1
|
Llombart R, Mariscal G, Barrios C, Llombart-Ais R. The Best Current Research on Patellar Tendinopathy: A Review of Published Meta-Analyses. Sports (Basel) 2024; 12:46. [PMID: 38393266 PMCID: PMC10893258 DOI: 10.3390/sports12020046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 01/24/2024] [Accepted: 01/30/2024] [Indexed: 02/25/2024] Open
Abstract
Patellar tendinopathy is a frequent overuse injury in sports that can cause significant pain and disability. It requires evidence-based guidelines on effective prevention and management. However, optimal treatments remain uncertain. We aimed to analyze available meta-analyses to summarize treatment recommendations, compare therapeutic modalities, examine included trials, and offer methodological suggestions to improve future systematic reviews. Meta-analyses were systematically searched for in PubMed (PROSPERO: CRD42023457963). A total of 21 meta-analyses were included. The AMSTAR-2 scale assessed study quality, which was low, with only 23.8% of the meta-analyses being of moderate quality, and none were considered to be of high quality. Heterogeneous outcomes are reported. Multiple platelet-rich plasma (PRP) injections appear superior to eccentric exercises and provide lasting improvements compared to eccentric exercises when conservative treatments fail. Extracorporeal shockwave therapy (ESWT) also seems superior to non-operative options and similar to surgery for patellar tendinopathy in the long term. However, evidence for eccentric exercise efficacy remains unclear due to inconclusive findings. Preliminary findings also emerged for genetic risk factors and diagnostic methods but require further confirmation. This review reveals a lack of high-quality evidence on optimal patellar tendinopathy treatments. While PRP and ESWT show promise, limitations persist. Further rigorous meta-analyses and trials are needed to strengthen the evidence base and guide clinical practice. Methodological enhancements are proposed to improve future meta-analyses.
Collapse
Affiliation(s)
- Rafael Llombart
- Orthopedic Surgery Department, University Clinic of Navarra, 31008 Pamplona, Spain
| | - Gonzalo Mariscal
- Institute for Research on Musculoskeletal Disorders, School of Medicine, Valencia Catholic University, 46001 Valencia, Spain
| | - Carlos Barrios
- Institute for Research on Musculoskeletal Disorders, School of Medicine, Valencia Catholic University, 46001 Valencia, Spain
| | - Rafael Llombart-Ais
- Institute for Research on Musculoskeletal Disorders, School of Medicine, Valencia Catholic University, 46001 Valencia, Spain
- Traumacenter, Casa de Salud Hospital, 46021 Valencia, Spain
| |
Collapse
|
2
|
Theodorou A, Komnos G, Hantes M. Patellar tendinopathy: an overview of prevalence, risk factors, screening, diagnosis, treatment and prevention. Arch Orthop Trauma Surg 2023; 143:6695-6705. [PMID: 37542006 PMCID: PMC10541843 DOI: 10.1007/s00402-023-04998-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 07/18/2023] [Indexed: 08/06/2023]
Abstract
Patellar tendinopathy (PT), or jumper's knee, is an overuse injury that occurs in professional, as well as recreational, athletes. This condition is a noncontact injury, typically characterized by gradually increasing pain in the patellar tendon. It is prevalent in participants of several sports, but it occurs mostly in jumping sports. The diagnosis of PT is primarily clinical; however, imaging techniques can be useful as well. Risk factors differ between sexes, playing conditions, the kind of sport, playing level and personal characteristics. Screening is an essential tool to assess PT. This condition affects athletic performance and often persists for years. The use of preventative methods is imperative because of the persistence of this condition, especially in elite athletes who sometimes end their career after long and failed treatments. There are a wide variety of treatment and rehabilitation options available, the majority of which are non-operative, such as eccentric exercises, cryotherapy, platelet-rich plasma (PRP) injections, and anti-inflammatory strategies. If conservative treatment fails, surgery is the next most preferable step. Even though there are many surgical treatment methods, there is no clear evidence on what is the most effective approach to address PT. Taking this into consideration, as well as the extent of this clinical entity, novel therapeutic techniques, as well as screening and prevention methods, are expected to emerge in the near future.
Collapse
Affiliation(s)
- Andreas Theodorou
- Faculty of Medicine, University of Thessaly, 41500, Larissa, Greece.
| | - Georgios Komnos
- Faculty of Medicine, University of Thessaly, 41500, Larissa, Greece
| | - Michael Hantes
- Faculty of Medicine, University of Thessaly, 41500, Larissa, Greece
| |
Collapse
|
3
|
Schmid T, Wegener F, Hotfiel T, Hoppe MW. Moderate evidence exists for four microRNAs as potential biomarkers for tendinopathies and degenerative tendon ruptures at the upper extremity in elderly patients: conclusion of a systematic review with best-evidence synthesis. J Exp Orthop 2023; 10:81. [PMID: 37563331 PMCID: PMC10415244 DOI: 10.1186/s40634-023-00645-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 07/22/2023] [Indexed: 08/12/2023] Open
Abstract
PURPOSE The aim of this systematic review was to investigate tendon-specific microRNAs (miRNAs) as biomarkers for the detection of tendinopathies or degenerative tendon ruptures. Also, their regulatory mechanisms within the tendon pathophysiology were summarized. METHODS A systematic literature research was performed using the PRISMA guidelines. The search was conducted in the Pubmed database. The SIGN checklist was used to assess the study quality of the included original studies. To determine the evidence and direction of the miRNA expression rates, a best-evidence synthesis was carried out, whereby only studies with at least a borderline methodological quality were considered for validity purposes. RESULTS Three thousand three hundred seventy studies were reviewed from which 22 fulfilled the inclusion criteria. Moderate evidence was found for miR-140-3p and miR-425-5p as potential biomarkers for tendinopathies as well as for miR-25-3p, miR-29a-3p, miR-140-3p, and miR-425-5p for the detection of degenerative tendon ruptures. This evidence applies to tendons at the upper extremity in elderly patients. All miRNAs were associated with inflammatory cytokines as interleukin-6 or interleukin-1ß and tumor necrosis factor alpha. CONCLUSIONS Moderate evidence exists for four miRNAs as potential biomarkers for tendinopathies and degenerative tendon ruptures at the upper extremity in elderly patients. The identified miRNAs are associated with inflammatory processes.
Collapse
Affiliation(s)
- Tristan Schmid
- Movement and Training Science, Leipzig University, Jahnallee 59, 04109, Leipzig, Germany.
