Research results from a pioneering new treatment for chronic knee pain led by Fortius Clinic in collaboration with Imperial College, published last night in the American Journal of Sports Medicine.
The use of sonographically guided Botulinum Toxin Type A (Dysport) injections into the Tensor Fasciae Latae for the treatment of Lateral Patellofemoral Overload Syndrome (LPOS).
This type of chronic knee pain, lateral patellofemoral overload syndrome (LPOS), is believed to affect up to one in five of the active population and can be caused by under-use of the buttock muscles (gluteal) and over-use of the muscles at the front of the hip (tensor fascia lata). Symptoms include inflammation and a sharp localised pain which can take many days to recover from.
“This is the first trial of its kind in the UK and has proved that treatment with botulinum toxin can provide better and longer lasting pain relief than conventional therapies. One injection and a few weeks of physiotherapy will see nearly seven out of ten sportsmen and women with this knee condition return to an active life, free from pain”, said Mr Sam Church, Consultant Knee Surgeon, Fortius Clinic, London.
The study involved injecting Dysport, a type of botulinum toxin, into the hip muscle to “switch it off” for 12 weeks, so the buttock muscles (glutes) were forced to work harder and thus enable physiotherapy to have a greater effect on the affected knee area. Patients involved in the study underwent at least six weeks of personalised physiotherapy treatment, following the initial injection.
“Many of the patients enrolled in our study had exhausted all other treatment options and this was their last resort. By “switching off” the hip muscle, the effects of physiotherapy on the glutes and knee were greatly enhanced following a single injection of a type of botulinum toxin,” explained lead author of the study, Dr Joanna Stephen, researcher at Fortius Clinic and Imperial College.
Andy Goode, former England rugby professional, who has come out of retirement to play for Newcastle Falcons explained: “I had the injection treatment at Fortius two years ago when I had chronic knee pain mid-season and it enabled me to carry on playing week-in week-out, without pain.
I retired from professional rugby because of shoulder and knee injuries and thought my rugby days were over forever. But when I got offered a fantastic opportunity of playing for Newcastle, I knew this treatment was my only chance. I returned to my knee specialist, Mr Church at Fortius, and now I’m back in the game and winning big points for the Newcastle Falcons”.
Preliminary investigations had shown that the patients displayed a weakness in their buttock (gluteal) muscles and had long-standing pain. To compensate for this weakness, more effort was being placed on the muscles at the front and side of the hip. This imbalance at the hip in turn altered the loading at the knee, which created persistent pain brought on by activity. Symptoms included pain at the front or on the outside of the knee which manifests during activity. Up to 80% of this population continued to have symptoms five years after conventional (physiotherapy and steroids) treatment.
Lateral patellofemoral overload syndrome (LPOS) affects people from a host of sporting activities including running, cycling, horse riding, football, tennis, rugby, gym work outs and many others.
LPOS is known to affect more female athletes (1 in 5) than male athletes (1 in 8) but the cause is not yet defined. The research of 45 adults from across the UK started seven years ago at Fortius Clinic and was conducted in conjunction with Imperial College, London.