Injection therapies for patellar tendinopathy

Effectiveness of Injection Strategies on Patients With Patellar Tendonitis (Jumpers' Knee): A Network Meta-analysis of Randomized Controlled Trials

CONTEXT

Patellar tendonitis (PT) is a common degenerative disease of the patellar tendon that seriously affects the sports careers of elite athletes and activities of daily living of sports enthusiasts. Injection therapy is a prevalent invasive treatment for PT.

OBJECTIVE

This work comprehensively analyzes various injection treatments for PT that consider agent type and characteristics, frequency, and assessment timepoints by meta-analysis.

DATA SOURCES

PubMed, Embase, and the Cochrane Library were sources of data.

DATA SELECTION

Randomized controlled trials (RCTs) analyzing the effect of various injection strategies on the treatment of patients with PT were considered.

STUDY DESIGN

Systematic review and meta-analysis.

LEVEL OF EVIDENCE

Level 2.

DATA EXTRACTION

First author, year of publication, research location, registration information, patient type, sample size, age, sex, intervention, control treatment, and follow-up period in each study were extracted.

RESULTS

Nineteen RCTs were included in the analysis. In the network meta-analysis of Victorian Institute of Sports Assessment-Patellar (VISA-P) outcomes, polidocanol (standardized mean difference (SMD), 6.52; 95% CI 4.75, 8.30; P < 0.01), tenocyte-like cells (SMD, 4.08; 95% CI 2.92, 5.25; P < 0.01), and leukocyte-poor platelet-rich plasma (LP-PRP) plus high-volume image-guided injection (HVIGI) (SMD, 1.56; 95% CI 0.62, 2.50; P < 0.01) were significantly superior to noninjection conservative treatment, mainly at the 6-month follow-up timepoint. For visual analog scale results, multiple dry needling (DN) (SMD, -1.78; 95% CI -2.56, -1.00; P < 0.01), LP-PRP (SMD, -0.71; 95% CI -1.31, -0.12; P = 0.02), and LP-PRP plus HVIGI (SMD, -1.31; 95% CI -2.22, -0.39; P < 0.01) were significantly superior to blank, which was also mainly at the 6-month timepoint.

CONCLUSION

Injection-related treatments: polidocanol, tenocyte-like cells, LP-PRP, and multiple DN showed potential short (1-3 months) or medium (6 months)-term treatment benefits. There is still no evidence for injection interventions with long-term therapeutic benefit.

Refractory lipoatrophy treated with autologous whole blood injection: A case report

BACKGROUND

Intramuscular corticosteroid injection may cause adverse effects such as dermal and/or subcutaneous atrophy, alopecia, hypopigmentation, and hyperpigmentation. Although cutaneous atrophy can spontaneously resolve, several treatment options have been suggested for this condition.

CASE SUMMARY

In this paper, we report a case of corticosteroid injection induced lipoatrophy treated with autologous whole blood (AWB) injection, as the condition had been unresponsive to fractional laser therapy. A 29-year-old female patient visited the dermatology clinic complaining of skin depression on her right buttock area, which had appeared six months earlier. There had been only subtle improvement at the margins after fractional CO2 laser treatment; therefore, after obtaining informed consent from the patient, AWB treatment was initiated. One month after the first AWB injection, the size and depth of the lesion had noticeably improved, and a slight improvement was also observed in discoloration.

CONCLUSION

Close observation is the initial treatment of choice for steroid induced skin atrophy; however, for patients in need of immediate cosmetic improvement, AWB injection may be a safe and cost-effective alternative.

Platelet-rich plasma for jumper's knee: a comprehensive review of efficacy, protocols, and future directions

PURPOSE

This comprehensive review evaluates the current state of platelet-rich plasma (PRP) treatment for jumper's knee, also known as patellar tendinopathy. The aim is to assess the efficacy of PRP as a therapeutic option compared to other available procedures, investigate the benefits and potential drawbacks of PRP infiltration, and provide insights into the optimal protocols for PRP preparation and administration.

METHODS

A comprehensive literature search of English articles published up to June 2023 was conducted using PubMed and Scopus databases. Studies evaluating PRP for treating jumper's knee or patellar tendinopathy were analyzed to assess the current state of research in this field.

RESULTS

PRP has demonstrated promising results in promoting cellular remodeling and accelerating the healing process in the jumper's knee. It shows potential benefits in pain reduction, improved function, and accelerated recovery. However, the efficacy of PRP varies depending on patient characteristics, disease severity, and the specific administration methodology. Establishing standardized PRP preparation and administration protocols are necessary to optimize its effectiveness. Further research is needed to define appropriate patient selection criteria and refine the application of PRP therapy in patellar tendinopathy management.