| | - Florian Wegener
- Movement and Training Science, Leipzig University, Jahnallee 59, 04109, Leipzig, Germany
| | - Thilo Hotfiel
- Center for Musculoskeletal Surgery Osnabrück (OZMC), Klinikum Osnabrück, Am Finkenhügel 1, 49076, Osnabrueck, Germany
| | - Matthias W Hoppe
- Movement and Training Science, Leipzig University, Jahnallee 59, 04109, Leipzig, Germany
| |
Collapse
|
4
|
Bi AS, Azam MT, Butler JJ, Alaia MJ, Jazrawi LM, Gonzalez-Lomas G, Kennedy JG. Increased incidence of acute achilles tendon ruptures in the peri-pandemic COVID era with parallels to the 2021-22 NFL season. Knee Surg Sports Traumatol Arthrosc 2023; 31:2160-2165. [PMID: 36645466 PMCID: PMC9842209 DOI: 10.1007/s00167-023-07309-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 01/02/2023] [Indexed: 01/17/2023]
Abstract
PURPOSE Acute Achilles tendon ruptures (AATRs) are a common sporting injury, whether for recreational athletes or elite athletes. Prior research has shown returning to physical activity after extended periods of inactivity leads to increased rates of musculoskeletal injuries. The purpose of this study was to investigate rates of acute Achilles' tendon ruptures at a single academic institute in the peri-COVID era, with corollary to the recent NFL season. METHODS A retrospective search was conducted using current procedural terminology to identify the total number of Achilles acute primary repair surgeries performed from years 2017 to 2021. Non-operatively managed AATRs were identified from the same electronic medical record using ICD-10 codes. NFL data were obtained from publicly available sites according to previously validated studies. RESULTS A total of 588 patients who sustained AATRs and underwent primary surgical repair were identified, primarily men (75.7%, n = 445), with an average age of 43.22 ± 14.4 years. The number and corresponding incidence of AATR repairs per year was: 2017: n = 124 (21.1%), 2018: n = 110 (18.7%), 2019: n = 130 (22.1%), 2020: n = 86 (14.6%), 2021: n = 138 (23.5%), indicating a 7.5% decrease in rate of AATRs from 2019 to 2020, followed by an 8.9% increase in incidence from 2020 to 2021. Within the NFL, the number of AATRs resulting in an injured reserve stint increased every regular season from 2019 to 2020: n = 11 (21.2%), to 2020-2021: n = 17 (32.7%), to this past 2021-2022 season: n = 24 (46.2%). CONCLUSION AATR surgeries seem to have increased in 2021 following a 2020 COVID pandemic-induced quarantine for recreational athletes at a single academic institution and for professional athletes in the NFL, although these results are of questionable clinical significance. This provides prognostic information when counseling patients and athletes on return to activity or sport. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Andrew S. Bi
- grid.240324.30000 0001 2109 4251Department of Orthopedic Surgery, NYU Langone Health, 301 E 17th St, New York, NY 10003 USA
| | - Mohammad T. Azam
- grid.240324.30000 0001 2109 4251Department of Orthopedic Surgery, Division of Foot and Ankle Surgery, NYU Langone Health, 171 Delancey St. 2nd Floor, New York, NY 10002 USA
| | - James J. Butler
- grid.240324.30000 0001 2109 4251Department of Orthopedic Surgery, Division of Foot and Ankle Surgery, NYU Langone Health, 171 Delancey St. 2nd Floor, New York, NY 10002 USA
| | - Michael J. Alaia
- grid.240324.30000 0001 2109 4251Department of Orthopedic Surgery, Division of Sports Medicine, NYU Langone Health, 333 East 38th St, 4th Floor, New York, NY 10016 USA
| | - Laith M. Jazrawi
- grid.240324.30000 0001 2109 4251Department of Orthopedic Surgery, Division of Sports Medicine, NYU Langone Health, 333 East 38th St, 4th Floor, New York, NY 10016 USA
| | - Guillem Gonzalez-Lomas
- grid.240324.30000 0001 2109 4251Department of Orthopedic Surgery, Division of Sports Medicine, NYU Langone Health, 333 East 38th St, 4th Floor, New York, NY 10016 USA
| | - John G. Kennedy
- grid.240324.30000 0001 2109 4251Department of Orthopedic Surgery, Division of Foot and Ankle Surgery, NYU Langone Health, 171 Delancey St. 2nd Floor, New York, NY 10002 USA
| |
Collapse
|
5
|
Quarmby A, Mönnig J, Mugele H, Henschke J, Kim M, Cassel M, Engel T. Biomechanics and lower limb function are altered in athletes and runners with achilles tendinopathy compared with healthy controls: A systematic review. Front Sports Act Living 2023; 4:1012471. [PMID: 36685067 PMCID: PMC9845578 DOI: 10.3389/fspor.2022.1012471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/30/2022] [Indexed: 01/06/2023] Open
Abstract
Achilles tendinopathy (AT) is a debilitating injury in athletes, especially for those engaged in repetitive stretch-shortening cycle activities. Clinical risk factors are numerous, but it has been suggested that altered biomechanics might be associated with AT. No systematic review has been conducted investigating these biomechanical alterations in specifically athletic populations. Therefore, the aim of this systematic review was to compare the lower-limb biomechanics of athletes with AT to athletically matched asymptomatic controls. Databases were searched for relevant studies investigating biomechanics during gait activities and other motor tasks such as hopping, isolated strength tasks, and reflex responses. Inclusion criteria for studies were an AT diagnosis in at least one group, cross-sectional or prospective data, at least one outcome comparing biomechanical data between an AT and healthy group, and athletic populations. Studies were excluded if patients had Achilles tendon rupture/surgery, participants reported injuries other than AT, and when only within-subject data was available.. Effect sizes (Cohen's d) with 95% confidence intervals were calculated for relevant outcomes. The initial search yielded 4,442 studies. After screening, twenty studies (775 total participants) were synthesised, reporting on a wide range of biomechanical outcomes. Females were under-represented and patients in the AT group were three years older on average. Biomechanical alterations were identified in some studies during running, hopping, jumping, strength tasks and reflex activity. Equally, several biomechanical variables studied were not associated with AT in included studies, indicating a conflicting picture. Kinematics in AT patients appeared to be altered in the lower limb, potentially indicating a pattern of "medial collapse". Muscular activity of the calf and hips was different between groups, whereby AT patients exhibited greater calf electromyographic amplitudes despite lower plantar flexor strength. Overall, dynamic maximal strength of the plantar flexors, and isometric strength of the hips might be reduced in the AT group. This systematic review reports on several biomechanical alterations in athletes with AT. With further research, these factors could potentially form treatment targets for clinicians, although clinical approaches should take other contributing health factors into account. The studies included were of low quality, and currently no solid conclusions can be drawn.
Collapse
Affiliation(s)
- Andrew Quarmby
- University Outpatient Clinic, Sports Medicine & Sports Orthopaedics, University of Potsdam, Potsdam, Germany,Correspondence: Andrew Quarmby
| | - Jamal Mönnig
- University Outpatient Clinic, Sports Medicine & Sports Orthopaedics, University of Potsdam, Potsdam, Germany
| | - Hendrik Mugele
- Department of Sport Science, Laboratory for Environmental and Exercise Science, University of Innsbruck, Innsbruck, Austria
| | - Jakob Henschke
- University Outpatient Clinic, Sports Medicine & Sports Orthopaedics, University of Potsdam, Potsdam, Germany
| | - MyoungHwee Kim
- University Outpatient Clinic, Sports Medicine & Sports Orthopaedics, University of Potsdam, Potsdam, Germany
| | - Michael Cassel
- University Outpatient Clinic, Sports Medicine & Sports Orthopaedics, University of Potsdam, Potsdam, Germany
| | - Tilman Engel
- University Outpatient Clinic, Sports Medicine & Sports Orthopaedics, University of Potsdam, Potsdam, Germany
| |
Collapse
|
6
|
Nuhmani S, Khan MH, Ahsan M, Abualait TS, Muaidi Q. Dry needling in the management of tendinopathy: A systematic review of randomized control trials. J Bodyw Mov Ther 2023; 33:128-135. [PMID: 36775507 DOI: 10.1016/j.jbmt.2022.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 02/24/2022] [Accepted: 09/18/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The objective of the study is to evaluate the best available evidence on the effectiveness of DN in the management of tendinopathy. METHODS Seven randomized control trials were selected following an electronic search in PubMed, Web of Science, Scopus, and SPORTDiscus databases. To be included in the current systematic review, the study had to be an RCT conducted on human participants, which investigated the effect of the DN technique on the management of tendinopathies. Only studies in the English language published in peer-reviewed journals between 1999 and 2020 were included. The methodological quality of the studies was assessed using the PEDro scale. RESULTS The PEDro score of the studies ranged from 5 to 9 with a mean score of 6.7 ± 1.2 (mean ± SD). A total of 357 participants were enrolled in the seven included studies, which were on greater trochanteric pain syndrome, lateral epicondylitis, supraspinatus tendinopathy and Achilles tendinopathy. DN was compared with various interventions, including platelet-rich plasma injection, autologous blood injection and non-steroidal anti-inflammatory medication. All the selected studies reported a significant positive effect of DN on pain intensity and other outcome measures, such as patient-specific functional score, disability index, range of motion and health-related quality of life. CONCLUSION The results indicate that DN appears to be as effective as other treatment methods at relieving pain and other symptoms of tendinopathy immediately after treatment and up to 6 months. DN can be considered among the many options available for the management of tendinopathy.
