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

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.