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. 2025 Jun 30;13(6):23259671251337093.
doi: 10.1177/23259671251337093. eCollection 2025 Jun.

Transcatheter Arterial Embolization of Abnormal Neovessels for Patellar Tendinopathy: A Safety Evaluation: A Proof-of-Concept Study

Shohei Inui  1 , Kentaro Onishi  2 , Anderson Tomoyuki Kochi  3 , Masahiko Shibuya  4 , Koichi Miyazaki  4 , Masaya Nakata  4 , Atsuhiko Kawabe  4 , Takashi Nakasone  4 , Nobuaki Sakai  4 , Yuji Okuno  4
Affiliations

Transcatheter Arterial Embolization of Abnormal Neovessels for Patellar Tendinopathy: A Safety Evaluation: A Proof-of-Concept Study

Shohei Inui et al. Orthop J Sports Med. .

Abstract

Background: Patellar tendinopathy (PT) is common among athletes, and the current care is largely palliative.

Purpose: To evaluate the safety of transcatheter arterial embolization (TAE) in patients with PT refractory to nonoperative treatments.

Study design: Case series; Level of evidence, 4.

Methods: This was a multicenter, retrospective study in which recalcitrant PT was treated using TAE. TAE was performed by infusing temporary embolic material through a catheter inserted into the targeted genicular artery. Complications, numeric rating scale (NRS) for pain, Victorian Institute of Sport Assessment for the patella (VISA-P), time to return to training, and ultrasound findings were reported.

Results: Between March 2017 and February 2023, a total of 98 patients with PT underwent TAE. Nine patients were lost to follow-up, and the remaining 89 patients (69 male; mean age, 26.1 ± 11.9 years) were followed up for 1 to 7 years (mean, 31.2 ± 16.1 months) after TAE. No major complications were observed. Mean VISA-P score improved from 24.9 ± 15.3 at baseline to 43.2 ± 21.6, 55.2 ± 22.3, and 67.4 ± 24.7, at 1, 3, and 6 months of follow-up, respectively. Mean NRS for pain improved from 7.6 ± 1.4 at baseline to 4.5 ± 2.3, 3.5 ± 2.4, and 2.7 ± 2.4 at the corresponding time points. VISA-P and NRS scores were 74.6 ± 26.2 and 2.3 ± 2.7, respectively, at the final follow-up. Mean times for return to light and full training were 7.8 ± 8.7 and 14.3 ± 11.5 weeks, respectively. Ultrasound demonstrated decreased patellar tendon thickness (9.5 ± 1.8 mm at baseline vs 6.6 ± 1.3 mm at the final follow-up) without tendon ruptures.

Conclusion: TAE can be considered a safe alternate to existing treatment options for recalcitrant PT. A randomized controlled trial is required to elucidate its efficacy.

Keywords: TAE; jumper’s knee; patellar tendinopathy; transcatheter arterial embolization.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: Y.O. has received consulting fees from Asahi Intecc Co, Terumo Corporation, Shimadzu Corporation, and Guerbet and is an advisory board member of Clearfynamic Inc and Nextbiomedical Co. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. Ethical approval for this study was obtained from Medical Corporation Yuyu-kai (OC 2024-014).

Figures

Figure 1.
Figure 1.
Fluoroscopic findings in a 19-year-old man with patellar tendinopathy. Digital subtraction angiography from the right inferior genicular artery before (b) and after (c) embolization. Abnormal neovessels (“tumor blush”–type enhancement; black arrowheads, b) disappeared after embolization. Black arrow: catheter tip.
Figure 2.
Figure 2.
Selective angiography in a 21-year-old woman with patellar tendinopathy before and after embolization. Digital subtraction angiography from the right inferior genicular artery before (a-c) and after (d-f) embolization. Abnormal neovessels and early venous return (white arrows, c) disappeared after embolization.
Figure 3.
Figure 3.
Bar graph showing the percentage change in modified Blazina scores before transcatheter arterial embolization (TAE); at 1, 3, and 6 months after TAE; and at the final evaluation.
Figure 4.
Figure 4.
Bar graph showing the mean time from the initial transcatheter arterial embolization to return to full training by sport level. The duration was shortest for professional athletes (8.9 ± 4.7 weeks) and longest for recreational athletes (21.9 ± 16.9 weeks), with significant differences between the 2 groups. C, college athletes; H, high school athletes; P, professional athletes; R, recreational athletes.
Figure 5.
Figure 5.
Ultrasound imaging of patellar tendon before and 1 year after embolization.
See this image and copyright information in PMC

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