Collapse
Affiliation(s)
- Shibili Nuhmani
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Saudi Arabia.
| | - Moazzam Hussain Khan
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, New Delhi, India
| | - Mohammad Ahsan
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Saudi Arabia
| | - Turki Saeed Abualait
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Saudi Arabia
| | - Qassim Muaidi
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Saudi Arabia
| |
Collapse
|
7
|
Hijlkema A, Roozenboom C, Mensink M, Zwerver J. The impact of nutrition on tendon health and tendinopathy: a systematic review. J Int Soc Sports Nutr 2022; 19:474-504. [PMID: 35937777 PMCID: PMC9354648 DOI: 10.1080/15502783.2022.2104130] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Aveline Hijlkema
- Wageningen University and Research, Division of Human Nutrition and Health, Wageningen, The Netherlands
| | | | - Marco Mensink
- Wageningen University and Research, Division of Human Nutrition and Health, Wageningen, The Netherlands
| | - Johannes Zwerver
- Hospital Gelderse Vallei, Sports Valley, Department of Sports Medicine, Ede, The Netherlands
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
| |
Collapse
|
8
|
Asensio-Olea L, Leirós-Rodríguez R, Marqués-Sánchez MP, de Carvalho FO, Maciel LYS. Efficacy of percutaneous electrolysis for the treatment of tendinopathies: A systematic review and meta-analysis. Clin Rehabil 2022; 37:747-759. [PMID: 36583575 DOI: 10.1177/02692155221144272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To evaluate the efficacy of percutaneous electrolysis for the treatment of patients with tendinopathies. DATA SOURCES A systematic search of publications was conducted in Pubmed, Cinahl, Medline, Scopus and Web of Science. METHODS The Oxford 2011 Levels of Evidence and the Jadad scale were used to assess the quality of studies. The mean and standard deviation were obtained for each study group and used to calculate the effect size. The DerSimonian and Laird method was used to develop a random-effects model. RESULTS Of the 14 articles, four applied percutaneous electrolysis to the knee, three to the shoulder, three to the elbow, two to the hip and two to the ankle and foot. A meta-analysis on intensity of pain (evaluated with algometer and the Visual Analogue Scale) was performed on studies comparing percutaneous electrolysis with a control group, indicating that the groups treated with percutaneous electrolysis had better results (p = 0.01). Although percutaneous electrolysis did not overcome the analgesic effect achieved by corticosteroid injections. CONCLUSIONS The percutaneous electrolysis is effective for the treatment of tendinopathies. The combination of this technique with eccentric training has proven to be one of the most effective treatments to date for improving pain. PROSPERO Registration: CRD42021230005.
Collapse
Affiliation(s)
- Laura Asensio-Olea
- Nursing and Physical Therapy Department, University of Leon, Ponferrada, Spain
| | - Raquel Leirós-Rodríguez
- SALBIS Research Group, Nursing and Physical Therapy Department, University of Leon, Ponferrada, Spain
| | - Mª Pilar Marqués-Sánchez
- SALBIS Research Group, Nursing and Physical Therapy Department, University of Leon, Ponferrada, Spain
| | | | - Leonardo Y S Maciel
- Physical Therapy Department of Lagarto, 74391Universidade Federal de Sergipe, São José, Lagarto, Brazil.,Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
| |
Collapse
|
9
|
Effect of Platelet-Rich Plasma Augmentation on Endoscopy-Assisted Percutaneous Achilles Tendon Repair. J Clin Med 2022; 11:jcm11185389. [PMID: 36143034 PMCID: PMC9501121 DOI: 10.3390/jcm11185389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/10/2022] [Accepted: 09/11/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Achilles tendon ruptures are one of the most common sports injuries. Recently, platelet-rich plasma (PRP) has been widely used in tendon-related disorders to enhance tendon healing. However, studies regarding PRP treatment in Achilles tendon rupture show inconsistent results. The purpose of this study was to evaluate the effectiveness of PRP in patients with acute Achilles tendon rupture treated with endoscopy-assisted percutaneous repair. Methods: A total of 62 patients with acute Achilles tendon rupture treated with surgical repair from January 2014 to December 2018 were enrolled in this study. Surgical repair in conjunction with PRP augmentation after surgery was classified as the PRP group. Surgical repair without PRP augmentation was classified as the non-PRP group. All patients were followed up at least 2 years post-operation. The outcomes were evaluated on the basis of rate of return to sports, time to return to play, Achilles Tendon Total Rupture Score (ATRS), calf circumference ratio, ankle range of motion (ROM) and complications following surgery. Results: At 2-year follow-up, the ATRS score was not significantly different between groups (p = 0.8), but the ATRS score in both groups improved with time. Rate of return to sports and time to return to play were not different between the two groups (p = 1.00). Moreover, calf circumference ratio and ankle ROM were evaluated at 6-month, 12-month, 18-month and 24-month follow-ups. At 6 months, the PRP group had better ankle ROM (p = 0.003) and a higher calf circumference ratio (p = 0.011); however, at the 24-month evaluation, there were no between-group differences regarding calf circumference ratio, ankle dorsiflexion and plantarflexion (p > 0.05). Conclusion: We show that PRP augmentation in Achilles tendon surgery did not yield superior functional and clinical outcomes. Therefore, clinicians should inform patients of the above information when undergoing Achilles tendon surgery and offer correct expectations to family and patients regrading PRP treatment.
Collapse
|
10
|
Burton I, McCormack A. Inertial Flywheel Resistance Training in Tendinopathy Rehabilitation: A Scoping Review. Int J Sports Phys Ther 2022; 17:775-786. [PMID: 35949372 PMCID: PMC9340832 DOI: 10.26603/001c.36437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 04/09/2022] [Indexed: 11/18/2022] Open
Abstract
Background Inertial Flywheel Resistance Training (IFRT) has recently emerged as a beneficial rehabilitation option for some musculoskeletal disorders. Although the use of resistance training as treatment for tendinopathy has become widespread, it is unclear if IFRT has efficacy as a treatment option for tendinopathies. Objective To identify current evidence on IFRT in the treatment of tendinopathy, evaluating intervention parameters and outcomes. Methods This scoping review was reported in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR). Databases searched included MEDLINE, CINAHL, AMED, EMBase, SPORTDiscus, Cochrane library (Controlled trials, Systematic reviews), and five trial registries. Two independent reviewers screened studies at title, abstract and full text. Following screening, data were extracted and charted, and presented as figures and tables alongside a narrative synthesis. Any study design conducted on adults, investigating the effects of IFRT for tendinopathy were included. Data were extracted on intervention parameters and outcomes of IFRT interventions. Results Four studies on patellar tendinopathy were included. A variety of outcomes were assessed, including pain, function, strength, power, and tendon morphological and mechanical properties, particularly changes in tendon thickness. IFRT intervention parameters were largely homogenously prescribed, with slight variances. Conclusion Despite a paucity of studies to date on the effects of IFRT for treating tendinopathy, preliminary evidence for beneficial effects of IFRT on clinical outcomes in patellar tendinopathy is encouraging. As IFRT is a relatively new and unexplored method in tendinopathy rehabilitation, definitive conclusions, and recommendations cannot be made at present, which should be addressed in future research, due to the potential therapeutic benefits highlighted in this review.
