Patellar Tendon Needle Tenotomy
Other Names
- Patellar Tendon Tenotomy
- Patellar Tendon Needle Tenotomy
Background
Key Points
- Needle: 1.5 to 2.5 inch, 18-22 gauge needle
- Transducer: high frequency, linear
- Long axis, in-plane is optimal approach
- Corticosteroid injection should not be performed in the patellar tendon
Anatomy of the Patellar Tendon
- Helps for extensor mechanism of the knee
- Distal continuation of quadriceps tendon when it extends past the inferior patellar pole
- Inserts onto tibial tubercle
Palpation Guidance vs Ultrasound Guidance
- Palpation-guided tenotomy is not advised because of the small target area necessitates precise needle placement
- Ultrasound guidance is critical
- There are currently no papers comparing ultrasound- vs palpation- guided injections
Indications
- Patellar Tendinopathy
- Refractory to conservative management
- No corticosteroids
- Consider autologous whole blood, platelet rich plasma, stem cell therapy
- Consider needle tenotomy
Contraindications
- Absolute
- Anaphylaxis to injectates
- Overlying cellulitis, skin lesion or systemic infection
- Relative
- Can be treated with less invasive means
- Hyperglycemia or poorly controlled diabetes
- Lack of symptom improvement with previous injection
Procedure
Equipment
- Sterile prep (i.e. chloraprep, chlorhexidine, iodine, etc)
- Gloves
- Needle: typically 21-25 gauge, 1.5 inch
- Syringe: 5-10 mL
- Gauze
- Ethyl Chloride
- Bandage
- Injectate
- Local anesthetic
- Corticosteroid
- Sterile probe cover
Ultrasound Findings
- Transducer: high frequency, linear array
- Normal patellar tendon
- Hyperechoic, fibrillar
- Uniform thickness
- Undisrupted linear echogenic fibers
- Tendinosis/ Pathologic findings
- Hypoechoic thickening, most commonly on the deep surface of the proximal portion
- Calcification of tendon with degenerative changes
- Intrasubstance/ partial thickness tears
- Hyperemia
Technique: Long Axis, In Plane
- Patient Position
- Supine, knee flexed to 30 degrees
- Supportive roll/ pillow beneath knee
- Transducer position
- Sagittal plane/ long axis over tendon
- Needle Approach/ Orientation
- In plane
- Inferior to superior
- Target
- Hypoechoic region of the tendon
- Pearls and Pitfalls
Technique: Long Axis, Out of Plane
- Patient Position
- Supine, knee flexed to 30 degrees
- Supportive roll/ pillow beneath knee
- Transducer position
- Sagittal plane/ long axis over tendon
- Needle Approach/ Orientation
- Out of plane
- Medial-to-Lateral/ Lateral-to-medial
- Target
- Hypoechoic region of the tendon
- Pearls and Pitfalls
- In out of plane approach, confirm needle placement by rotating into short axis
Aftercare
- No major restrictions in most cases
- Can augment with ice, NSAIDS
- Consider Knee Compression Sleeve to reduce re-accumulation/ swelling
Complications
- Infection
- Damage to surrounding tissue
See Also
References
- ↑ Fazal, Muhammad Ali, Pradeep Moonot, and Fares Haddad. "Radiographic features of acute patellar tendon rupture." Orthopaedic Surgery 7.4 (2015): 338-342.
- ↑ Manske, Robert C., et al. "Musculoskeletal ultrasound: an essential tool in diagnosing patellar tendon injuries." International Journal of Sports Physical Therapy 18.4 (2023).
- ↑ 3.0 3.1 3.2 3.3 Malanga, Gerard A., and Kenneth R. Mautner. "Atlas of ultrasound-guided musculoskeletal injections." (No Title) (2014).
Created by:
John Kiel on 16 January 2025 19:27:18
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Last edited:
16 January 2025 20:05:13
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