Nicola Maffulli1, Angelo Del Buono, Francesco Oliva, Vittorino Testa, Giovanni Capasso, Gayle Maffulli. 1. *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.
Abstract
OBJECTIVE: To assess the effectiveness of high-volume image-guided injection in the middle term in patients with recalcitrant patellar tendinopathy. DESIGN: Case series study; Level of evidence, 4. SETTING: All tertiary referrals, public, and private healthcare. PATIENTS: Forty-four patients (41 men and 3 women) with diagnosis of recalcitrant patellar tendinopathy were included. INTERVENTION: 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. MAIN OUTCOME MEASURES: 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. CLINICAL RELEVANCE: This procedure is minimally invasive, safe, and effective in the short term in athletes.
OBJECTIVE: To assess the effectiveness of high-volume image-guided injection in the middle term in patients with recalcitrant patellar tendinopathy. DESIGN: Case series study; Level of evidence, 4. SETTING: All tertiary referrals, public, and private healthcare. PATIENTS: Forty-four patients (41 men and 3 women) with diagnosis of recalcitrant patellar tendinopathy were included. INTERVENTION: 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. MAIN OUTCOME MEASURES: 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. CLINICAL RELEVANCE: This procedure is minimally invasive, safe, and effective in the short term in athletes.
Authors: Robert M Barker-Davies; Alastair Nicol; I McCurdie; James Watson; Polly Baker; Patrick Wheeler; Daniel Fong; Mark Lewis; Alexander N Bennett Journal: BMC Musculoskelet Disord Date: 2017-05-22 Impact factor: 2.362
Authors: Robert M Barker-Davies; Polly Baker; James Watson; Duncan Goodall; Patrick C Wheeler; Alastair M Nicol; Daniel T P Fong; Mark P Lewis; Alexander N Bennett Journal: Orthop J Sports Med Date: 2022-04-08