Collapse
Affiliation(s)
- Ian Burton
- Musculoskeletal physiotherapy, NHS Grampian
| | | |
Collapse
|
11
|
Burton I. Interventions for prevention and in-season management of patellar tendinopathy in athletes: A scoping review. Phys Ther Sport 2022; 55:80-89. [DOI: 10.1016/j.ptsp.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 10/18/2022]
|
12
|
Ready LV, Li NY, Worobey S, Lemme NJ, Yang DS, Yang J, Krill M, Owens BD. Influence of Preseason Versus In-Season Play on Achilles Tendon Injuries in the National Football League. Orthop J Sports Med 2021; 9:23259671211056083. [PMID: 34901290 PMCID: PMC8655453 DOI: 10.1177/23259671211056083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 08/24/2021] [Indexed: 11/22/2022] Open
Abstract
Background: A ruptured Achilles tendon (AT) can sideline a player for 6 to 12 months and reduce their power rankings by more than 50%. Previous research has compared AT rupture rates in different game conditions. Purpose: To determine environmental and physiological risk factors for AT tears, given the minimal amount of research on AT ruptures in the National Football League (NFL). Study Design: Case series; Level of evidence, 4. Methods: NFL players with a diagnosed AT tear between 2009 and 2016 were selected as the study population for this retrospective analysis. Data on NFL injury were collected from an established database composed of publicly available information. Player profiles were employed to determine position, team, and game statistics at the time of injury. The proportion of NFL rookies was approximated by summing the number of draft picks and the number of signed, undrafted free agents and measured against the number of roster spots before the season. Results: Between 2009 and 2016, there were 101 documented AT tears. Of these, 64% (65/101) occurred before the official season, including preseason games. Of the 36 tears that occurred in-season, 34 were during games. Overall, 29% (19/65) of the preseason tears occurred in rookies and 100% (36/36) of the in-season tears affected nonrookies. Of the rookies with AT ruptures, 42.11% returned to play in the NFL, while 62.20% of the nonrookies came back to partake in future seasons. Despite an average age of 26.7 years, the tear distribution was bimodal with players aged 24 and 36 years exhibiting the highest rates of tear. Conclusion: In our review of AT tears in NFL athletes, a large percentage of the tears occurred in rookie players, especially during the preseason. We also found that tears during the season occurred in only nonrookies, suggesting that the preseason is when rookies experience the greatest risk for injury.
Collapse
Affiliation(s)
- Lauren V Ready
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Neill Y Li
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | | | - Nicholas J Lemme
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Daniel S Yang
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - JaeWon Yang
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Michael Krill
- Department of Family Medicine, University of Iowa Sports Medicine, Iowa City, Iowa, USA
| | - Brett D Owens
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| |
Collapse
|
13
|
Bittencourt NFN, Oliveira RRD, Vaz RDPM, Silva RS, Mendonça LDM. Preventive effect of tailored exercises on patellar tendinopathy in elite youth athletes: A cohort study. Phys Ther Sport 2021; 53:60-66. [PMID: 34837804 DOI: 10.1016/j.ptsp.2021.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To investigate the effects of an intervention with tailored exercises on the incidence of patellar tendinopathy (PT) in elite youth jumping athletes. DESIGN Prospective crossover cohort. SETTING One sport club facility. PARTICIPANTS 271 elite youth basketball and volleyball player were followed in the first year of the study (Observation year) and 270 athletes were followed in the second year (intervention year). MAIN OUTCOME MEASURE Incidence rates of PT per 1,000h of exposure. Cox survival analysis was used to verify the effects of the intervention (exercises implemented according to the findings of a preseason assessment) on PT incidence. RESULTS The exercise prevention program significantly reduced the number of cases of PT, with athletes submitted to the intervention showing 51% less risk of developing PT. The overall PT incidence in the Observation year (5.9 per 1,000h of exposure) was significantly higher than that in the intervention year (2.8 per 1,000h of exposure) (P = .037). Twenty-six athletes developed PT in the observation year, whereas 13 athletes developed PT in the intervention year. CONCLUSIONS A tailored preventive program may be able to reduce the incidence of patellar tendinopathy, especially in male youth volleyball athletes. Randomized controlled trials are encouraged to confirm these findings.
Collapse
Affiliation(s)
- Natália Franco Neto Bittencourt
- Sports Physical Department - Minas Tênis Club, Belo Horizonte, MG, Brazil; Centro Universitário Uni-BH, Belo Horizonte, MG, Brazil; Tendon Research Group - Brazil, Fortaleza, CE, Brazil
| | - Rodrigo Ribeiro de Oliveira
- Tendon Research Group - Brazil, Fortaleza, CE, Brazil; Master Program in Physiotherapy and Functioning - Federal University of Ceará, Fortaleza, CE, Brazil
| | | | - Rodrigo Scattone Silva
- Tendon Research Group - Brazil, Fortaleza, CE, Brazil; Postgraduate Program in Rehabilitation Sciences, Faculty of Health Sciences of Trairi, Federal University of Rio Grande Do Norte, Santa Cruz, RN, Brazil; Postgraduate Program in Physical Therapy, Federal University of Rio Grande Do Norte, Natal, RN, Brazil
| | - Luciana De Michelis Mendonça
- Tendon Research Group - Brazil, Fortaleza, CE, Brazil; Physical Therapy Department - Universidade Federal Dos Vales Do Jequitinhonha e Mucuri, Brazil; Programa de Pós-Graduação Em Reabilitação e Desempenho Funcional, Universidade Federal Dos Vales Do Jequitinhonha e Mucuri, Diamantina, Brazil.
| |
Collapse
|
14
|
Stephenson SD, Kocan JW, Vinod AV, Kluczynski MA, Bisson LJ. A Comprehensive Summary of Systematic Reviews on Sports Injury Prevention Strategies. Orthop J Sports Med 2021; 9:23259671211035776. [PMID: 34734094 PMCID: PMC8558815 DOI: 10.1177/23259671211035776] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 05/03/2021] [Indexed: 12/26/2022] Open
Abstract
Background A large volume of systematic reviews and meta-analyses has been published on the effectiveness of sports injury prevention programs. Purpose To provide a qualitative summary of published systematic reviews and meta-analyses that have examined the effectiveness of sports injury prevention programs on reducing musculoskeletal injuries. Study Design Systematic review; Level of evidence, 4. Methods We searched the PubMed, CINAHL, EMBASE, and the Cochrane databases for systematic reviews and meta-analyses that evaluated the effectiveness of sports injury prevention programs. We excluded published abstracts, narrative reviews, articles not published in English, commentaries, studies that described sports injury prevention strategies but did not assess their effectiveness, studies that did not assess musculoskeletal injuries, and studies that did not assess sports-related injuries. The most relevant results were extracted and summarized. Levels of evidence were determined per the Oxford Centre for Evidence-Based Medicine, and methodological quality was assessed using the AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews, revised version). Results A total of 507 articles were retrieved, and 129 were included. Articles pertaining to all injuries were divided into 9 topics: sports and exercise in general (n = 20), soccer (n = 13), ice hockey (n = 1), dance (n = 1), volleyball (n = 1), basketball (n = 1), tackle collision sports (n = 1), climbing (n = 1), and youth athletes (n = 4). Articles on injuries by anatomic site were divided into 11 topics: general knee (n = 8), anterior cruciate ligament (n = 34), ankle (n = 14), hamstring (n = 11), lower extremity (n = 10), foot (n = 6), groin (n = 2), shoulder (n = 1), wrist (n = 2), and elbow (n = 1). Of the 129 studies, 45.7% were ranked as evidence level 1, and 55.0% were evidence level 2. Based on the AMSTAR-2, 58.9% of the reviews reported a priori review methods, 96.1% performed a comprehensive literature search, 47.3% thoroughly described excluded articles, 79.1% assessed risk of bias for individual studies, 48.8% reported a valid method for statistical combination of data (ie, meta-analysis), 45.0% examined the effect of risk of bias on pooled study results, and 19.4% examined the risk for publication bias. Conclusion This comprehensive review provides sports medicine providers with a single source of the most up-to-date publications in the literature on sports injury prevention.
