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Purpose <p>To evaluate the feasibility and safety of combined percutaneous sclerotherapy plus transarterial embolization for refractory sports-related tendinopathy in young athletes.</p> Materials and Methods <p>Twelve athletes with 20 lesions (13 Achilles tendinopathies, 6 patellar tendinopathies, 1 iliotibial band syndrome), suffering pain persisting &gt;3&#xa0;months despite conservative management were included. Ultrasound-guided foam sclerosant was injected into the peri-tendinous subcutaneous tissue at the most painful area until approximately 50% pain relief was achieved. Immediately after the sclerotherapy, angiography was performed, and hypervascular neovessels at the pain site were embolized with a mixture of iondinated contrast medium and Imipenem/Cilastatin. Visual analog scale (VAS) scores were measured and peri- and post-procedural adverse events were recorded.</p> Results <p>Sclerosant injection produced an immediate ~50% pain reduction in all treated lesions, after which TAME was performed in 19 of 20 lesions (95%). Angiographic hypervascular staining was observed in 95% (19/20) of cases, facilitating targeted embolization. The mean sclerosant volume and imipenem amount were 1.4 ± 0.7&#xa0;mL and 370.1 ± 14.9&#xa0;mg, respectively. Mean VAS scores decreased from 6.7 ± 1.2 at baseline to 3.2 ± 1.1 at 1&#xa0;week and 2.7 ± 0.8 at 6&#xa0;months (<i>p</i> &lt; 0.01). Clinical success was achieved in 18 of 20 lesions (90%), corresponding to 10 of 12 patients (83%). Minor complications occurred in 2 cases (2 groin hematomas), and all patients experienced mild post-injection soreness resolving within 4&#xa0;days. No major complications or serious adverse events were observed.</p> Conclusion <p>The combined sclerotherapy plus embolization technique is feasible and safe for treating refractory lower-extremity tendinopathies in young athletes. Comparative studies are needed to assess potential added benefits.</p> Graphical Abstract <p>Imaging findings from a patient with Achilles tendinopathy treated with combined percutaneous sclerotherapy and transarterial embolization (sTAME). Upper panels: Ultrasonographic images obtained before (left) and immediately after (right) sclerosant injection, showing echogenic lines and acoustic shadowing (yellow arrows), indicative of sclerosant distribution within the lesion. Lower panels: Sagittal MRI demonstrates a lesion with high signal intensity at the Achilles tendon insertion (left, yellow arrow). Corresponding angiography performed immediately after sclerosant injection reveals prominent hypervascular staining at the lesion site (middle, yellow arrow), which resolved completely following embolization (right).</p>

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Combined Percutaneous Sclerotherapy Plus Transarterial Embolization for Refractory Sports Injuries in Young Athletes: A Feasibility Study

  • 期刊论文

  • 发表日期：

    2025年7月14日

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  • Jae Hwan Lee,
  • Soo Buem Cho,
  • Kun Young Kim,
  • Chong-ho Lee,
  • Chang Jin Yoon,
  • Minuk Kim,
  • Young Ho So,
  • Sang Hwan Lee,
  • Saebeom Hur

摘要

Purpose

To evaluate the feasibility and safety of combined percutaneous sclerotherapy plus transarterial embolization for refractory sports-related tendinopathy in young athletes.

Materials and Methods

Twelve athletes with 20 lesions (13 Achilles tendinopathies, 6 patellar tendinopathies, 1 iliotibial band syndrome), suffering pain persisting >3 months despite conservative management were included. Ultrasound-guided foam sclerosant was injected into the peri-tendinous subcutaneous tissue at the most painful area until approximately 50% pain relief was achieved. Immediately after the sclerotherapy, angiography was performed, and hypervascular neovessels at the pain site were embolized with a mixture of iondinated contrast medium and Imipenem/Cilastatin. Visual analog scale (VAS) scores were measured and peri- and post-procedural adverse events were recorded.

Results

Sclerosant injection produced an immediate ~50% pain reduction in all treated lesions, after which TAME was performed in 19 of 20 lesions (95%). Angiographic hypervascular staining was observed in 95% (19/20) of cases, facilitating targeted embolization. The mean sclerosant volume and imipenem amount were 1.4 ± 0.7 mL and 370.1 ± 14.9 mg, respectively. Mean VAS scores decreased from 6.7 ± 1.2 at baseline to 3.2 ± 1.1 at 1 week and 2.7 ± 0.8 at 6 months (p < 0.01). Clinical success was achieved in 18 of 20 lesions (90%), corresponding to 10 of 12 patients (83%). Minor complications occurred in 2 cases (2 groin hematomas), and all patients experienced mild post-injection soreness resolving within 4 days. No major complications or serious adverse events were observed.

Conclusion

The combined sclerotherapy plus embolization technique is feasible and safe for treating refractory lower-extremity tendinopathies in young athletes. Comparative studies are needed to assess potential added benefits.

Graphical Abstract

Imaging findings from a patient with Achilles tendinopathy treated with combined percutaneous sclerotherapy and transarterial embolization (sTAME). Upper panels: Ultrasonographic images obtained before (left) and immediately after (right) sclerosant injection, showing echogenic lines and acoustic shadowing (yellow arrows), indicative of sclerosant distribution within the lesion. Lower panels: Sagittal MRI demonstrates a lesion with high signal intensity at the Achilles tendon insertion (left, yellow arrow). Corresponding angiography performed immediately after sclerosant injection reveals prominent hypervascular staining at the lesion site (middle, yellow arrow), which resolved completely following embolization (right).