{
  "abstract": "Background and Aims Anterior knee pain is a common manifestation in spondyloarthropathy (SpA), frequently attributed to enthesopathy triggered by an inflammatory cascade. Some cases remain refractory with conventional treatment including anti-inflammatory medications and rehabilitation. Focused shockwave has been widely used for calcific lesions and tendinopathy, but reports of its application in spondyloarthropathy is limited. This report presents a novel use of focused shockwave therapy in managing SpA-related knee pain, highlighting its potential role in pain relief and tissue recovery.Methods A 27-year-old male with peripheral SpA presented with right anterior knee pain for six months, unresponsive to oral hydroxychloroquine, NSAIDs and physical therapy. The pain was activity-related, with morning stiffness and localized tenderness at the distal patella and Hoffa’s fat pad. Focused shockwave was administered under ultrasound guidance to the proximal patellar tendon and Hoffa’s fat pad three times every other day (2500 pulses/session, energy flux density: 0.142–0.341 mJ/mm 2).Results Following two sessions, the patient‘s visual analog scale improved from 8 to 0. The Knee injury and Osteoarthritis Outcome Score (KOOS) also improved significantly, increasing from 59% to 90%, with the greatest improvements observed in the pain and sports subscales, which increased by 113% and 78%, respectively. The Victorian Institute of Sport Assessment Questionnaire for Patellar Tendon (VISA-P) improved from 32 to 79. Follow-up ultrasonography at one month, comparing both the affected and asymptomatic sides, along with pre- and post-treatment images, revealed reduced tendon thickness, improved fibrillar pattern, and resolution of fat pad inflammation ( figure 1, 2, 3).Abstract EP005 Figure 1(A) Thickened proximal patellar tendon and hypoechoic loss of fibrillar pattern suggesting active inflammation was appreciated on the middle and (B) lateral patella border, also, paratenonitis was appreciated. (C) Bone erosions were noted on the proximal patellar tendon enthesis. Intact fibrillar pattern was noted at the (D) middle and (E) lateral distal patella on the asymptomatic sideAbstract EP005 Figure 2(A) The blue line indicates the transducer position on the lateral side of the knee, when in line with the distal end of the patella and fibular head, we could better appreciate grade 2 hyperemia in Hoffa’s fat pad on the (B, C) symptomatic side. (D) No hyperemia was noted on the asymptomatic sideAbstract EP005 Figure 3Healed patellar enthesopathy was appreciated in the (A) previously symptomatic knee compared to the (B) intact patellar tendon on the contralateral side. (C) Hoffa’s fat pad hyperemia was no longer demonstrated as the (D) contralateral sideConclusions The patient experienced complete resolution of pain and sonographic signs of enthesopathy without adverse effects. Focused shockwave may enhance recovery of soft tissue structures in SpA-associated knee pathology, and appears to be a promising adjunct for refractory patellar enthesopathy in SpA. Its non-invasive nature and favorable safety profile warrant further evaluation in larger studies and controlled trials.",
  "authors": [
    {
      "affiliations": [
        "Department of Physical Medicine and Rehabilitation, Cathay General Hospital, Taipei, Taiwan"
      ],
      "name": "Yi-Hong Wu"
    }
  ],
  "title": "EP005 Focused shockwave therapy on patellar enthesopathy in spondyloarthropathy",
  "uid": "c8c660cd-432b-5bbf-955f-048079ffc1b4"
}