Discussion
functional disability, anterior knee pain, shoulder pain, pain, heterogenous hypochoic, supraspinatous tendinopathy, tendinopathy, patellar tendinopathy, patellar tendinosis, tendinopathies, disability
DEGENERATED
The current study was designed to determine the effects of ultrasound guided dry needling in addition to conventional physical therapy versus conventional physical therapy alone on pain intensity, functional disability and ultrasonographic features in patients with jumper’s knee. In comparison to the conventional group, the experimental group showed better statistical improvement in terms of pain intensity, functional impairment, and patellar tendon ultrasonographic characteristics.The results of this study showed decrease in pain intensity (VAS) more in experimental group than conventional group (p = 0.000). The current study's findings are in line with RCTs conducted by Housner et.al. that demonstrate sonographically guided tendon fenestration is effective in decreasing VAS score at both 4 (mean ± SEM, 2.4 ± 0.7) and 12 (22 ± 0.7) weeks in comparison to the baseline scores (5.8 ± 0.6; p < 0.001). Therefore, sonographically guided needle tenotomy is effective in improving patient’s symptoms without complicationsThe experimental group significantly improved more than the conventional group in terms of functional disability (VISA-P) score after 4 weeks following the intervention, according to the current study(p = 0.000). Similarly, James et al. concluded that significant improvement in VISA-P score was seen after ultrasound-guided dry needling with autologous blood injections: mean pre-procedure score = 39.8 (range 8 to 72) v mean post-procedure score = 74.3 (range 29 to 100), p < 0.001; mean follow-up 14.8 months (range 6 to 22 months). Patients with patellar tendinosis could return to sports activitiesThe present study evaluated ultrasonographic features of the patellar tendon where heterogenous hypoechoic area in patellar tendon is resolved after UG-DN and subjective resolution of anterior knee pain, similar results were found by Roy Settergren in which UG-DN was performed to treat supraspinatous tendinopathy in addition to exercise therapy. The sonographic changes in supraspinatous tendon were evaluated after 10 days of procedure. The pathological tendon had heterogenous hypochoic area, which was resolved with increased echogenicity observed in the supraspinatous tendon after intervention. There was also subjective resolution in shoulder pain even with increased physical activityIn literature, several groups use very diverse needle techniques. The current study's UG-DN approach softened the degenerated area of the patellar tendon with 20 to 30 passes, and the entire treatment session involved three needle insertions that lasted for 3 to 5 min with repetitive in and out movements is similar to technique used by Housner et al.The present study used 22-guage dry needle for treatment of tendinopathy which is similar to 22-guage dry needle used by Jeffrey A. Housner et al. to treat PTThe findings of the current study demonstrated that selecting ultrasound guided dry needling and conventional physical therapy may help the health care professionals in improving the symptoms of jumper’s knee in less time. As a successful minimally invasive technique, its cost is less than the cost of the surgery, long term outcome studies are recommended with almost 1–2-year follow-up to investigate that either ultrasound guided tendon dry needling prevents further surgical procedure or at least delays it.There are certain limitations in the study. In this study, only the patients were blinded, and physical therapist was not when applying the intervention. Blinding the treating radiologist and physical therapist would have been advisable to reduce the possibility of bias. This study only found out the follow-up of one month only. Therefore, we are unable to confirm the long-term effectiveness of UG-DN in reducing symptoms of tendinopathy. Further research is required to determine the long-term effects of ultrasound guided dry needling, compared with other techniques. In addition, future high-quality studies are recommended to investigate the mechanical properties in tendons after DN therapy in individuals with tendinopathies which is one of the major concerns in daily clinical practice. The UG-DN procedure was not validated. The UG-DN used in the current study is, however, considered to be a standard technique for research into the clinical effectiveness of DN. The analgesic use could not be avoided during the study. Lastly, the study included only young population with range of 18–45 years, therefore the results cannot be generalized to all patients of patellar tendinopathy. It is also suggested to perform UG-DN technique in other tendons and measure the long-term effects.