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Hjortshoej MH, Agergaard A, Larsen FK, Thomsen LJP, Svensson RB, Couppé C, Magnusson SP. Determination of differences in ultrasound parameters for patellar tendons in males with unilateral patellar tendinopathy-An ancillary analysis of data from two randomized controlled trials. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024; 52:548-557. [PMID: 38488675 DOI: 10.1002/jcu.23655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 02/07/2024] [Indexed: 06/15/2024]
Abstract
PURPOSE To investigate power Doppler (PD) activity and tendon structure (between the injured and contralateral limb) in patients with unilateral patellar tendinopathy (PT) using ultrasonography (US). Secondly, the aim was to determine the intra-rater reliability of the PD activity and tendon structure. METHODS This study analyzed US baseline data from 57 male participants with symptomatic unilateral PT who had been enrolled in one of two randomized clinical trials. Data were analyzed to examine if systematic differences existed between injured and contralateral limbs using Fiji ImageJ. RESULTS The PD activity of the symptomatic tendon was larger 25.6 (Q1 = 14.9; Q3 = 41.6) mm2 than the asymptomatic 0 (Q1 = 0.0; Q3 = 0.0) mm2 (p < 0.001). There was a significantly greater tendon thickness at the proximal (2.5 mm 95% CI [2.0; 3.0]), mid (0.8 mm 95% CI [0.5; 1.1]), and distal (0.2 mm 95% CI [0.1; 0.4]) part of the tendon for the symptomatic compared to the asymptomatic tendon. Intra-rater reliability for PD activity and tendon structure ranged from moderate-to-excellent (0.74; 0.99). CONCLUSION These results provide mean estimates for tendon thickness of symptomatic and asymptomatic tendons, that can be used for clinicians to reliably estimate pathological tendon thickness.
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Affiliation(s)
- M H Hjortshoej
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Center for Healthy Aging, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg University Hospital, Copenhagen, NV, Denmark
- Centre for Health and Rehabilitation, University College Absalon, Slagelse, Denmark
| | - A Agergaard
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Center for Healthy Aging, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg University Hospital, Copenhagen, NV, Denmark
| | - F K Larsen
- Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg University Hospital, Copenhagen, NV, Denmark
| | - L J P Thomsen
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Center for Healthy Aging, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - R B Svensson
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Center for Healthy Aging, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - C Couppé
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Center for Healthy Aging, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg University Hospital, Copenhagen, NV, Denmark
| | - S P Magnusson
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Center for Healthy Aging, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg University Hospital, Copenhagen, NV, Denmark
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Ragone F, Pérez-Guillén S, Carrasco-Uribarren A, Cabanillas-Barea S, Ceballos-Laita L, Rodríguez-Rubio PR, Cabanas-Valdés R. The Effects of Soft-Tissue Techniques and Exercise in the Treatment of Patellar Tendinopathy-Systematic Review and Meta-Analysis. Healthcare (Basel) 2024; 12:427. [PMID: 38391804 PMCID: PMC10887760 DOI: 10.3390/healthcare12040427] [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: 11/06/2023] [Revised: 01/29/2024] [Accepted: 02/05/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Patellar tendinopathy is a degenerative clinical disorder that causes load-related pain in the lower pole of the patella or patellar tendon. It predominantly affects young male athletes engaged in sports involving repetitive tendon loading, particularly explosive jumping. The combination of manual techniques with therapeutic exercise is hypothesized to provide greater benefits than exercise alone. OBJECTIVE The aim of this study is to analyze the scientific evidence regarding the effects of soft-tissue techniques combined with therapeutic exercise versus therapeutic exercise alone on pain intensity and function in individuals with patellar tendinopathy. METHODS A systematic review with meta-analysis was conducted following the PRISMA guidelines. PubMed, Lilacs, IBECS, CENTRAL, WOS, SciELO, Academic Search, CINAHL, SportDiscus, PEDro, and Google Scholar databases were consulted. Randomized controlled trials and quasi-randomized trials focusing on the effects of soft-tissue techniques combined with therapeutic exercise (experimental group) versus therapeutic exercise alone (control group) on pain and function in individuals aged 16 years and older with patellar tendinopathy were selected. The Cochrane tool for risk-of-bias assessment and the PEDro scale for methodological quality were used. RESULTS AND DISCUSSION A total of six studies (n = 309; age range = 16-40 years), considered to have a low risk of bias and moderate-to-high methodological quality, were included. The results showed improvements in function in the experimental group (mean of 60% on the Visa-P scale) and pain in the experimental group (mean decrease of 2 points in the VAS scale). There were improvements in 50% of the studies when comparing variables between the experimental and control groups. CONCLUSIONS The combination of manual techniques, such as dry needling, percutaneous electrolysis, transverse friction massage, and stretching, along with a squat on a 25° inclined plane, appears to be effective in the treatment of patellar tendinopathy. Static stretching of the quadriceps before and after the squat five times per week, along with dry needling or percutaneous electrolysis sessions twice a week for 8 weeks, is recommended. However, future studies analyzing groups with passive techniques versus therapeutic exercise are needed to standardize the treatment and establish the optimal dose.
