Sarah Morton, Presenter: Nothing to Disclose

Otto Chan MD, Abstract Co-Author: Nothing to Disclose

Dylan Morrissey PhD, Abstract Co-Author: Nothing to Disclose

John King MD, Abstract Co-Author: Nothing to Disclose

Tom Crisp MD, Abstract Co-Author: Nothing to Disclose

Nicola Maffulli, Abstract Co-Author: Nothing to Disclose

To quantify the effect of high volume image-guided injection (HVIGI) for treating recalcitrant patellar tendinopathy.

Eighteen patients (mean age 31.5; range 18-48) referred to a tertiary centre with proximal patellar tendinopathy after failed conservative management were recruited. The mean symptom duration was 19.4 months(1 - 40 months). Nine were followed retrospectively over a mean period of 9 months. The remaining 9 (male n=9) were followed prospectively over a mean period of 12 weeks. The diagnosis of patellar tendinopathy was confirmed with ultrasound. The average patellar tendon maximal thickness measured on ultrasound scanning was 10.2mm (range 6.8-13.9mm) with an average neovascularisation grade of 4.3 (range 1.0 – 5.0) using a modified Ohberg scale from power doppler images. Two patients had a cyst present in their tendon and one had multiple areas of calcification. The patients were injected under real-time ultrasound guidance with 10ml of 0.5% Marcaine mixed with 25mg of hydrocortisone followed by 30ml of normal saline at the interface between the tendon and Hoffa’s fat pad, adjacent to the area of neovascularisation. There was instantaneous resolution of the neovascularisation following the injection in all subjects. The same rehabilitation programme was followed by all the patients as advised by a chartered physiotherapist; this included heavy load eccentric training from day 3 post injection. The VISA-P questionnaire, the gold standard for patellar tendinopathy, was administered for pre-injection severity (n = 18) and at follow up (n = 9, with 9 patients still to be re-sampled). 

The mean VISA-P score at presentation was 44.1 (range 11 – 92), with 100 representing full function and a complete absence of pain. The retrospective data has shown a mean VISA-P improvement of 22 points (t = 2.02, p = 0.028 ) at follow-up, also considered clinically significant. The follow up prospective data is still being collected. 

High volume image-guided injections should be considered as a treatment in recalcitrant chronic patellar tendinopathy. However, studies over a longer period of time are required to consolidate these findings.

High volume image-guided injections have the potential to treat chronic patellar tendinopathy that has failed to respond to conservative measures. 

Morton, S, Chan, O, Morrissey, D, King, J, Crisp, T, Maffulli, N, High Volume Image-Guided Injections in Patellar Tendinopathy.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12027699.html