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Color Doppler Ultrasound Findings in Patellar Tendinopathy (Jumper’s Knee)

Aasne Hoksrud^*, Lars Öhberg, MD, PhD, Håkan Alfredson, MD, PhD^, and Roald Bahr, MD, PhD^*,||

From the ^* Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway, Department of Radiation Sciences, Diagnostic Radiology, University of Umeå, Umeå, Sweden, Department of Surgical and Perioperative Science, Sports Medicine, University of Umeå, Umeå, Sweden, and Department of Musculoskeletal Research, National Institute of Working Life, University of Umeå, Umeå, Sweden

^|| Address correspondence to Roald Bahr, MD, PhD, Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, PO Box 4014 Ullevaal Stadion, 0806 Oslo, Norway (e-mail: roald.bahr{at}nih.no).

Background: Recent studies have revealed structural changes with neovessels in patients with jumper’s knee and Achilles tendinopathy, and treatment with sclerosing injections has shown promising clinical results.

Purpose: To study the prevalence of neovascularization and structural tendon changes on color Doppler ultrasound examination in elite athletes with clinical symptoms of jumper’s knee and to examine the ultrasound characteristics of the tendon after sclerosing injection treatment with polidocanol.

Study Design: Cohort study; Level of evidence, 3.

Methods: The authors recruited patients among elite athletes with a clinical diagnosis of jumper’s knee who participated in a previous randomized clinical trial. The patients recorded knee function using the Victorian Institute of Sport Assessment score. Patients were examined by color Doppler ultrasound at baseline and, for patients with structural changes and neovascularization who received sclerosing treatment, after treatment.

Results: Sixty-three patients (11 women and 52 men) with 79 symptomatic tendons were studied. The ultrasound examination revealed that neovascularization was present in 48 of the 79 tendons (60%). Of 33 patients (43 tendons) who received sclerosing injections, 29 patients (37 tendons, 86%) were examined 37 (19 to 53) weeks after their final sclerosing injections. Of these, 7 tendons (18.9%) had no change in neovascularization after treatment, 21 tendons (56.8%) had less neovascularization, and 9 tendons (24.3%) had more visible neovascularization. There were no significant differences in the change in Victorian Institute of Sport Assessment score between patients who had less, more, or unchanged neovascularization after treatment (analysis of variance, P = .9).

Conclusion: About two thirds of patients with jumper’s knee can be expected to have structural tendon changes with neovascularization. There was no relationship between changes in ultrasound characteristic and knee function after sclerosing treatment.

Key Words: patellar tendinopathy • color Doppler ultrasound • neovascularization • sclerosing therapy • tendon changes