High-Volume Image-Guided Injection for Recalcitrant Patellar Tendinopathy in Athletes.
OBJECTIVE
To assess the effectiveness of high-volume image-guided injection in the middle term in patients with recalcitrant patellar tendinopathy.


METHODS
Case series study; Level of evidence, 4.


METHODS
All tertiary referrals, public, and private healthcare.


METHODS
Forty-four patients (41 men and 3 women) with diagnosis of recalcitrant patellar tendinopathy were included.


METHODS
Tendon injection of a mixture of 10 mL of 0.5% bupivacaine hydrochloride, 62 500 international units of aprotinin, and 40 mL of normal saline solution.


METHODS
The Victorian Institute of Sport Assessment-patellar tendon (VISA-P), visual analogue scale, and Roles and Maudsley were assessed at baseline and at the last follow-up.


RESULTS
The baseline VISA-P score of 46 ± 18.2 (range, 28-75) improved to 75.3 ± 19.2 (range, 68-100) by 15 months (P = 0.003). The mean pain visual analogue scale changed from 91 mm (range, 66-92 mm) before the injection to 28 mm (2-52 mm) (P = 0.01). Of 32 physically active patients, 23 (72%) had returned to sport at the same level practiced before the onset of symptoms. Thirty-five of the 44 patients (80%) rated their condition as good or excellent.


CONCLUSIONS
High-volume injection at the interface between the deep surface of the patellar tendon and Hoffa body improves in the short-term symptoms and function of the knee.


CONCLUSIONS
This procedure is minimally invasive, safe, and effective in the short term in athletes.
*Department of Musculoskeletal Disorders, University of Salerno, Salerno, Italy; †Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, London, United Kingdom; ‡Department of Orthopaedic and Trauma Surgery, Ospedale Sant'Anna, Como, Italy; §Department of Orthopaedic and Trauma Surgery, University of Rome, Rome, Italy; ¶Department of Sports Traumatology, Dynamic Center, Angri, Italy; and ‖Department of Orthopaedics and Traumatology, University of Napoli, Napoli, Italy.
Nicola
N
Maffulli
Angelo
A
Del Buono
Francesco
F
Oliva
Vittorino
V
Testa
Giovanni
G
Capasso
Gayle
G
Maffulli
D000328:Adult; D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage*; D007611:Aprotinin / Q000008:administration & dosage; D001265:Athletic Injuries / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D002045:Bupivacaine / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000188:drug therapy* / Q000209:etiology; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging / Q000188:drug therapy*; D010147:Pain Measurement; D017847:Patellar Ligament / Q000098:blood supply; D019233:Retreatment; D000068958:Return to Sport; D015842:Serine Proteinase Inhibitors / Q000008:administration & dosage; D012965:Sodium Chloride / Q000008:administration & dosage; D052256:Tendinopathy / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D018084:Ultrasonography, Interventional; D055815:Young Adult
D000779:Anesthetics, Local; D015842:Serine Proteinase Inhibitors; D012965:Sodium Chloride; D007611:Aprotinin; D002045:Bupivacaine