Causes and findings:
• Overuse - jumpers and runners
• Pain at inferior pole of patella
• Painful: resisted extension of knee
Equipment:
Syringe - 2ml
Needle - 23G 1.25 inches (30mm) blue
Kenalog 40 - 20 mg
Lidocaine - 1.5 ml 2%
Total volume - 2 ml
Anatomy:
The infrapatellar tendon arises from the inferior pole of the patella and it is here that it is commonly inflamed. The tendon is at least two fingers wide at
its origin. It is an absolute contraindication to inject corticosteroid into the body of the tendon as it is a large, weight-bearing and relatively avascular structure. Tenderness at mid-point of the tendon is usually caused by infrapatellar bursitis.
Technique:
• Patient sits with knee supported and extended
• Place web of cephalic hand on superior pole of patella and tilt inferior pole up. Identify and mark tender area at origin of tendon on distal end of patella
• Insert needle at mid-point of tendon origin at an angle of 45°
• Pepper solution along tendon in two rows. There should always be some resistance to the needle to ensure that the solution is not being introduced intra-articularly
Aftercare:
Absolute rest is recommended for at least 10 days before a stretching and strengthening programme is initiated.
Comments:
Injecting the origin of the infrapatellar tendon at the inferior pole is very safe, provided adequate rest is maintained afterwards and that no more than two injections are given in one attack. In an ageing patient with a chronic tendinopathy, scanning is recommended first to ensure that there are no degenerative changes in the substance of the tendon.
Alternative approach:
In the case of the committed athlete or if scanning shows changes as above, deep friction, electrotherapy and taping should be given as potential danger of rupture is more real.
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