title: High volume image-guided Injections for patellar tendinopathy: a combined retrospective and prospective case series.
abstract: BACKGROUND
  the aim was to quantify the effect of a novel high volume-image guided injection (HVIGI) technique for recalcitrant patellar tendinopathy (PT).
  
  
  METHODS
  twenty patients (8 prospective; 12 retrospective) with ultrasonographically confirmed proximal PT were recruited. A HVIGI under ultra-sound guidance of 10 ml 0.5% Bupivacaine, 25 mg Hydrocortisone and 30 ml normal saline at the interface of the patellar tendon and Hoffa's fat pad was administered. A standardised eccentric loading rehabilitation protocol was prescribed.
  
  
  RESULTS
  the VISA-P score improved from 45.0 to 64.0 (p<0.01) for all subjects, likely to be clinically significant. There was no statistically significant difference between the increase in the retrospective group of 19.9 (± 23.5) and the prospective of 16.4 (± 11.3) p = 0.7262.5% of prospective subjects agreed that they had significantly improved, with 37.5% returning to sport within 12 weeks.
  
  
  CONCLUSIONS
  HVIGI should be considered in the management of recalcitrant PT. Randomised controlled trials are warranted.
authors.affiliation: Centre for Sports and Exercise Medicine, William Harvey Research Institute Barts and the London School of Medicine and Dentistry Queen Mary University of London, Mile End Hospital, London, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Morton
authors.affiliation: BMI London Independent Hospital.
authors.forename: Otto
authors.initials: O
authors.lastname: Chan
authors.affiliation: Centre for Sports and Exercise Medicine, William Harvey Research Institute Barts and the London School of Medicine and Dentistry Queen Mary University of London, Mile End Hospital, London, UK ; BMI London Independent Hospital.
authors.forename: John
authors.initials: J
authors.lastname: King
authors.affiliation: Centre for Sports and Exercise Medicine, William Harvey Research Institute Barts and the London School of Medicine and Dentistry Queen Mary University of London, Mile End Hospital, London, UK ; BMI London Independent Hospital.
authors.forename: David
authors.initials: D
authors.lastname: Perry
authors.affiliation: Centre for Sports and Exercise Medicine, William Harvey Research Institute Barts and the London School of Medicine and Dentistry Queen Mary University of London, Mile End Hospital, London, UK ; BMI London Independent Hospital.
authors.forename: Tom
authors.initials: T
authors.lastname: Crisp
authors.affiliation: BMI London Independent Hospital ; Head of Department of Physical and Rehabilitation Medicine, University of Salerno, Azienda Ospedaliera San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Maffulli
authors.affiliation: Centre for Sports and Exercise Medicine, William Harvey Research Institute Barts and the London School of Medicine and Dentistry Queen Mary University of London, Mile End Hospital, London, UK ; BMI London Independent Hospital.
authors.forename: Dylan
authors.initials: D
authors.lastname: Morrissey
keywords: VISA-P; injection; patellar tendon; tendinopathy; ultrasound