Ultrasound-guided percutaneous longitudinal tenotomy for the management ofpatellar tendinopathy

Thirty-eight athletes with unilateral patellar tendinopathy (17 with a lend inopathy of the main body of the tendon, and 21 with an insertional tendino pathy) underwent ultrasound-guided multiple percutaneous longitudinal tenot omy under local anaesthetic infiltration after failure of conservative mana gement. Thirty-four patients were reviewed at least 24 months after the ope ration. Sixteen patients were rated excellent, nine good, eight fair, and f ive poor. Nine of the 13 patients with a fair or poor result had an inserti onal tendinopathy, and eight of them underwent a formal exploration of the patellar tendon. Before the operation, there were some areas of altered ech ogenicity at and around the sire of involvement. These were still visible 6 wk after surgery in 70% of the patients. At the latest follow-up, in the p atients with an excellent or good result, the tendon was generally isoechog enic but slightly thicker (P = 0.06) than the normal contralateral. In the patients with a fair or poor result, the tendon was significantly thicker t han the contralateral (P = 0.03), and showed some areas of mixed echogenici ty. In the patients in whom the procedure was successful, the thicker opera ted tendon did not interfere with physical training. Bilateral isokinetic p eak torque (Nm), average work (Joules), and average power (Watts) were test ed at 90 degrees s(-1). Immediately before the operation, there was no sign ificant difference in peak torque, but total work and average power were si gnificantly lower in the limb to be operated (0.01 < P < 0.05). By the end of the study, although peak torque was, on average, within 7% of the unoper ated limb, total work and average power were still significantly lower than in the unoperated limb (0.01 < P < 0.04). Percutaneous longitudinal intern al tenotomy is simple, can be performed on an outpatient basis, requires mi nimal follow-up care, does not hinder further surgery should it be unsucces sful, and, in our experience, has produced no significant complications. In our hands, it has become the first line operative intervention in the trea tment of chronic patellar tendinopathy after failure of conservative manage ment. However, patients should be advised that, if they suffer from an tend inopathy at the attachment of the patellar tendon at the lower pole of the patella, a formal surgical exploration with stripping of the paratenon is p referable.