CONCLUSION

Jumper's knee is commonly managed conservatively, but there is a lack of consensus on further treatment options. PRP treatment holds promise in promoting tissue healing and repair. However, standardized protocols for PRP preparation and administration, as well as optimal dosage and number of injections, require further investigation to enhance its efficacy. Continued research efforts are necessary to ascertain the precise role of PRP and its refinement in the management of patellar tendinopathy.

Patellar Tendinopathy—Does Injection Therapy Have a Role? A Systematic Review of Randomised Control Trials

Injection treatment is one of the most widely used methods for the conservative management of patellar tendinopathy. The objective of this systematic review was to synthesise data from randomised control trails on the effectiveness of various injections used in the management of patellar tendinopathy. An electronic search was conducted in the Web of Science, Scopus, PubMed, and SPORTDiscus databases. To be included in the current systematic review, the study had to be an RCT conducted on human participants that investigated the effect of at least one injection treatment on the management of patellar tendinopathy. Selected studies were required to report either patient-reported outcomes or biological and clinical markers of the tendon healing. The methodological quality of the studies was appraised using the revised Cochrane risk of bias tool for RCTs (RoB 2.0). Nine RCTs on seven types of injections were included in this review, with an overall positive outcome. Pain intensity was measured in all the studies. The VISA P score was the most used outcome measure (n = 8). A wide variety of interventions were compared with injection therapy, including eccentric training, extracorporeal shockwave, and arthroscopy. It can be concluded that the injection treatments can produce promising results in the management of patellar tendinopathy. However, because of the limited number of studies and the disparities in the study populations and protocols, it is not possible to make a firm conclusion on the efficacy of these injection methods, and these results should be inferred with care.

Current understanding of the diagnosis and management of the tendinopathy: An update from the lab to the clinical practice

Tendinopathy is labeled by many authors as a troublesome, common pathology, present in up to 30% medical care consultations involving musculoskeletal conditions. Despite the lasting interest for addressing tendon pathology, current researchers agree that even the exact definition of the term tendinopathy is unclear. Tendinopathy is currently diagnosed as a clinical hypothesis based on the patient symptoms and physical context. One of the main goals of current clinical management is to personalize treatment approaches to adapt them to the many different needs of the population. Tendons are complex structures that unite muscles and bones with two main objectives: to transmit forces and storage and release energy. Regarding the tensile properties of the tendons, several authors argued that tendons have higher tensile strength compared with muscles, however, are considered less flexible. Tendinopathy is an accepted term which is used to indicated a variety of tissue conditions that appear in injured tendons and describes a non-rupture damage in the tendon or paratendon, which is intensified with mechanical loading Even when the pathoetiology of tendinopathy is unclear, there is a wide array of treatments available to treat and manage tendinopathy. Although tendinitis usually debuts with an inflammatory response, the majority of chronic tendinopathies do not present inflammation and so the choosing of treatment should vary depending on severity, compliance, pain and duration of symptoms. The purpose of this article is to review and provide an overview about the currently research of the tendon diagnosis, management and etiology.

Autologous blood injection for treatment of steroid atrophy: A case report

BACKGROUND

Intramuscular corticosteroid injections are frequently used for a variety of conditions in dermatology practice. Unfortunately, many complications are associated with systemic and local administration of corticosteroids. Localized subcutaneous lipoatrophy is among the most common adverse effects that can lead to permanent disfigurement. Autologous blood is collected from peripheral veins and injected immediately to the affected tissue with the intention of stimulating the body's own tissue-healing mechanisms through cellular and humoral mediators.

AIMS

Although platelet-rich plasma therapy, produced by centrifugation of autologous blood, is very popular in dermatology practice, autologous blood injection (ABI) is not routinely preferred. With this case, it was aimed to report that ABI can be a safe and effective option in the treatment of steroid atrophy.

PATIENTS/METHODS

A case of steroid atrophy in a female patient treated successfully with ABI was presented.

RESULTS

A 17-year-old female patient presented with epidermal/dermal atrophy, depigmentation, and subcutaneous fat atrophy after intramuscular corticosteroid injection. ABI treatment was initiated because there were no signs of spontaneous improvement after 6 months. 4 cc autologous blood was injected in small volumes into the superficial, middle, and deep parts of the atrophic tissue. After 2 sessions of ABI, the size and depth of the atrophy were markedly improved and depigmentation was resolved.

CONCLUSION

There are several treatment options for localized steroid atrophy with varying success rates. This is the first report that shows ABI is a simple, effective, and safe procedure for correction of corticosteroid-induced cutaneous and subcutaneous atrophy with satisfying results.