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Affiliation(s)
- Federico Ragone
- Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallés, Spain
| | - Silvia Pérez-Guillén
- Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallés, Spain
| | - Andoni Carrasco-Uribarren
- Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallés, Spain
| | - Sara Cabanillas-Barea
- Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallés, Spain
| | - Luis Ceballos-Laita
- Department of Surgery, Ophthalmology, Otorhinolaryngology and Physiotherapy, University of Valladolid, 42004 Soria, Spain
| | - Pere Ramón Rodríguez-Rubio
- Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallés, Spain
| | - Rosa Cabanas-Valdés
- Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallés, Spain
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Devran S, Gözübüyük ÖB, Dinçer Ş, Günver MG, Bayraktar B. Diagnostic value of shear-wave elastography for patellar tendinopathy in female volleyball and basketball athletes: a cross sectional case control study. PHYSICIAN SPORTSMED 2024:1-8. [PMID: 38243396 DOI: 10.1080/00913847.2024.2308507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/18/2024] [Indexed: 01/21/2024]
Abstract
OBJECTIVES We aim to investigate the accuracy of shear-wave elastography (SWE) in diagnosing patellar tendinopathy in female volleyball and basketball players. In addition, we compared different parts of the patellar tendon and investigated the effects of different knee angles on elastography measurements. METHODS This cross-sectional case-control study evaluated 63 female athletes from professional basketball and volleyball teams (NCT06199583). Patellar tendinopathy diagnoses were made using clinical and ultrasonographic criteria. SWE measurements were taken at 30-degree knee flexion and extension. Rectangular regions of interest boxes were placed in three different parts of the tendon (proximal, middle, distal). The global SWE value was calculated by taking the mean of measurements in the three parts. Receiver operating characteristic (ROC) curves were used to identify significant cutoff points for SWE, and 2 × 2 tables were generated to determine sensitivity and specificity. RESULTS Thirteen (20.6%) of the 63 athletes were diagnosed with patellar tendinopathy. The ROC curves have identified different cutoff scores for SWE measurements. The SWE score of 130.75 from the proximal part showed the highest sensitivity of 89% and specificity of 80% (p < 0.001) with a 4.45 likelihood ratio at the 30-degree knee flexion. The likelihood ratio is 1.5 at a 30-degree angle and 1.65 at a 0-degree angle when measuring the entire tendon, whereas other portions indicate a ratio ranging from 1.12 to 1.73. CONCLUSIONS Shear-wave elastography is a reliable evaluation method for diagnosing patellar tendinopathy. It has more accuracy when applied to the proximal part and at 30-degree knee flexion compared to measurements taken at knee extension and other parts of the tendon.
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Affiliation(s)
- Sergen Devran
- Faculty of Medicine, Sports Medicine Department, Istanbul University, Istanbul, Turkey
| | | | - Şensu Dinçer
- Faculty of Medicine, Sports Medicine Department, Istanbul University, Istanbul, Turkey
| | - Mehmet Güven Günver
- Faculty of Medicine, Biostatistics Department, Istanbul University, Istanbul, Turkey
| | - Bülent Bayraktar
- Faculty of Medicine, Sports Medicine Department, Istanbul University, Istanbul, Turkey
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4
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Arias-Buría JL, Borrella-Andrés S, Rodríguez-Sanz J, López-de-Celis C, Malo-Urriés M, Fernández-de-las-Peñas C, Gallego-Sendarrubias GM, González-Rueda V, Pérez-Bellmunt A, Albarova-Corral I. Precision and Safety of Ultrasound-Guided versus Palpation-Guided Needle Placement on the Patellar Tendon: A Cadaveric Study. Life (Basel) 2023; 13:2060. [PMID: 37895441 PMCID: PMC10608026 DOI: 10.3390/life13102060] [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: 08/10/2023] [Revised: 10/01/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
For decades, needling interventions have been performed based on manual palpation and anatomic knowledge. The increasing use of real-time ultrasonography in clinical practice has improved the accuracy and safety of needling techniques. Although currently ultrasound-guided procedures are routinely used for patellar tendon pathology, e.g., during percutaneous electrolysis, the accuracy of these procedures is still unknown. This study used a cadaveric model to compare and evaluate both the accuracy and safety of ultrasound-guided and palpation-guided needling techniques for the patellar tendon. A total of five physical therapists performed a series of 20 needle insertion task each (n = 100), 10 insertions based on manual palpation (n = 50) and 10 insertions guided with ultrasound (n = 50) to place a needle along the interface between the patellar tendon and Hoffa's fat pad. All procedures were performed on cryopreserved knee specimens. Distance to the targeted tissue, time of the procedure, accurate rate of insertions, number of passes, and unintentional punctured structures between both applications (with and without ultrasound guiding) were compared. The results revealed higher accuracy (100% vs. 80%), a lower distance from needle to the targeted tissue (0.25 ± 0.65 vs. 2.5 ± 1.9 mm), longer surface of contact with the needle (15.5 ± 6.65 vs. 4.7 ± 7.5 mm), and a lower frequency of patellar tendon puncture (16% vs. 52%, p < 0.001) with the ultrasound-guided procedure as opposed to palpation-guided one. Nevertheless, the ultrasound-guided procedure took longer (54.8 ± 26.8 vs. 23.75 ± 15.4 s) and required more passes (2.55 ± 1.9 vs. 1.5 ± 0.95) to be conducted than the palpation-guided procedure (all, p < 0.001). According to these findings, the accuracy of invasive procedures applied on the patellar tendon is higher when conducted with ultrasound guidance than when conducted just on manual palpation or anatomical landmark. These results suggest that ultrasound could improve the clinical application of invasive procedures at the fat-patellar tendon interface. Due to the anatomical features of the targeted tissue, some procedures require this precision, so the use of ultrasound is recommended.
