title: High-volume image-guided injection for recalcitrant medial collateral ligament injuries of the knee.
abstract: OBJECTIVE
  To evaluate the effectiveness of a novel injection technique in the management of recalcitrant medial collateral ligament (MCL) injuries of the knee.
  
  
  METHODS
  The injection, comprising 10 ml local anaesthetic with 25-50 mg hydrocortisone, is directed beneath the periosteal attachment of the MCL. Twenty-eight patients who received the intervention were asked to complete a questionnaire, a visual analogue scale (VAS) and the International Knee Documentation Committee (IKDC) subjective knee form to quantify symptoms pre-injection and at follow-up. Data were assessed using descriptive statistics. Further analysis was conducted using the Wilcoxon signed-rank test and Fisher's exact test.
  
  
  RESULTS
  Sixty-eight percent (n = 19) of patients responded. Three patients were excluded according to the exclusion criteria. Of those studied, 37.5% (n = 6) were professional athletes. At follow-up, patients reported a mean improvement on the VAS of 75.5% (SD = 23.6). There was a significant improvement in IKDC scores (mean difference 42%, SD = 14.2) pre- and post-injection (Wilcoxon signed-rank test, p < 0.001). No residual symptoms were reported by 50% (n = 8) of patients, and a further 37.5% (n = 6) of patients had improved. Of those patients who played sport, two-thirds (n = 10) had returned to their previous level of sport at follow-up, including all of the professional athletes.
  
  
  CONCLUSIONS
  Periosteal high-volume image-guided injection is a useful treatment for recalcitrant MCL injury. Results are encouraging, particularly amongst the professional athletes studied.
authors.affiliation: Centre for Sports and Exercise Medicine, William Harvey Research Institute, Bart's and the London School of Medicine and Dentistry, Queen Mary University of London, Mile End Hospital, London, UK. Electronic address: odrumm@yahoo.co.uk.
authors.forename: O
authors.initials: O
authors.lastname: Drumm
authors.affiliation: Department of Radiology, London Independent Hospital, London, UK.
authors.forename: O
authors.initials: O
authors.lastname: Chan
authors.affiliation: Centre for Sports and Exercise Medicine, William Harvey Research Institute, Bart's and the London School of Medicine and Dentistry, Queen Mary University of London, Mile End Hospital, London, UK.
authors.forename: P
authors.initials: P
authors.lastname: Malliaras
authors.affiliation: Centre for Sports and Exercise Medicine, William Harvey Research Institute, Bart's and the London School of Medicine and Dentistry, Queen Mary University of London, Mile End Hospital, London, UK.
authors.forename: D
authors.initials: D
authors.lastname: Morrissey
authors.affiliation: Centre for Sports and Exercise Medicine, William Harvey Research Institute, Bart's and the London School of Medicine and Dentistry, Queen Mary University of London, Mile End Hospital, London, UK; Department of Musculoskeletal Disorders, University of Salerno School of Medicine and Surgery, Salerno, Italy.
authors.forename: N
authors.initials: N
authors.lastname: Maffulli
mesh_terms: D000293:Adolescent; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D001265:Athletic Injuries / Q000150:complications* / Q000503:physiopathology; D017885:Collateral Ligaments / Q000293:injuries* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage*; D007270:Injections, Intra-Articular / Q000379:methods; D007718:Knee Injuries / Q000150:complications* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010147:Pain Measurement; D017410:Practice Guidelines as Topic; D020127:Recovery of Function; D011795:Surveys and Questionnaires
chemical_list: D000893:Anti-Inflammatory Agents; D006854:Hydrocortisone