Ultrasound guided dry needling and autologous blood injection for patella tendinosis

Steven L. J James ¹, Kaline Ali ², Chris Pocock ³, Claire Robertson ⁴, Joy Walter ⁴, Jonathan Bell ³ and David Connell ^2*

¹ The Royal Orthopaedic Hospital, Birmingham, United Kingdom
² The Royal National Orthopaedic Hospital, Stanmore, United Kingdom
³ Kingston Hospital, United Kingdom
⁴ Joy Walter Clinic, United Kingdom

^* To whom correspondence should be addressed. E-mail: david.connell{at}rnoh.nhs.uk.

Accepted 21 February 2007

Abstract

Objective: To evaluate the efficacy of ultrasound guided dry needling and autologous blood injection for the treatment of patella tendinosis.

Design: Prospective

Setting: Institutional

Patients: Forty seven knees in 44 patients (40 men, 7 women, mean age 34.5 years, age range 17-54 years) with refractory tendinosis underwent sonographic examination of the patella tendon following referral with a clinical diagnosis of patella tendinosis (mean symptom duration 12.9 months).

Interventions: Ultrasound guided dry needling and injection of autologous blood into the site of patella tendinosis was performed on two occasions, 4 weeks apart.

Main Outcome Measurements: Pre and post procedure Victorian Institute of Sport Assessment scores (VISA) were collected to assess patient response to treatment. Follow up ultrasound examination was performed in 21 patients (22 knees).

Results: Therapeutic intervention led to a significant improvement in VISA score when pre and post procedure scores were compared (mean pre-procedure score 39.8; range 8-72; mean post procedure score 74.3; range 29-100; mean follow up 14.8 months, range 6-22 months) and patients were able to return to their sporting interests. Follow up sonographic assessment revealed a reduction in overall tendon thickness and in the size of the area of tendinosis (hypoechoic/anechoic areas within the proximal patella tendon). Furthermore, a reduction was identified in interstitial tears within the tendon substance. Interestingly, neovascularity did not reduce significantly and indeed was more dramatic on follow up in a number of patients.

Conclusions: Dry needling and autologous blood injection under ultrasound guidance shows promise as a treatment for patients with patella tendinosis.

Key Words: autologous blood, dry needling, patella tendinosis, tendon healing, ultrasound

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