Abstract
Sclerosing injections targeting the area with neovessels and nerves on the dorsal side of the patellar tendon has been demonstrated as giving promising clinical results in patients with chronic painful Jumper’s knee-patellar tendinosis (PT). However, a mean number of three treatments with 6–8 weeks in between were needed for a good clinical result. This study aimed to evaluate a more radical removal of the area with neovessels and nerves by using arthroscopic shaving. Fifteen patients (12 men and three women) with the diagnose Jumper’s knee-PT in altogether 15 patellar tendons were included. All patients had a long duration of pain-symptoms (mean 27 months) from the patellar tendon, and ultrasonography (US) + colour Doppler (CD) examination showed structural tendon changes with hypo-echoic areas and a neovascularisation inside and on the dorsal side of the tendon, corresponding to the painful area. All patients were treated with arthroscopic shaving of the dorsal side of the proximal tendon. At follow-up (mean 6 months) after treatment, there was a good clinical result in 13/15 tendons (6/8 elite athletes). The satisfied patients were back to previous (before injury) sport activity level, and the amount of pain recorded on a visual analogue scale (VAS)-scale had decreased significantly (VAS from 79 to 12, P < 0.05). A telephone follow-up 13 months (mean) postoperatively showed that the same 13/15 were still satisfied and active in their sports, and that the 2/15 poor cases were still not satisfied with the treatment. Our short-term results indicate that arthroscopic shaving targeting the area with neovessels and nerves on the dorsal side of the patellar tendon has a potential to reduce the tendon pain and allow for the majority of patients to go back to full tendon loading activity within 2 months after surgery. Further studies evaluating this new technique for treating Jumper’s knee-PT are in progress.
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References
Alfredson H, Forsgren S, Thorsen K, Lorentzon R (2001) In vivo microdialysis and immuno-histochemical analyses of tendon tissue demonstrated high amounts of free glutamate and glutamate NMDAR1 receptors, but no signs of inflammation, in Jumper’s knee. J Orth Res 19:881–886
Alfredson H, Öhberg L, Forsgren S (2003) Is vasculo-neural ingrowth the cause of pain in chronic Achilles tendinosis?-An investigation using ultrasonography and colour Doppler, immunohistochemistry, and diagnostic injections. Knee Surg Sports Traumatol Arthrosc 11:334–338
Alfredson H, Öhberg L (2005) Neovascularisation in chronic painful patellar tendinosis promising results after sclerosing neovessels outside the tendon challenges the need for surgery. Knee Surg Sports Traumatol Arthrosc 13:74–80
Alfredson H, Öhberg L (2005) Sclerosing injections to areas of neovascularisation reduce pain in chronic Achilles tendinopathy: a double-blind randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 13:338–344
Bjur D, Alfredson H, Forsgren S (2005) The innervation pattern of the human Achilles tendon—studies on the normal and tendinosis tendon using markers for general, sensory and sympathetic innervations. Cell Tiss Res 320:201–206
Coleman BD, Khan KM, Maffulli N, Cook JL, Wark JD (2000) Studies of surgical outcome after patellar tendinopathy: clinical significance of methodological deficiencies and guidelines for future studies. Scand J Med Sci Sports 10:2–11
Coleman BD, Khan KM, Kiss ZS, Bartlett J, Young DA, Wark JD (2000) Open and arthroscopic patellar tenotomy for chronic patellar tendinopathy. A retrospective outcome study. Am J Sports Med 28(2):183–190
