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Non-Surgical Repair of Patellar Tendonitis with Autologous Platelet
Concentrate Using Ultrasound Guidance: Two Case Reports
Beacon Orthopedic & Sports Medicine, Cincinnati, OH Case 1 – 26 y/o Male with Chronic Left Patellar Tendonitis

Clinical History:
A 26 year old professional male basketball player presented with a 4 year history of chronic left
patellar tendonitis initially diagnosed by MRI while he was playing in college. This was treated
with various non-steroidal anti-inflammatory medications, physical therapy, tendon strapping,
iontophoresis, and relative rest. The patient gained no significant relief from these treatments.
Physical Examination:
Physical examination revealed full range of motion of the knee with excellent flexibility of the
quadriceps and hamstrings. No effusion was noted. The cruciate and collateral ligaments were
intact; no joint line tenderness was noted. The patellar tendon revealed point tenderness at the
inferior pole of the patella. Pain was reproduced with resisted extension of the knee at 90 degrees
flexion as well as with one-legged hops.
X-rays- 3 views including standing AP, lateral, and merchants revealed no acute abnormality.
Diagnostic MSK ultrasound was performed using the 12MgHz probe and revealed significant
thickening of the tendon proximally and an area of anechogenicity consistent with mucoid
degeneration (Fig.1-A). The opposite patellar tendon appeared normal (Fig.1-B).
Description of Procedure:
• Left Knee sterilely prepped and draped • 3cc of Platelet Rich Plasma (PRP) was prepared from 20cc of whole blood (SmartPReP System, Harvest Technologies Corp., Plymouth, MA). • 4cc 2% xylocaine with 1:100,000 dilution of epinephrine was injected into the tendon to fenestrate the area of chronic tendonosis and to help activate the platelets. • 3cc of PRP was injected into the thickened area of tendonosis • 1cc of Bovine Thrombin with Calcium Chloride (CaCl) was then injected to create a
A second identical procedure was preformed two weeks later. Two weeks after the second
injection the tendon was no longer tender to palpation, nor was there pain with resisted extension
of the knee.

Physical Therapy:
Physical therapy was started and consisted of stretching, eccentric strengthening, and
cardiovascular conditioning. After four weeks of therapy including a functional return to
basketball, the patient was able to play the entire professional season pain free.
Patient Follow-Up:
Repeat MSK ultrasound was performed 16 weeks after the final injection. The tendon was
significantly less thickened and the area of anechogenicity was no longer visible (Fig.2).
Case 2 – 20 y/o Female with Patellar Tendonitis

Clinical History:
A 20 year old female Division 1 collegiate basketball player presented with a 6 month history of
patellar tendonitis diagnosed by point tenderness at the inferior pole of the right patella. This was
treated with ice, modalities including iontophoresis, NSAIDS, physical therapy and activity
modification. The patient was for the most part able to play through the pain.
Six months after being diagnosed with patellar tendonitis, the patient sustained a valgus blow to
the knee in the flexed position and was found by MRI to have an acute, partial tear of the patellar
tendon superimposed on chronic tendonosis (Fig.3).
Physical Examination:
Physical examination revealed full range of motion of the knee with fair flexibility of hamstrings
and quadriceps with no atrophy noted. The patient was point tender at the inferior pole of the
patellar with pain present upon resisted extension of knee. The remainder of the knee exam was
WNL.
Diagnostic MSK ultrasound revealed thickening of the tendon proximally beginning at the
inferior pole the patella and an area of anechogenicity corresponding to area of high signal
intensity on MRI scan (Fig.4).

Description of Procedure:

• Right Knee sterilely prepped and draped • 3cc of Platelet Rich Plasma (PRP) was prepared from 20cc of whole blood (SmartPReP System, Harvest Technologies Corp., Plymouth, MA). • 4cc 2% xylocaine with 1:100,000 dilution of epinephrine was injected into the tendon to fenestrate the area of chronic tendonosis and to activate the platelets. • 3cc of PRP was injected into the thickened area of tendonosis and the area of acute • 1cc of Bovine Thrombin with CaCl was then injected to create a lasting platelet plug The identical procedure was repeated in 3 weeks. The 4ccs of PRP were this time injected into
the area of chronic tendonosis and thrombin was not used as the area of partial tearing had shown
significant healing.

Patient Follow-Up
Three weeks after the second injection, the tendon was no longer tender to palpation, nor was
there pain with resisted extension of the knee. Physical therapy was started and consisted of
stretching, eccentric strengthening, and cardiovascular conditioning. After three weeks of
therapy including a functional return to basketball, the patient was able to return to basketball
with no anterior knee pain or limitations.

Twelve weeks after the second PRP injection, repeat MSK ultrasound was performed and the
area of partial tendon appeared to be healed. The chronic area of tendonosis appeared less
thickened and normal tendon striations were noted (Fig.5).

Discussion:
Chronic patellar tendonitis is a very difficult condition to treat. The patellar tendon is a weight
bearing tendon and therefore corticosteroid injections are contraindicated and surgery is often
unsuccessful. The most common presenting symptom is pain with jumping activities and
therefore is most common in athletes who are involved in basketball and volleyball. Relative
rest, ice, NSAIDS, iontophoresis, and other physical therapy modalities offer little relief.
PRP with ultrasound guided needle placement to allow precise placement of the tissue graft
offers a very simple and safe treatment modality that not only alleviates the pain, but replaces the
mucoid degeneration within the tendon with healthy tendon as illustrated above thereby allowing
the athlete a safe and pain free return to sports.

Source: http://www.mauiregenerativemedicine.com/download/Patellar%20Tendonitis%20-%20Stiene(2).pdf

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