Collapse
Affiliation(s)
- Samuel D Stephenson
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, The State University of New York at Buffalo, New York, USA
| | - Joseph W Kocan
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, The State University of New York at Buffalo, New York, USA
| | - Amrit V Vinod
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, The State University of New York at Buffalo, New York, USA
| | - Melissa A Kluczynski
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, The State University of New York at Buffalo, New York, USA
| | - Leslie J Bisson
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, The State University of New York at Buffalo, New York, USA
| |
Collapse
|
15
|
Cushman DM, Petrin Z, Eby S, Clements ND, Haight P, Snitily B, Teramoto M. Ultrasound evaluation of the patellar tendon and Achilles tendon and its association with future pain in distance runners. PHYSICIAN SPORTSMED 2021; 49:410-419. [PMID: 33153352 PMCID: PMC8648045 DOI: 10.1080/00913847.2020.1847004] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Objectives: To examine whether asymptomatic ultrasonographic abnormalities in the Achilles and patellar tendons in runners are associated with an increased risk of pain development.Methods: This is a longitudinal, prospective cohort study with 139 runners recruited at a half and full marathon race. Ultrasound examination of the Achilles and patellar tendons was performed bilaterally the day prior to the race. Self-reported injury data were collected at 1, 3, 6 and 12 months. 104 (74.8%) runners were included in the data analysis.Results: Ultrasonographic tendon abnormalities were found in 24.1% of the Achilles and in 23.1% of the patellar tendons prior to the race. Runners with tendon abnormality were 2-3 times more likely to develop pain within 12 months than those without (relative risk = 3.14, p = 0.010 for Achilles; relative risk = 2.52, p = 0.008 for patellar tendon). After adjusting for gender, age, years of running, average miles per week of running over a year, and pre-race pain, runners with ultrasound abnormality were about 3 times (hazard ratio = 2.89, p = 0.039 for Achilles; hazard ratio = 2.73, p = 0.030 for patellar tendon) more likely to develop pain after the race. Tendon delamination was most strongly associated with pain in both the Achilles (relative risk = 6.00; p = 0.001) and patellar tendons (relative risk = 3.81; p = 0.001).Conclusions: Structural changes in asymptomatic tendons were found in almost 25% of runners. Presence of structural changes was associated with increased development of Achilles and patellar tendon pain within one year.
Collapse
Affiliation(s)
- Daniel M Cushman
- University of Utah Division of Physical Medicine & Rehabilitation
| | - Ziva Petrin
- Rutgers New Jersey Medical School, Department of Physical Medicine & Rehabilitation
| | - Sarah Eby
- University of Utah Division of Physical Medicine & Rehabilitation
| | - Nathan D. Clements
- University of Texas, San Antonio, Department of Physical Medicine & Rehabilitation
| | | | | | - Masaru Teramoto
- University of Utah Division of Physical Medicine & Rehabilitation
| |
Collapse
|
16
|
Burton I. Autoregulation in Resistance Training for Lower Limb Tendinopathy: A Potential Method for Addressing Individual Factors, Intervention Issues, and Inadequate Outcomes. Front Physiol 2021; 12:704306. [PMID: 34421641 PMCID: PMC8375597 DOI: 10.3389/fphys.2021.704306] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 07/06/2021] [Indexed: 01/08/2023] Open
Abstract
Musculoskeletal disorders, such as tendinopathy, are placing an increasing burden on society and health systems. Tendinopathy accounts for up to 30% of musculoskeletal disorders, with a high incidence in athletes and the general population. Although resistance training has shown short-term effectiveness in the treatment of lower limb tendinopathy, more comprehensive exercise protocols and progression methods are required due to poor long-term outcomes. The most common resistance training protocols are predetermined and standardized, which presents significant limitations. Current standardized protocols do not adhere to scientific resistance training principles, consider individual factors, or take the importance of individualized training into account. Resistance training programs in case of tendinopathy are currently not achieving the required intensity and dosage, leading to high recurrence rates. Therefore, better methods for individualizing and progressing resistance training are required to improve outcomes. One potential method is autoregulation, which allows individuals to progress training at their own rate, taking individual factors into account. Despite the finding of their effectiveness in increasing the strength of healthy athletes, autoregulation methods have not been investigated in case of tendinopathy. The purpose of this narrative review was 3-fold: firstly, to give an overview and a critical analysis of the individual factors involved in tendinopathy and current resistance training protocols and their limitations. Secondly, to give an overview of the history, methods, and application of autoregulation strategies both in sports performance and physiotherapy. Finally, a theoretical adaptation of a current tendinopathy resistance training protocol using autoregulation methods is presented, providing an example of how the method could be implemented in clinical practice or future research.
Collapse
Affiliation(s)
- Ian Burton
- National Health Service (NHS) Grampian, Aberdeen, United Kingdom
| |
Collapse
|
17
|
Maestroni L, Read P, Bishop C, Papadopoulos K, Suchomel TJ, Comfort P, Turner A. The Benefits of Strength Training on Musculoskeletal System Health: Practical Applications for Interdisciplinary Care. Sports Med 2021; 50:1431-1450. [PMID: 32564299 DOI: 10.1007/s40279-020-01309-5] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Global health organizations have provided recommendations regarding exercise for the general population. Strength training has been included in several position statements due to its multi-systemic benefits. In this narrative review, we examine the available literature, first explaining how specific mechanical loading is converted into positive cellular responses. Secondly, benefits related to specific musculoskeletal tissues are discussed, with practical applications and training programmes clearly outlined for both common musculoskeletal disorders and primary prevention strategies.
Collapse
Affiliation(s)
- Luca Maestroni
- Smuoviti, Viale Giulio Cesare, 29, 24121, Bergamo, BG, Italy. .,StudioErre, Via della Badia, 18, 25127, Brescia, BS, Italy. .,London Sport Institute, School of Science and Technology, Middlesex University, Greenlands Lane, London, UK.
| | - Paul Read
- Athlete Health and Performance Research Center, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,School of Sport and Exercise, University of Gloucestershire, Gloucester, UK
| | - Chris Bishop
- London Sport Institute, School of Science and Technology, Middlesex University, Greenlands Lane, London, UK
| | - Konstantinos Papadopoulos
- London Sport Institute, School of Science and Technology, Middlesex University, Greenlands Lane, London, UK
| | - Timothy J Suchomel
- Department of Human Movement Sciences, Carroll University, Waukesha, WI, USA.,Directorate of Psychology and Sport, University of Salford, Frederick Road, Salford, Greater Manchester, UK
| | - Paul Comfort
- Directorate of Psychology and Sport, University of Salford, Frederick Road, Salford, Greater Manchester, UK.,Institute for Sport, Physical Activity and Leisure, Carnegie School of Sport, Leeds Beckett University, Leeds, UK.,Centre for Exercise and Sport Science Research, Edith Cowan University, Joondalup, Australia
| | - Anthony Turner
- London Sport Institute, School of Science and Technology, Middlesex University, Greenlands Lane, London, UK
| |
Collapse
|
18
|
Tham A, McLean M, Atherton C, Millar NL. Treatment of periscapular tendinopathy with radiofrequency coblation: A case report. SAGE Open Med Case Rep 2020; 8:2050313X20930612. [PMID: 32695397 PMCID: PMC7350035 DOI: 10.1177/2050313x20930612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 05/09/2020] [Indexed: 11/17/2022] Open
Abstract
Overuse injuries of the tendon – ‘tendinopathy’ – account for 30%–50% of all sporting injuries and a high proportion of orthopaedic referrals from primary care physicians. Tendinopathies often have a multifactorial aetiology and injury can be due to a combination of both acute and chronic trauma which contributes to loss of tissue integrity and eventual rupture. Our incomplete understanding of the mechanisms surrounding tendon pathophysiology continues to cause difficulties in treatments beyond loading regimes which can be unsuccessful in up to 30% of cases. We describe an uncommon case of tendinopathy affecting the periscapular muscle/tendon unit in a 35-year-old female with persistent pain around the inferior posterior pole of her right scapula. Magnetic resonance imaging findings confirmed oedema of the muscles around the inferior scapular margin in keeping with enthesopathy/tendinopathy and she was treated with radiofrequency coblation to the area. This case highlights radiofrequency ablation as a surgical option should non-operative treatments fail in the rare diagnosis of periscapular tendinopathy.
