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.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, 62500 international units of aprotinin, and 40 mL of normal saline solution.Main Outcome Measures:The Victorian Institute of Sport Assessmentpatellar 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.