Effects of Adding Ultrasound-Guided Percutaneous Neuromodulation to a Percutaneous Needle Electrolysis and Eccentric Exercise Intervention in Patellar Tendinopathy: A Randomized Controlled Trial

Background/Objectives: Eccentric exercise (EE) combined with percutaneous needle electrolysis (PNE) is an evidence-based treatment for patellar tendinopathy (PT). Percutaneous neuromodulation (PNM) is a promising adjunctive technique, yet its complementary effect in PT remains unstudied. This study aimed to determine whether adding ultrasound-guided PNM to an intervention based on PNE and EE provides additional benefits regarding pain intensity, function, quality of life and ultrasound imaging variables in individuals with PT. Methods: A single-blinded randomized clinical trial was conducted with 26 participants with PT, allocated to an active control group (EE+PNE) or an experimental group (EE+PNE+PNM). Percutaneous interventions were applied on days 1, 7, and 14, while EE was performed twice daily for four weeks. Pain intensity (VAS) was assessed at days 1, 7, 14, and 21, and analyzed using a linear mixed-effect model. Remaining outcomes (VISA-P, SF-36, pistol squat and ultrasound imaging) were assessed at days 1 and 21 and analyzed accordingly using either ANCOVA or non-parametric methods. Results: Significant reductions in pain intensity were observed over time in both groups (p < 0.001), with no between-group differences (p = 0.844) or group x time interaction (p = 0.561). No significant between-group differences were found for VISA-P (p = 0.181), SF-36 (p = 0.400), functional capacity (p = 0.716), or ultrasound imaging outcomes (p > 0.05 for all of them). Conclusions: Adding ultrasound-guided PNM to an EE+PNE protocol did not provide statistically significant short-term additional benefits over EE+PNE alone in individuals with PT. Further research with larger samples and longer follow-up is warranted.