2015 ISAKOS Biennial Congress ePoster #1902
Patellar Tendinopathy: Hyaluronan Injection Therapy
Gian Luigi Canata, MD, Torino ITALY
Valentina Casale, MD, Turin ITALY
Koelliker Hospital, Turin, ITALY
FDA Status Cleared
Summary: The present study compares hyaluronic acid to cortisone injections in the treatment of patellar tendinopathy.
Patellar tendinopathy is a common sports injury. The literature about infiltrative treatments does not provide conclusive results. The aim of this study is comparing hyaluronic acid (HA) to cortisone injections therapies.
This prospectively randomized study identified 22 male patients affected by insertional patellar tendinopathy. They were divided into 2 groups. The protocol involved a therapy of three fortnightly injections of cortisone for group A and HA for group B. 16 patients were evaluated between January 1996 and December 2010. Group A: 5 patients (males 5 females 0), mean age 32 years (range 22-43), were submitted to three betamethasone injections. In Group B, 11 patients (males 11 females 0), mean age 36 years (range 21-54), three injections of HA were administered. In all cases, a pre- and postoperative evaluation was performed using the Lysholm Score, the Tegner Activity Level Scale, the Visual Analog Scale (VAS) for pain and the Modified Blazina Jumper’s Knee Scale. Mean follow-up 8 years. Statistical analysis with T- test.
No significant long-term benefit was observed in group A: all of them were subsequently submitted to surgical treatment. Mean Lysholm Score pretreatment and posttreatment was 82 (SD 7), mean VAS pre- and post- treatment was 8 (SD 1), mean Blazina Scale pre- and post- treatment was 3,5. After 5 patients, cortisone injections therapy was suspended for not showing proof of benefit. In Group B significant improvements in all scores were assessed. The mean Lysholm Score pretreatment was 79 (SD 10), posttreament 95 (SD 7). Mean VAS was reduced from pretreatment 6 (SD 2) to posttreatment 2 (SD 2). Mean Blazina Scale pretreatment value was 3, postreatment 0,5. Mean Tegner Activity preinjury level was 8 (SD 1), posttreatment 7 (SD 1). No one patient of the second group underwent surgical treatment.
When patellar tendinopathy does not respond to medical and physical therapies, the infiltrative treatment should be carefully taken into account. Hyaluronic acid appears to be effective without side effects. Instead, the use of cortisone substances does not provide positive long-term results, as emerging in current literature.
In multimodal therapy, when conservative treatments are ineffective, the infiltrative therapy with hyaluronic acid can be performed before proceeding with the surgical treatment.