TAME for Refractory Patellar Tendinopathy and Hoffa Fat Pad Disease

TAME selectively treats abnormal neovessels that correspond to the painful lesion

The 89-patient series showed improvement in pain, function, and ultrasound measures, but lacked a control group

2025: 89-patient patellar-tendinopathy series

Among the direct studies currently available, the series by Inui and colleagues has the largest sample. It retrospectively examined recalcitrant patellar tendinopathy treated with TAE from 2017 through 2023. Ninety-eight patients underwent treatment, 9 were lost to follow-up, and 89 were followed for 1 to 7 years, with a mean follow-up of 31.2 months. Mean age was 26.1 years, and the design was a Level 4 case series.

Mean return times were 7.8 weeks for light training and 14.3 weeks for full training; 80 of 89 patients returned to full training within one year. Mean tendon thickness decreased from 9.5 mm to 6.6 mm at final follow-up. No major complication or sonographically visible tendon rupture was observed.

Bow Wang’s team, 2025 JVIR: two cases of quadriceps/patellar tendinitis

In a 2025 JVIR Letter, Bow Wang’s team described two patients with persistent anterior knee pain despite conservative care. MRI showed edema and enhancement in the quadriceps tendon and patellar tendon, respectively; selective angiography demonstrated abnormal neovessels in the corresponding symptomatic regions. Supply arose mainly from the superior patellar and lateral superior genicular arteries in the quadriceps case, and the descending genicular and lateral inferior genicular arteries in the patellar case.

In the patellar case, pain fell from NRS 8/10 to 2/10 within 2 months after one GAE, with resolution of tendon enhancement on follow-up MRI. In the quadriceps case, pain fell from 8/10 to 4/10 after the first treatment but plateaued; repeat GAE was performed 2 months later, followed by a reduction to 2/10 and resolution of edema and enhancement on MRI 2 months after the repeat treatment. No adverse event was reported in either case. The Letter adds diagnostic and technical detail, but a 2/2 outcome cannot estimate population efficacy.

TAME treatment for Hoffa fat pad disease: the 2022 JVIR case

In 2022, Bow Wang’s team reported in JVIR a 32-year-old woman with persistent severe left anterior knee pain, swelling, and inability to bear weight after a traffic accident. Symptoms persisted after surgery and 5 months of corticosteroid treatment and physiotherapy. MRI showed infrapatellar fat-pad hyperintensity and joint effusion. Baseline scores were VAS 9.5/10, WOMAC total 61/96, and WOMAC pain 18/20.

Angiography demonstrated abnormal neovessels in the infrapatellar region supplied by the descending genicular and lateral inferior genicular arteries. VAS fell to 3 one week after the first GAE but then plateaued. Because the vessels had recanalized and the patient sought further relief, repeat GAE was performed at 2 months. One month later, VAS was 1.5, WOMAC total 15, and WOMAC pain 2; VAS was 0 at 2 months, and she remained pain free with an unremarkable range of motion at 6 months. No adverse event was reported.

For a structured imaging differential, see Hoffa’s Fat Pad and Anterior Knee Pain: An MRI Reading Pathway.

How is TAME performed for patellar tendinopathy? From target artery to treatment endpoint

Treatment does not occlude the entire periarticular circulation. A microcatheter is used to identify and selectively treat abnormal vessels that correspond to the painful region. The following steps describe the study protocol; actual strategy depends on lesion location and vascular anatomy.

When might refractory patellar tendinopathy or Hoffa disease be considered for TAME assessment?

Confirm the true pain generator before TAME

The treatment target must match the clinical pain generator. Anterior knee pain can arise from the patellar tendon, infrapatellar fat pad, patellofemoral joint, plica, bursae, postoperative fibrosis, or another intra-articular lesion. Increased signal in Hoffa’s fat pad on fluid-sensitive MRI is common. It may be the pain generator, a secondary reaction, or an incidental finding.

Imaging serves treatment: MRI excludes alternatives, ultrasound follows the tendon, and DSA identifies target vessels

Imaging is not the main subject of this article, but it determines whether TAME has a rational target. MRI evaluates the tendon, Hoffa’s fat pad, patellofemoral joint, and alternative intra-articular causes. Ultrasound can match the point of tenderness while assessing thickness, hypoechogenicity, fiber disorganization, and Doppler flow. Angiography during treatment identifies abnormal local enhancement and early venous drainage.

“No adverse event” in these reports does not mean zero risk

Periarticular knee vessels communicate with cutaneous, neural, muscular, and osseous branches. Potential risks include access-site hematoma, arterial spasm or injury, nontarget embolization with skin discoloration or ischemia, transient sensory symptoms, postembolization pain, and contrast- or medication-related reactions. Because the patellar tendon is a high-load structure, return to sport should follow symptoms, strength, and rehabilitation progress rather than a fixed calendar alone.

Core references and image licensing

Medical disclaimer: This page provides general medical information and a research summary. It does not replace an in-person consultation or guarantee a specific result. Suitability for TAME requires physician assessment of the history, examination, imaging, previous treatment, and individual risk.