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Low intensity pulsed ultrasound
(LIPUS)
Warden
et al.
, in a high-quality article showed
that LIPUS was not shown to provide any
benefit beyong that of the placebo [13] in
agreement
with
another
investigation
suggesting that LIPUS is questionable in the
treatment of tendinopathies [14].
Extra-corporeal shockwave (ECSW)
therapy
Wang
et al.
, in a study with a low quality score,
compared ECSW with conservative treatment
regarding pain reduction and concluded, that
the results had an indeterminate basis [15].
Ultrasound-guided sclerosing
injections
The etiology for patellar tendinopathy remains
uncertain. One explanation would be
neovascularization and anticipation of pain by
accompanying nerves. So, injection agent such
a polidocanol [16, 17] in the area with
neovessels should reduce pain. Some studies
[18, 19] report reduced pain in patients with
patellar tendinopathy after this treatment. But,
contradictory results were recently presented in
a retrospective study [20] of 48 patients with
chronic Achilles tendinopathy revealing less
promising results than expected.
Further investigation is required to proove the
effectiveness of this treatment.
Open surgery
Multiple open surgical procedures have been
described for patellar tendinosis but the most
common involves an open excision of the
diseased portion of the patellar tendon.
Treatment of the paratendon greatly varies, as
does post-operative immobilization. In addi
tion, some surgeons have described drilling,
debriding or excising the distal pole of the
patella [21, 22]. Kaeding
et al.
performed a
recent systematic review of the literature
concerning surgical treatment [23]. Eight out
of nine studies reported >80% success with a
variety of principally open techniques.
However, success was not always clearly
defined and the return to high-level sports
varied from 46 to 91%. They also found no
difference with respect to whether bony work
was performed, whether the paratenon was
closed, or whether the patient was immobilized
after operation.
The greatest limitation to open surgical
procedures appears not to be related to their
success rates but to the protracted post-
operative course of immobilization and the
time needed to return to sport. This can range
from six to ten months [24, 25, 26].
Arthroscopic surgery
Arthroscopic surgical procedures have been
described with good results and a faster return
to function [26, 27]. At the time of arthroscopic
surgery, different authors have described a
simple excision of the distal patellar pole, or a
tendinosis debridement, or both. All of these
studies have reported success rates in terms of
symptomatic improvement (>85%). Coleman
and al.
reported that only 46% of their patients
returned to sports [26].
Muccioli
et al.
, in a systematic review of the
literature, reported that minimally invasive
arthroscopically assisted procedures don’t have
statistically significant better results when
compared to open surgery in the treatment of
chronic proximal patellar tendinopathy [28].
Platelet-rich plasma injection
Platelet-rich plasma injection for the
management of patellar tendinopathy, have
shown promising results [29].