Injection treatments for patellar tendinopathy

Abstract

ObjectiveInjection treatments are increasingly used as treatment for patellar tendinopathy. The aim of this systematic review is to describe the different injection treatments, their rationales and the effectiveness of treating patellar tendinopathy.MethodsA computerised search of the Medline, Embase, CINAHL and Web of Knowledge databases was conducted on 1 May 2010 to identify studies on injection treatments for patellar tendinopathy.Results11 articles on seven different injection treatments (dry needling, autologous blood, high-volume, platelet-rich plasma, sclerosis, steroids and aprotinin injections) were found: 4 randomised controlled trials (RCTs), 1 non-RCT, 4 prospective cohort studies and 2 retrospective cohort studies. All studies reported positive results. The Delphi scores of the four RCTs ranged from 5 to 8 out of 9. Different and sometimes contradictory rationales were used for the injection treatments.ConclusionAll seven different injection treatments seem promising for treating patellar tendinopathy. Unlike the other injection treatments, steroid treatment often shows a relapse of symptoms in the long term. Results should be interpreted with caution as the number of studies is low, few high-quality studies have been conducted and the studies are hard to compare due to different methodology. More high-quality studies using the same cross-cultural reliable and valid outcome measure are needed, as well as further research into the pathophysiology. Finally, some implications are provided for clinicians who want to use injection treatments as a part of their treatment for patellar tendinopathy, distinguishing between reactive and degenerative phase of patellar tendinopathy.

Patellar Tendinopathy: Clinical Diagnosis, Load Management, and Advice for Challenging Case Presentations

“…Kongsgaard et al 54 reported that steroid injection used in isolation was associated with a poorer outcome at 6 months compared with exercise. It must be emphasized that there are few high-quality studies on injection therapies to date, 88 and injections are often offered when rehabilitation has been inadequate. 80 The key strategy for avoiding multiple passive interventions is setting realistic goals based on a sound understanding of the condition and its rehabilitation.…”

Radiological interventions for soft tissue injuries in sport

“…Two recent meta-analyses of different injection therapies for tendonopathy both concluded that all treatments had promising effects, with the exception of steroids, which often showed relapse of symptoms in the long term [11,43]. However, another conclusion might be that the other techniques are not necessarily beneficial, but that steroids are detrimental to tendons.…”

Dry Needling Versus Cortisone Injection in the Treatment of Greater Trochanteric Pain Syndrome: A Noninferiority Randomized Clinical Trial

“…7,10,16,[23][24][25]28,30,45 Evidence suggests that analgesic injection is not superior to DN in other regions of the body. 17,21,46 Therefore, it is possible that cortisone injection for GTPS is not superior to DN. If DN is equally or more effective in treating GTPS than cortisone injection, then effective patient care could be delivered without subjecting patients to the harmful effects of steroids.…”