonography, Doppler, Color