Collapse
Affiliation(s)
- Alexander Tham
- Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Michael McLean
- Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Caroline Atherton
- Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Neal L Millar
- Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| |
Collapse
|
19
|
Kim TH, Lim OK, Park KD, Lee JK. Comparison of Two Static Stretching Techniques for the Triceps Surae in Healthy Individuals: Wall and Inclined Board Stretchings. Ann Rehabil Med 2020; 44:125-130. [PMID: 32392651 PMCID: PMC7214133 DOI: 10.5535/arm.2020.44.2.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 09/10/2019] [Indexed: 11/10/2022] Open
Abstract
Objective To compare the effectiveness of static stretching techniques for correcting the tightness of the triceps surae. Methods In this observational, cross-sectional study, participants (30 healthy volunteers) completed 10 repetitions of each stretching exercise, holding each stretch for 10 seconds, with a 1-minute rest period between repetitionsand a 1-hour rest period between the two stretching techniques, namely, wall and inclined board stretchings. The length of the triceps surae and range of ankle dorsiflexion were measured on lateral view radiographs. The muscle activity during the stretch was measured using quantified surface electromyography of the lateral gastrocnemius. The subjective stretching sensation was evaluated using the visual analog scale. Results Both stretching techniques showed statistical differences in all the parameters. Stretching on an inclined board yielded a greater increase in the triceps surae length than did wall stretching (mean difference, 0.72; p=0.02). The range of ankle dorsiflexion was higher with inclined board stretching than with wall stretching (mean difference, 2.57; p=0.03). The mean muscle activity was significantly lower withinclined board stretching than with wall stretching (mean difference, 53.72; p<0.01). The visual analog scale score was higher with inclined board stretching than with wall stretching (mean difference, 2.07; p<0.01). Conclusion In this study, inclined board stretching was more effective than wall stretching for correcting tightness of the triceps surae. Therefore, inclined board stretching should be encouraged for the triceps surae.
Collapse
Affiliation(s)
- Tae Hee Kim
- Department of Rehabilitation Medicine, Konkuk University Chungju Hospital, Chungju, Korea
| | - Oh Kyung Lim
- Department of Rehabilitation Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Ki Deok Park
- Department of Rehabilitation Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Ju Kang Lee
- Department of Rehabilitation Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| |
Collapse
|
20
|
Influence of genetic factors in elbow tendon pathology: a case-control study. Sci Rep 2020; 10:6503. [PMID: 32300121 PMCID: PMC7162873 DOI: 10.1038/s41598-020-63030-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 03/18/2020] [Indexed: 11/09/2022] Open
Abstract
Elbow tendinopathy is a common pathology of the upper extremity that impacts both athletes and workers. Some research has examined the genetic component as a risk factor for tendinopathy, mainly in the lower limbs. A case-control study was designed to test for a relationship between certain collagen gene single nucleotide polymorphisms (SNPs) and elbow tendon pathology. A sample of 137 young adult athletes whose sports participation involves loading of the upper limb were examined for the presence of structural abnormalities indicative of pathology in the tendons of the lateral and medial elbow using ultrasound imaging and genotyped for the following SNPs: COL5A1 rs12722, COL11A1 rs3753841, COL11A1 rs1676486, and COL11A2 rs1799907. Anthropometric measurements and data on participants’ elbow pain and dysfunction were collected using the Disabilities of the Arm, Shoulder and Hand and the Mayo Clinic Performance Index for the Elbow questionnaires. Results showed that participants in the structural abnormality group had significantly higher scores in pain and dysfunction. A significant relationship between COL11A1 rs3753841 genotype and elbow tendon pathology was found (p = 0.024), with the CT variant associated with increased risk of pathology.
Collapse
|
21
|
Stoychev V, Finestone AS, Kalichman L. Dry Needling as a Treatment Modality for Tendinopathy: a Narrative Review. Curr Rev Musculoskelet Med 2020; 13:133-140. [PMID: 31942676 DOI: 10.1007/s12178-020-09608-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW Tendinopathy describes a combination of pain, swelling, and impaired performance of the tendon and around structures. There are various treatment options for tendinopathy with unclear efficacy. Dry needling involves inserting needles into the affected tendon, and it is thought to disrupt the chronic degenerative process and encourage localized bleeding and fibroblastic proliferation. The purpose of this review is to review the use of dry needling as a treatment modality for tendinopathy. RECENT FINDINGS The effectiveness of dry needling for treatment of tendinopathy has been evaluated in 3 systematic reviews, 7 randomized controlled trials, and 6 cohort studies. The following sites were studied: wrist common extensor origin, patellar tendon, rotator cuff, and tendons around the greater trochanter. There is considerable heterogeneity of the needling techniques, and the studies were inconsistent about the therapy used after the procedure. Most systematic reviews and randomized controlled trials support the effectiveness of tendon needling. There was a statistically significant improvement in the patient-reported symptoms in most studies. Some studies reported an objective improvement assessed by ultrasound. Two studies reported complications. Current research provides initial support for the efficacy of dry needling for tendinopathy treatment. It seems that tendon needling is minimally invasive, safe, and inexpensive, carries a low risk, and represents a promising area of future research. In further high-quality studies, tendon dry needling should be used as an active intervention and compared with appropriate sham interventions. Studies that compare the different protocols of tendon dry needling are also needed.
Collapse
Affiliation(s)
- Vladimir Stoychev
- Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.,Bait Balev Hospital, Bat Yam, Israel
| | - Aharon S Finestone
- Department of Orthopaedic Surgery, Shamir Medical Center, Zerifin, affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Leonid Kalichman
- Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
| |
Collapse
|
22
|
Nunes GS, Tessarin BM, Scattone Silva R, Serrão FV. Relationship between the architecture and function of ankle plantar flexors with Achilles tendon morphology in ballet dancers. Hum Mov Sci 2019; 67:102494. [PMID: 31326740 DOI: 10.1016/j.humov.2019.102494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 06/06/2019] [Accepted: 07/03/2019] [Indexed: 11/16/2022]
Abstract
Achilles tendinopathy is the most frequent foot overuse injury in ballet dancers and knowledge of clinically modifiable factors related to tendon structure in a population at risk, such as ballet dancers, would be important for the development of preventive programs. Therefore, the present study aimed to assess relationships of gastrocnemius muscle architecture and ankle plantar flexors function with Achilles tendon morphology in ballet dancers. Fifty-four measures from 27 ballet dancers were collected. Tendon morphology (thickness, echogenicity, hypoechoic areas and neovascularisation) and muscle architecture (thickness, pennation angle and fascicle length) were evaluated using ultrasonography; ankle plantar flexors torque was evaluated using hand-held dynamometry, flexibility was evaluated in maximal weight-bearing ankle dorsiflexion position using inclinometer, and endurance was evaluated using the heel rise test. Ankle plantar flexors torque and medial gastrocnemius muscle architecture (thickness, pennation angle and fascicle length) are associated with Achilles tendon thickness in ballet dancers (r2 = 0.24, p = 0.008). Ankle plantar flexors torque and medial gastrocnemius muscle fascicle length are also associated with the echogenicity of the Achilles tendon (r2 = 0.13, p = 0.03). These findings call attention to the potential importance of ankle plantar flexors muscle force in healthy ballet dancers for the prevention of alterations in Achilles tendon structure.