Cook JL, Khan KM, Harcourt PR, Grant M, Young DA, Bonar SF (1997) A cross sectional study of 100 athletes with jumper’s knee managed conservatively and surgically. Br J Sports Med 31:332–336
Cook JL (2001) What’s the appropriate treatment for patellar tendinopathy? Br J Sports Med 35(5):291–294
Forsgren S, Danielsson P, Alfredson H (2005) Vascular NK-1R receptor occurrence in normal and chronic painful Achilles and patellar tendons. Studies on chemically unfixed as well as fixed specimens. Regul Pept 126:173–181
Johnson DP (1998) Arthroscopic surgery for patellar tendonitis. Arthroscopy 14(Suppl1):44
Karlsson J, Lundin O, Wigerstad Lossing I, Peterson L (1991) Partial rupture of the patellar ligament. Results after operative treatment. Am J Sports Med 19(4):403–408
Karlsson J, Kälebo P, Goksör L-Å, Thomee R, Swärd L (1992) Partial rupture of the patellar ligament. Am J Sports Med 20(4):390–395
Kettunen JA, Kvist M, Alanen E, Kujala UM (2002) Long-term prognosis for Jumper’s knee in male athletes. A prospective follow-up study. Am J Sports Med 30(5):689–692
Khan KM, Cook JL, Kiss ZS, Visentini PJ, Fehrmann MW, Harcourt PR, Tress BW, Wark JD (1997) Patellar tendon ultrasonography and Jumper’s knee in female basketball players: a longitudinal study. Clin J Sports Med 7:199–206
Khan KM, Maffuli N, Coleman BD, Cook JL, Taunton JE (1998) Patellar tendinopathy: some aspects of basic science and clinical management. Br J Sports Med 32:346–355
Khan KM, Visentini PJ, Kiss ZS, Desmond PM, Coleman BD, Cook JL, Tress BM, Wark JD, Forster BB (1999) Correlation of ultrasound and magnetic resonance imaging with clinical outcome after patellar tenotomy: prospective and retrospective studies. Clin J Sports Med 9:129–137
Khan KM, Cook JL, Maffuli N, Kannus P (2000) Where is the pain coming from in tendinopathy? It may be biochemical, not only structural, in origin. Br J Sports Med 34(2):81–83
Lian Ö, Holen KJ, Engebretsen L, Bahr R (1996) Relationship between symptoms of Jumper’s knee and the ultrasound characteristics of the patellar tendon among high level male volleyboll players. Scand J Med Sci Sports 6:291–296
Öhberg L, Lorentzon R, Alfredson H (2001) Neovascularisation in Achilles tendons with painful tendinosis but not in normal tendons: an ultrasonographic investigation. Knee Surg Sports Traumatol Arthrosc 9:233–238
Öhberg L, Alfredson H (2002) Ultrasound guided sclerosis of neovessels in painful chronic Achilles tendinosis: pilot study of a new treatment. Br J Sports Med 36:173–177
Raatikainen T, Karpakka J, Puranen J, Orava S (1994) Operative treatment of partial rupture of the patellar ligament. Int J Sports Med 15:46–49
Saillant G, Rolland E, Garcon P, Melchior B, Benacet JP, Roy-Camille R (1991) Surgical treatment of patellar tendonitis. A series of 80 cases. J Traumatol Sport 8:114–120
Terslev L (2001) Ultrasound and power Doppler findings in Jumper’s knee-preliminary observations. Eur J Ultrasound 13(3):183–189
Testa V, Capasso G, Maffulli N, Bifulco G (1998) Ultrasound-guided percutaneous longitudinal tenotomy for the management of patellar tendinopathy. Med Sci Sports Exerc 31(11):1509–1515
Weinberg EP, Adams MJ, Hollenberg GM (1998) Color Doppler sonography of patellar tendinosis. Am J Roentgenol 171(3):743–744
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Funding for the study has been achieved through the Swedish Research Council for Sports.
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Willberg, L., Sunding, K., Öhberg, L. et al. Treatment of Jumper’s knee: promising short-term results in a pilot study using a new arthroscopic approach based on imaging findings. Knee Surg Sports Traumatol Arthrosc 15, 676–681 (2007). https://doi.org/10.1007/s00167-006-0223-6
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DOI: https://doi.org/10.1007/s00167-006-0223-6