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. 2025 Jun 3;10(2):208.
doi: 10.3390/jfmk10020208.

The Safety of Ultrasound-Guided Needle Approaches for Patellar Tendinopathy: A Theoretical Cadaveric Model

Laura Calderón-Díez  1   2 , Pedro Belón-Pérez  3 , César Fernández-de-Las-Peñas  4 , José L Sánchez-Sánchez  2   5
Affiliations

The Safety of Ultrasound-Guided Needle Approaches for Patellar Tendinopathy: A Theoretical Cadaveric Model

Laura Calderón-Díez et al. J Funct Morphol Kinesiol. .

Abstract

Background: Patellar tendinopathy is a musculoskeletal pain condition capable of impairing physical or sport activities. Preliminary evidence supports the efficacy of percutaneous electrolysis (PE) in reducing pain and related disability in patients with patellar tendinopathy.

Objective: This study proposes a theoretical model for the application of a percutaneous electrolysis approach targeting the deep zone of the proximal and distal parts of the patellar tendon in both human (ultrasound-guided) and fresh cadaver (not ultrasound-guided) models.

Methods: A filiform solid needle was inserted from the lateral side of the patellar tendon targeting two areas: 1, the deep proximal interface of the Hoffa's fat pad; and 2, the distal insertion of the patellar tendon at the tibial tuberosity in 10 fresh cadavers and in 10 healthy individuals. The patellar tendon, the saphenous nerve, and the infrapatellar nerve and its branches were identified by dissecting fresh cadavers to determine the anatomical trajectory of the infrapatellar nerve branches in relation to the needle.

Results: The cadaveric model shows an anatomical relationship between the patellar tendon and infrapatellar nerve branches at the medial part of the knee. Infrapatellar nerve branches ran subcutaneously obliquely from the medial to the anterior and lateral parts of the knee, crossing in front of the patellar tendon. In all cadavers, the superior and inferior infrapatellar branches ran through the superior or inferior parts of the medial knee area. Only in 2/10 knees infrapatellar nerve branches reached the lateral part of the knee, specifically the superior lateral part. No neurovascular bundle of infrapatellar nerve branches was pierced in any insertion when the needle was inserted from the lateral part of the knee.

Conclusion: This anatomical model supports the use of a lateral approach as a potentially safe approach to apply in needling interventions, e.g., percutaneous electrolysis for patellar tendinopathies. The infrapatellar nerve branches are vulnerable to needle procedures applied through the anteromedial side of the knee.

Keywords: cadaver; infrapatellar nerve; patellar tendon; percutaneous electrolysis; tendinopathy.

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Conflict of interest statement

Pedro Belón-Pérez is affiliated with Real Madrid C.F. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Cadaveric dissection of knee area showing the infrapatellar nerve and its branches (arrows). (P) patella, PT (Patellar tendon), and TT (Tibial Tuberosity). (A–C) show different angles.
Figure 2
Figure 2
Diagram with reference points marked on the knee. Medial quadrants (red) and lateral quadrants (green).
Figure 3
Figure 3
(A) Illustration of the percutaneous electrolysis approach at the interphase Hoffa’s fat pad—Patellar tendon (from lateral border); (B) Cadaver preparation with needle approach to the Hoffa’s fat pad interface from the lateral to medial side; (C) Ultrasound imaging (short axis view) of the needle reaching the interphase of the Hoffa’s fat pad without the needle marked (C-a) and with the needle marked (C-b). Lat (Lateral), Med (Medial), and PT (Patellar tendon).
Figure 4
Figure 4
Ultrasound image (long axis view) of the infrapatellar nerve inferior branch. Pt: Patellar tendon.
See this image and copyright information in PMC

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