Collapse
Affiliation(s)
- Guilherme S Nunes
- Department of Physiotherapy, Federal University of São Carlos, São Carlos, Brazil
| | | | - Rodrigo Scattone Silva
- Postgraduate Program in Rehabilitation Sciences, Faculty of Health Sciences of Trairi, Federal University of Rio Grande do Norte, Santa Cruz, Brazil
| | | |
Collapse
|
23
|
|
24
|
Mendonça LDM, Bittencourt NFN, Alves LEM, Resende RA, Serrão FV. Interventions used for Rehabilitation and Prevention of Patellar Tendinopathy in athletes: a survey of Brazilian Sports Physical Therapists. Braz J Phys Ther 2018; 24:46-53. [PMID: 30581095 DOI: 10.1016/j.bjpt.2018.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 10/30/2018] [Accepted: 12/06/2018] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES (1) To identify the type and frequency of interventions used by Brazilian physical therapists to treat and prevent the occurrence of patellar tendinopathy in athletes and the criteria used to return to sport; (2) to compare the interventions used to the grade of recommendation of current evidence. METHODS Design: cross-sectional study. SETTING online survey throughout sports physical therapy association. PARTICIPANTS Physical therapists who were invited to complete a structured questionnaire. MAIN OUTCOME MEASURES Interventions more frequently used for treating and preventing PT in athletes and the criteria used to define return to sport. RESULTS One-hundred and twenty-one physical therapists participated in this study. Quadriceps eccentric strengthening (75.2%), education (61.2%) and lower limb joint/lumbo-pelvic stabilization/hamstrings stretching (59.5%) were more frequently cited for prevention purposes, while lower limb joint stabilization (81.8%), education (80.2%) and myofascial release (78.5%) were more frequently reported for treatment. The majority of the physical therapists based their decision of athlete discharge on a combination of pain intensity, function and functional test results (44.6%). CONCLUSION There was inconsistency between interventions used in clinical practice and interventions recommended by the best available evidence.
Collapse
Affiliation(s)
- Luciana De Michelis Mendonça
- Physical Therapy Department, School of Biological and Health Sciences (FCBS), Universidade Federal dos Vales do Jequitinhonha e do Mucuri (UFVJM), Diamantina, MG, Brazil; Postgraduate Program of Rehabilitation and Functional Performance (PPGReab), Universidade Federal dos Vales do Jequitinhonha e do Mucuri (UFVJM), Diamantina, MG, Brazil.
| | | | - Laís Emanuelle Meira Alves
- Physical Therapy Department, School of Biological and Health Sciences (FCBS), Universidade Federal dos Vales do Jequitinhonha e do Mucuri (UFVJM), Diamantina, MG, Brazil
| | - Renan Alves Resende
- Postgraduate Program of Rehabilitation and Functional Performance (PPGReab), Universidade Federal dos Vales do Jequitinhonha e do Mucuri (UFVJM), Diamantina, MG, Brazil; Physical Therapy Department, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Fábio Viadanna Serrão
- Physical Therapy Department, Universidade Federal de São Carlos (UFSCar), São Carlos, SP, Brazil; Postgraduate Program of Physical Therapy, Universidade Federal de São Carlos (UFSCar), São Carlos, SP, Brazil
| |
Collapse
|
25
|
Challoumas D, Kirwan PD, Borysov D, Clifford C, McLean M, Millar NL. Topical glyceryl trinitrate for the treatment of tendinopathies: a systematic review. Br J Sports Med 2018; 53:251-262. [PMID: 30301735 PMCID: PMC6362607 DOI: 10.1136/bjsports-2018-099552] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2018] [Indexed: 12/03/2022]
Abstract
Objective To produce a best evidence synthesis of the clinical effects of topical glyceryl trinitrate (GTN) in the treatment of tendinopathies. Design A systematic review of published randomised controlled trials (RCTs) of the use of GTN in patients with tendinopathy. Data sources MEDLINE, Embase, Scopus and CINAHL from database inception to January 2018. Methods We examined RCTs comparing the effects of topical GTN with either placebo or other treatments on tendinopathy. Overall quality of each eligible study was determined based on a combined assessment of internal validity, external validity and precision. The level of evidence for each assessed parameter was rated based on the system by van Tulder et al. Results A total of 10 eligible RCTs were identified including patients with tendinopathy of the rotator cuff (n=4), wrist extensors (n=3), Achilles (n=2) and patellar (n=1) tendons. For all tendinopathies, improvements in pain were significant when comparing GTN versus placebo in the short term (<8 weeks; poor evidence). Significant improvements in midterm outcomes for treatment with GTN versus placebo included the following: patient satisfaction (strong evidence); chances of being asymptomatic with activities of daily living (strong evidence); range of movement (moderate evidence); strength (moderate evidence); pain (at night and with activity; poor evidence) and local tenderness (poor evidence). Patients treated with topical GTN reported a higher incidence of headaches than those who received placebo (moderate evidence). Conclusions and relevance Treatment of tendinopathies with topical GTN for up to 6 months appears to be superior to placebo and may therefore be a useful adjunct to the treating healthcare professions.
Collapse
Affiliation(s)
- Dimitris Challoumas
- Institute of Infection, Immunity and Inflammation, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Paul D Kirwan
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland.,Physiotherapy Department, Connolly Hospital, Dublin, Ireland
| | - Dmytro Borysov
- Institute of Infection, Immunity and Inflammation, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | | | - Michael McLean
- Institute of Infection, Immunity and Inflammation, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Neal L Millar
- Institute of Infection, Immunity and Inflammation, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| |
Collapse
|
26
|
Morgan S, Coetzee FF. Proposing a Patellar Tendinopathy Screening tool following a systematic review. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2018; 74:454. [PMID: 30349877 PMCID: PMC6191685 DOI: 10.4102/sajp.v74i1.454] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 07/31/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Patellar tendinopathy (PT) is an overuse injury of the knee. The mechanism of injury is associated with repetitive stress on the patellar tendon of the knee as a result of explosive movement. Patellar tendinopathy is prevalent in all populations and is associated with intrinsic and extrinsic risk factors. OBJECTIVES Primarily, the objective was to report on the intrinsic and extrinsic risk factors for PT, entailing a systematic review of the literature; the secondary objective was to use these risk factors to compile a proposed PT screening tool from the review and standard outcome measures. METHOD A systematic review was undertaken according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Elimination criteria of the articles included duplicates, titles, abstracts and methodological quality. The evidence was collected, characterised with regard to the intrinsic and extrinsic risk factors and summarised descriptively. RESULTS The search yielded 157 feasible articles prior to commencement of article elimination. Six articles were included with a mean methodological quality score of 69%. Eight intrinsic and five extrinsic risk factors were identified. These identified risk factors are all relevant to the pathology and formed the basis for a proposed PT screening tool. The Victorian Institute of Sports Assessment for Patellar Tendinopathy Questionnaire, Visual Analog Scale and the Pain Provocation Test are also included in the proposed test. CONCLUSION Intrinsic and extrinsic risk factors for PT were identified, and consequently, the proposed PT screening tool was formulated for possible future testing in appropriate studies. CLINICAL IMPLICATIONS Prevention of PT through intrinsic and extrinsic risk factor identification, and implementation in the clinical setup as a possible outcome measurement tool with which to verify functional improvement in PT rehabilitation.
