Ultrasound-Guided Percutaneous Ultrasonic Tenotomy for Refractory Patellar Tendinopathy in High-Level Athletes: A Case Series

Abstract

Objective: To elucidate the clinical outcomes and return-to-sport status of high-level athletes with refractory patellar tendinopathy treated with ultrasound-guided percutaneous ultrasonic tenotomy (PUT). Design: Case series study. Setting: Single orthopaedic clinic. Patients: Five cases involving 8 knees from athletes (average age: 22 years, range: 17-30 years) who presented with refractory patellar tendinopathy and underwent PUT between 2022 and 2024. Conservative treatments had previously been attempted without sufficient pain relief or return to sports. Interventions: All patients underwent ultrasound-guided PUT using the TX-2 device from Tenex Health. Jogging was resumed 1 month after surgery, and a return to competitive sports was permitted as early as 3 months postsurgery. Main Outcome Measures: Preoperative and postoperative Victorian Institute of Sport Assessment (VISA) scores and Numerical Rating Scale (NRS) scores for pain. Time to return to full training and competitive sports, and presence of postoperative infection signs. Results: The VISA score significantly improved from a preoperative average of 43.1 to a postoperative average of 77.1 (P = 0.0004). The NRS significantly decreased from a preoperative average of 6.4 to a postoperative average of 2.8 (P = 0.0005). Four cases involving 6 knees fully returned to sports, with an average return time of 3 months and 19 days (range: 3 months to 4 months and 13 days). One case involving 2 knees did not show sufficient pain improvement and the patient could not return to sports. No signs of infection were observed in any case. Conclusions: PUT for refractory patellar tendinopathy in high-level athletes generally results in favorable treatment outcomes and successful return to sports. This study provides novel insights into the effectiveness of PUT for patellar tendinopathy in athletes, highlighting the need for future studies with larger sample sizes to validate these findings and explore factors associated with poor outcomes.