title: 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: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.affiliation: Centre for Sports and Exercise Medicine, Mile End Hospital, London, UK.
authors.forename: Tom
authors.initials: T
authors.lastname: Crisp
authors.forename: Faisal
authors.initials: F
authors.lastname: Khan
authors.forename: Nat
authors.initials: N
authors.lastname: Padhiar
authors.forename: Dylan
authors.initials: D
authors.lastname: Morrissey
authors.forename: John
authors.initials: J
authors.lastname: King
authors.forename: Rosy
authors.initials: R
authors.lastname: Jalan
authors.forename: Nicola
authors.initials: N
authors.lastname: Maffulli
authors.forename: Otto Chan
authors.initials: OC
authors.lastname: Frcr
mesh_terms: D000293:Adolescent; D000328:Adult; D000779:Anesthetics, Local / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D002045:Bupivacaine / Q000627:therapeutic use; D002908:Chronic Disease; D005500:Follow-Up Studies; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use; D007270:Injections, Intra-Articular; D008875:Middle Aged; D010147:Pain Measurement; D017847:Patellar Ligament / Q000000981:diagnostic imaging*; D010865:Pilot Projects; D012720:Severity of Illness Index; D052256:Tendinopathy / Q000000981:diagnostic imaging / Q000188:drug therapy*; D018084:Ultrasonography, Interventional; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D006854:Hydrocortisone; D002045:Bupivacaine