title: Hyaluronan injection therapy for athletic patients with patellar tendinopathy.
abstract: BACKGROUND
  Patellar tendinopathy produces activity-related pain and focal tenderness at the attachment of the patellar tendon at the lower pole of the patella. It frequently causes a reduction in athletic ability. An injection of hyaluronan was found to be useful for patellar tendinopathy, provided the indication is appropriate, based on the authors' pilot cases. The purpose of this study was to summarize the clinical experience of and to describe the appropriate indication for this injection therapy.
  
  
  METHODS
  Fifty patients were treated from January 1999 to December 2006. The observation period averaged 25.7 months (range 6-88). All patients were graded stage 2 or 3 by Blazina's classification. Each treatment was counted separately for 9 patients (10 knees) who had more than one treatment period with 3 months or more between the injections. There were 4 bilaterally injected patients. Patellar tendinopathy was classified into 4 types according to the degree of tenderness and the regions that are tender. Hyaluronan was injected into the interface between the patellar tendon and the infrapatellar fat pad at the proximal insertion, or into the region of maximum tenderness.
  
  
  RESULTS
  The total number of injections was 135, and there were an average of 2.0 injections per case (range 1-11). Following treatment, 54 % of the cases were rated in excellent condition, as they were able to return to their previous athletic activities with little difficulty, while 40 % of the cases were rated in good condition-these patients were able to return to their previous sporting activities with some degree of limitation.
  
  
  CONCLUSIONS
  Hyaluronan injection therapy for athletic patients with patellar tendinopathy is an optional but effective treatment.
authors.affiliation: Department of Orthopaedic Surgery, School of Medicine, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan. muneta.orj@tmd.ac.jp
authors.forename: Takeshi
authors.initials: T
authors.lastname: Muneta
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Koga
authors.forename: Young-Jin
authors.initials: YJ
authors.lastname: Ju
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Mochizuki
authors.forename: Ichiro
authors.initials: I
authors.lastname: Sekiya
mesh_terms: D000293:Adolescent; D000328:Adult; D001265:Athletic Injuries / Q000188:drug therapy* / Q000534:rehabilitation; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage / Q000627:therapeutic use*; D007270:Injections, Intra-Articular; D007718:Knee Injuries / Q000188:drug therapy* / Q000534:rehabilitation; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D017847:Patellar Ligament; D026741:Physical Therapy Modalities; D052256:Tendinopathy / Q000145:classification / Q000188:drug therapy* / Q000534:rehabilitation; D016896:Treatment Outcome; D055675:Viscosupplements / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D055675:Viscosupplements; D006820:Hyaluronic Acid