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Ultrasound-guided tendon debridement improves pain, function and structure in persistent patellar tendinopathy: short term follow-up of a case series
  1. Lorenzo Masci1,2,
  2. Hakan Alfredson3,4,
  3. Brad Neal1,4,
  4. William Wynter Bee2
  1. 1Department of Sports and Execise Medicine, Queen Mary University of London, London, UK
  2. 2Department of Sports and Exercise Medicine, ISEH, London, UK
  3. 3Department of Community Medicine and Rehabilitation, Sports Medicine, Umeå University, Umea, Sweden
  4. 4Clinical Research, Pure Sports Medicine, London, UK
  1. Correspondence to Dr Lorenzo Masci; lorenzo{at}


There is a need for effective therapeutic options for resistant patellar tendinopathy. Ultrasound (US)-guided arthroscopic debridement has demonstrated promising clinical results.

Objectives To prospectively evaluate pain, function, tendon structure and adverse events after US and colour Doppler (CD)-guided arthroscopic debridement for persistent painful patellar tendinopathy.

Materials and methods Twenty-three consecutive patients (19 males and 4 females, mean age 28 years (±8), symptom duration 25 months (±21)), who had failed conservative management including progressive loading, were included. US+CD and ultrasound tissue characterisation (UTC) examination verified the clinical diagnosis and quantified baseline tendon structure. Patients were treated with US+CD-guided arthroscopic debridement followed by a specific rehabilitation protocol. Outcomes were VISA-P score for pain and function and UTC for tendon structure. Adverse events were specifically elicited.

Results At 6-month follow-up, mean VISA-P score increased from 40 (±21.0) to 82 (±15) (mean deviation (MD)=42.0, 95% CI 32 to 53, d=2.4), while organised echo pixels (combined UTC type I+II) increased from 55.0% (±17.0) to 69.0% (±15.0) (MD=14.0, d=0.7, 95% CI 2 to 21). Both outcomes exceeded minimum detectable change values. Twenty-one participants returned to their prediagnosis activity levels, and there were no significant adverse events.

Conclusions US-guided patellar tendon debridement for persistent patellar tendinopathy improved symptoms and tendon structure without complications at 6-month follow-up. A majority (21/23) of the patients returned to their preinjury activity level. Further studies with longer follow-ups, preferably randomised and controlled, are needed.

  • knee injuries
  • surgery
  • tendinopathy

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  • Contributors LM was the main researcher and primary author. HA contributed to the research and writing of the paper. BN contributed to the statistics and writing of the paper. WWB was involved in data collection.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Obtained.

  • Ethics approval Ethical approval was granted by the Umea University, Umea Sweden (Dnr 04-157 M).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Deidentified clinical and UTC data will be available from first author on reasonable request via email

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