Purpose: The purpose of this study was to determine the efficacy and safety of Hyaluronan alone and Hyaluronan combined with Botulinum toxin vs placebo injection in patellar tendinopathy. Methods: 120 patients were treated between January 2010 to June 2015. The observation period averaged 36.8 months. All patients were graded stage 1-3 by Blazina's classification. Hyaluronan was injected into the interface between the patellar tendon and the infrapatellar fat pad at the proximal insertion, or into the region of maximum tenderness. Patients were randomized using a computer generated program to one of: Hyaluronan 2.8cc (750- 1300kDa), 2.8cc Hyaluronan + 40 units Botulinus toxin or 2.8cc saline placebo. Injection was repeated at 7 days. Assessments were obtained at baseline, 7, 14, 30 and 90 days. Participants were volleyball, soccer, football, tennis and basketball players with symptoms of patellar tendinopathy for a minimum of 3 to a maximum duration of 12 months. Primary outcome measure was the VISA-P (Victorian Institute of Sport Assessment - patella) score. Secondary outcomes with regard to pain during function tests (jump tests) including patient's pain VAS on weight bearing (0-100mm), patients' global assessment of knee injury (5 point categorical scale), patients' assessment of normal function/activity (5 point categorical scale), physician's global assessment of knee injury (5 point categorical scale), patients/physician satisfaction assessment (10 point categorical scale), time to return to pain-free and disability-free sport and adverse events as per WHO definition. Results: The 120 patients included 49 males. Twelve placebo patients withdrew after 14 days due to lack of efficacy, eight patients experienced local pain at the injection site in the Hyaluronan combined with Botulinum toxin group, 5 in the Hyaluronan alone and three patients in the placebo group. No serious adverse events were reported. Two patients in the Hyaluronan combined with Botulinum toxin group experienced weakness in knee extension limited to 24 hours. This did not interfere with activities of daily living. At 14, 30 and 90 days after treatment, the mean VISA-P scores for the Hyaluronan group improved (4%, 6% and 7%, P < .001) and Hyaluronan combined with Botulinum toxin improved (6%, 18% and 18%, P < .001) respectively. No change was observed in the placebo group. Return to pain free sport was significantly faster in the combined group (P<0.01). Conclusions: Hyaluronan injection alone or in combination with Botulinum toxin for athletic patients with patellar tendinopathy is an effective treatment option.
R.J., P., A.F., P., & J., D. (2016). Hyaluronan alone, combined with botulinus toxin or placebo injection therapy for athletic patients with patellar tendinopathy (jumpers knee). Osteoarthritis and Cartilage, 24, S191–S192. Retrieved from http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L72246313