Background
Tendon degeneration in the lower limb is a common overuse problem for athletes
who do a lot of running and jumping.
In the ankles, this manifests as Achilles
tendinopathy.
In the knee, this manifests as patellar
tendinopathy.
In people who are less active and/ or overweight, this can also occur but is thought to be less frequent.
Symptoms may include marked pain, localised swelling and stiffness.
A diagnostic ultrasound scan will often show that the tendon is
thickened, disorganised and damaged.
In severe cases, the addition of power doppler during the ultrasound
scan will also demonstrate areas of abnormal blood vessel flow (neovascularity)
around and into the tendon.
Looking at these tissues under the microscope, these abnormal blood vessels are often
accompanied by new nerve endings.
It has been proposed that these nerve endings
are responsible for the persistent pain that patients may experience.
Procedure
High volume image-guided
injections (HVIGI) are a novel and promising treatment for Achilles and
patellar tendinopathy.
Using ultrasound guidance, a peritendinous injection of
fluid (50mls around the Achilles tendon; 40mls around the patellar tendon) is
injected into the interface between the tendon and underlying fat pad.
This sterile
fluid comprises local anesthetic, normal saline and only a small amount of
corticosteroid.
The intention of HVIGIs is to destroy the abnormal blood vessels and
nerve endings that have grown into the tendon.
This often results in significantly decreased
pain, enabling patients to progress with their rehabilitation.
This procedure is not a cure, but provides decreased pain and a ‘window
of opportunity’ in which patients can progress with their rehabilitation.
For
this reason, it must be coupled with a comprehensive physiotherapy program to
give a patient who suffers with tendinopathy the best chance of success.