Collapse
Affiliation(s)
- Sanell Morgan
- Department of Physiotherapy, University of the Free State, South Africa
| | - Frederik F. Coetzee
- Department of Exercise and Sport Sciences, University of the Free State, South Africa
| |
Collapse
|
27
|
Filardo G, Di Matteo B, Kon E, Merli G, Marcacci M. Platelet-rich plasma in tendon-related disorders: results and indications. Knee Surg Sports Traumatol Arthrosc 2018; 26:1984-1999. [PMID: 27665095 DOI: 10.1007/s00167-016-4261-4] [Citation(s) in RCA: 177] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 08/02/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE Platelet-rich plasma (PRP) is currently the most exploited strategy in the clinical practice to provide a regenerative stimulus for tendon healing. The aim of the present study was to systematically review the available evidence on the treatment of the main tendon disorders where PRP is currently applied. METHODS A systematic review of the literature was performed on the use of PRP as a treatment for tendinopathies focusing on the following sites: Achilles tendon, patellar tendon, rotator cuff tendons, and lateral elbow tendons. The following inclusion criteria for relevant articles were used: clinical trials written in English language up to 21 June 2016 on the use of PRP in the conservative or surgical treatment of the aforementioned tendinopathies. RESULTS The research identified the following clinical trials dealing with the application of PRP in the selected tendons: 19 papers on patellar tendon (6 being RCTs: 4 dealing with PRP conservative application and 2 surgical), 24 papers on Achilles tendon (4 RCTs: 3 conservative and 1 surgical), 29 on lateral elbow tendons (17 RCTs, all conservative), and 32 on rotator cuff (22 RCTs: 18 surgical and 3 conservative). CONCLUSION Patellar tendons seem to benefit from PRP injections, whereas in the Achilles tendon, PRP application is not indicated neither as a conservative approach nor as a surgical augmentation. Lateral elbow tendinopathy showed an improvement in most of the high-level studies, but the lack of proven superiority with respect to the more simple whole-blood injections still questions its use in the clinical practice. With regard to rotator cuff pathology, the vast majority of surgical RCTs documented a lack of beneficial effects, whereas there is still inconclusive evidence concerning its conservative application in rotator cuff disorders. LEVEL OF EVIDENCE Systematic review of level I-IV trials, Level IV.
Collapse
Affiliation(s)
- Giuseppe Filardo
- Nano-Biotechnology Laboratory, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Berardo Di Matteo
- I Orthopaedic and Traumatologic Clinic, Rizzoli Orthopaedic Institute, Via Di Barbiano, 1/10, 40136, Bologna, Italy.
| | - Elizaveta Kon
- Nano-Biotechnology Laboratory, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Giulia Merli
- Nano-Biotechnology Laboratory, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Maurilio Marcacci
- Biomechanics and Technology Innovation Laboratory, Rizzoli Orthopaedic Institute, Via Di Barbiano, 1/10, 40136, Bologna, Italy
| |
Collapse
|
28
|
Biceps Autograft Augmentation for Rotator Cuff Repair: A Systematic Review. Arthroscopy 2018; 34:1297-1305. [PMID: 29373293 DOI: 10.1016/j.arthro.2017.10.044] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 10/19/2017] [Accepted: 10/21/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To improve surgical outcomes in patients with massive cuff defects, different techniques and augmentations are proposed. The biceps tendon is easily available as an autograft. Our aim was to conduct a qualitative systematic review of various methods and surgical techniques that use a biceps autograft (BAG) for rotator cuff repair. Functional outcomes are also reported. We hypothesized that by using a BAG to treat massive rotator cuff tears, a more anatomic and biomechanical reconstruction could be achieved compared with other techniques. METHODS A qualitative systematic review was conducted (MEDLINE and Embase databases) to inventory surgical techniques for use of a BAG for rotator cuff repair. The following search terms were used for MEDLINE: biceps AND (augment* OR autograft* OR transplantation* OR (cuff AND graft*) OR biceps-incorporat*). Studies were included if the following criteria were fulfilled: description of surgical technique, only human subjects, functional outcomes noted, all study designs except technical notes, and no restrictions on study date. The quality of the studies was assessed in a standardized manner using a tool based on the Cochrane handbook. RESULTS We identified 981 studies; among these, 8 case series met the inclusion criteria. We identified 6 studies as high quality and 2 as medium quality. Different techniques for harvest and augmentation were used. Some studies left the proximal or distal portion intact, whereas others used it as a free graft. The clinical results of these studies showed significantly improved function, pain relief, and range of motion at follow-up, although this was not compared with a control group. The constructs were intact on magnetic resonance imaging in most patients (82%) within 2 years. CONCLUSIONS It can be concluded that use of a BAG is an option for augmentation in massive rotator cuff tears, although no definitive recommendations can be given. This is based on Level IV medium- and high-quality studies. LEVEL OF EVIDENCE: Level IV, systematic review of Level IV studies.
Collapse
|
29
|
Mersmann F, Bohm S, Arampatzis A. Imbalances in the Development of Muscle and Tendon as Risk Factor for Tendinopathies in Youth Athletes: A Review of Current Evidence and Concepts of Prevention. Front Physiol 2017; 8:987. [PMID: 29249987 PMCID: PMC5717808 DOI: 10.3389/fphys.2017.00987] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 11/17/2017] [Indexed: 01/09/2023] Open
Abstract
Tendons feature the crucial role to transmit the forces exerted by the muscles to the skeleton. Thus, an increase of the force generating capacity of a muscle needs to go in line with a corresponding modulation of the mechanical properties of the associated tendon to avoid potential harm to the integrity of the tendinous tissue. However, as summarized in the present narrative review, muscle and tendon differ with regard to both the time course of adaptation to mechanical loading as well as the responsiveness to certain types of mechanical stimulation. Plyometric loading, for example, seems to be a more potent stimulus for muscle compared to tendon adaptation. In growing athletes, the increased levels of circulating sex hormones might additionally augment an imbalanced development of muscle strength and tendon mechanical properties, which could potentially relate to the increasing incidence of tendon overload injuries that has been indicated for adolescence. In fact, increased tendon stress and strain due to a non-uniform musculotendinous development has been observed recently in adolescent volleyball athletes, a high-risk group for tendinopathy. These findings highlight the importance to deepen the current understanding of the interaction of loading and maturation and demonstrate the need for the development of preventive strategies. Therefore, this review concludes with an evidence-based concept for a specific loading program for increasing tendon stiffness, which could be implemented in the training regimen of young athletes at risk for tendinopathy. This program incorporates five sets of four contractions with an intensity of 85–90% of the isometric voluntary maximum and a movement/contraction duration that provides 3 s of high magnitude tendon strain.
Collapse
Affiliation(s)
- Falk Mersmann
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Movement Science, Berlin, Germany
| | - Sebastian Bohm
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Movement Science, Berlin, Germany
| | - Adamantios Arampatzis
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Movement Science, Berlin, Germany
| |
Collapse
|
30
|
Beatty NR, Félix I, Hettler J, Moley PJ, Wyss JF. Rehabilitation and Prevention of Proximal Hamstring Tendinopathy. Curr Sports Med Rep 2017; 16:162-171. [PMID: 28498225 DOI: 10.1249/jsr.0000000000000355] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Proximal hamstring tendinopathy (PHT) comprises a small but significant portion of hamstring injuries in athletes, especially runners. PHT is a chronic condition that is clinically diagnosed but can be supported with imaging. The main presenting complaint is pain in the lower gluteal or ischial region that may or may not radiate along the hamstrings in the posterior thigh. There is little scientific evidence on which to base the rehabilitation management of PHT. Treatment is almost always conservative, with a focus on activity modification, addressing contributing biomechanical deficiencies, effective tendon loading including eccentric training, and ultrasound-guided interventional procedures which may facilitate rehabilitation. Surgery is limited to recalcitrant cases or those involving concomitant high-grade musculotendinous pathology. The keys to PHT management include early and accurate diagnosis, optimal rehabilitation to allow for a safe return to preinjury activity level, and preventative strategies to reduce risk of reinjury.
Collapse
Affiliation(s)
- Nicholas R Beatty
- 1Physiatry Department, Hospital for Special Surgery, New York, NY; 2Sports Rehabilitation and Performance Center, Hospital for Special Surgery, New York, NY
| | | | | | | | | |
Collapse
|