Presentation
Fire fighter, bilateral sore proximal patellar tendon at the attachment to the lower pole of the patella. Has noticed some swelling on the left side. Worse with jumping, basketball, left more than right. No prior knee injuries.
Patient Data
Severely thickened and heterogeneous hypoechoic appaerance of the proximal patellar tendon with pronounced intra- and peritendinous hypervascularisation. In addition, there is an intrasubstance and partial-thickness tear.
FU US after microtenotomy Rx
After three combined microtenotomy and dextrose prolotherapy treatment sessions, spread over a period of 6 months, the patient experienced substantial improvement with only minimal residual complaints.
The follow-up ultrasound showed significant improvement of the proximal patellar tendinopathy. The overall thickness of the proximal patellar tendon was decreased and the hyperemia had disappeared. The partial-thickness tear in the deep portion of the tendon was clearly decreased in size as well.
Case Discussion
Combined microtenotomy and dextrose prolotherapy is an easy-to-perform, quick and low-cost ultrasound-guided intervention with a low risk of adverse events. In addition, dextrose is a cheap and harmless substance to inject that is effective in initiating the healing cascade by causing cell lysis and consequently inflammation.
Multiple treatment sessions might be needed to achieve a satisfying result and are best performed with an interval of 4 to 6 weeks to optimally stimulate the normal healing tissue repair cascade.
Several indications exist, however it has been proven to be most efficient for chronic tendinopathy failing conservative therapy.