Disclosures: Anton Matveev, MBS, MD: Nothing to disclose

Case Description: A former professional soccer player carrying a diagnosis of chronic patellar tendinopathy previously treated with NSAIDs, PT (including eccentrics) and intragluteal steroids, presented with infrapatellar and inferolateral patellar pain at the tendon insertion. Pain severity was 6/10 at its worst, exacerbated by squatting, going down stairs and landing from a jump. Associated symptoms included clicking and sensations of instability without giving way. Terminal knee extension was positive for pain. A diagnostic ultrasound was consistent with chronic midsubstance patellar tendinosis with marked hypertrophy, longitudinal intrasubstance tearing and chronic neovessel invagination from Hoffa’s fat pad into the patellar tendon with visualization on Doppler. After discussion of treatment options, rigorous HEP already employed, and fear of reinitiating eccentrics owing to pain, the patient underwent an ultrasound-guided percutaneous tendon scraping and neovessel ablation of the left patellar tendon with extra-tendinous triamcinolone injection.

Setting: Outpatient

Patient: 36-year-old male former athlete with 15 years of anterior knee pain.

Assessment/Results: Patient had immediate post-procedural pain relief with maintained strength. At 4-week follow-up, he reported 100% pain relief for 2 weeks without any activity and 90% relief for the 2 weeks following resumption of running and playing tennis. Patient initiated therapy for eccentric quadriceps strengthening at that time without hesitance. At 7 months follow-up, he completed PT and a formal return to play program, maintained 100% pain relief and returned to playing semi-professional soccer without residual symptoms.

Discussion: Interventional approaches for disruption of neovascularization in chronic patellar tendinopathy vary by injectate and ultrasound or arthroscopic guidance. The procedure aims to decrease chronic irritation and allow tendinous healing by destroying aberrant vessels crossing from Hoffa’s fat pad into the patellar tendon. This limits anchoring and reduces avenues for proinflammatory effector recruitment.

Conclusion: Ultrasound-guided percutaneous neovessel ablation with triamcinolone infusion is a suitable non-surgical treatment option for chronic patellar tendinopathy with sonographic evidence of neovascularization.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/ultrasound-guided-percutaneous-neovessel-ablation-for-chronic-patellar-tendinopathy-in-a-semi-professional-soccer-player-a-case-report/