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Affiliation(s)
- José L. Arias-Buría
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos. Av. de Atenas, s/n, Alcorcón, 28922 Madrid, Spain
| | - Sergio Borrella-Andrés
- Health Sciences Faculty, Department of Physiatry and Nursing, University of Zaragoza, C/Domingo Miral S/N, 50009 Zaragoza, Spain
| | - Jacobo Rodríguez-Sanz
- Faculty of Medicine and Health Science, Universitat Internacional de Catalunya C/Josep Trueta S/N, Sant Cugat del Vallés, 08195 Barcelona, Spain
- ACTIUM Functional Anatomy Group, Sant Cugat del Vallés, 08195 Barcelona, Spain
| | - Carlos López-de-Celis
- Faculty of Medicine and Health Science, Universitat Internacional de Catalunya C/Josep Trueta S/N, Sant Cugat del Vallés, 08195 Barcelona, Spain
- ACTIUM Functional Anatomy Group, Sant Cugat del Vallés, 08195 Barcelona, Spain
- Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08007 Barcelona, Spain
| | - Miguel Malo-Urriés
- Health Sciences Faculty, Department of Physiatry and Nursing, University of Zaragoza, C/Domingo Miral S/N, 50009 Zaragoza, Spain
| | - César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos. Av. de Atenas, s/n, Alcorcón, 28922 Madrid, Spain
| | - Gracia M. Gallego-Sendarrubias
- Department of Physical Therapy, Camilo José Cela University. C. Castillo de Alarcón, 49, Villafranca del Castillo, 28692 Madrid, Spain
| | - Vanessa González-Rueda
- Faculty of Medicine and Health Science, Universitat Internacional de Catalunya C/Josep Trueta S/N, Sant Cugat del Vallés, 08195 Barcelona, Spain
- ACTIUM Functional Anatomy Group, Sant Cugat del Vallés, 08195 Barcelona, Spain
- Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08007 Barcelona, Spain
| | - Albert Pérez-Bellmunt
- Faculty of Medicine and Health Science, Universitat Internacional de Catalunya C/Josep Trueta S/N, Sant Cugat del Vallés, 08195 Barcelona, Spain
- ACTIUM Functional Anatomy Group, Sant Cugat del Vallés, 08195 Barcelona, Spain
| | - Isabel Albarova-Corral
- Health Sciences Faculty, Department of Physiatry and Nursing, University of Zaragoza, C/Domingo Miral S/N, 50009 Zaragoza, Spain
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Nutarelli S, da Lodi CMT, Cook JL, Deabate L, Filardo G. Epidemiology of Patellar Tendinopathy in Athletes and the General Population: A Systematic Review and Meta-analysis. Orthop J Sports Med 2023; 11:23259671231173659. [PMID: 37347023 PMCID: PMC10280536 DOI: 10.1177/23259671231173659] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 02/09/2023] [Indexed: 06/23/2023] Open
Abstract
Background Patellar tendinopathy (PT) mainly affects athletes who use the tendon for repeated energy storage and release activities. It can have a striking impact on athletes' careers, although data on its real prevalence and incidence are sparse. Research efforts should start from the results of reliable and updated epidemiological research to help better understand the impact of PT and underpin preventative measures. Purpose To determine the prevalence and incidence of PT in athletes and the general population. Design Systematic review; Level of evidence, 3. Methods A systematic review of the literature was performed on January 17, 2022, and conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed, Web of Science, and Wiley Cochrane Library databases were searched for epidemiological reports of any evidence level and clinical studies reporting data on the incidence or prevalence of PT for the 11,488 retrieved records. The primary endpoint was the prevalence and incidence of PT in sport-active patients. The secondary endpoints were PT prevalence and incidence in subgroups of athletes based on sex, age, sport type, and sport level played, as well as the same epidemiological measures in the general population. Results A total of 28 studies, with 28,171 participants, were selected and used for the qualitative and quantitative analysis. The general and athletes' populations reported an overall PT prevalence of 0.1% and 18.3%, respectively. In athletes, the prevalence of PT was 11.2% in women and 17% in men (P = .070). The prevalence of PT in athletes <18 years was 10.1%, while it was 21.3% in athletes ≥18 years (P = .004). The prevalence of PT was 6.1% in soccer players, 20.8% in basketball players, and 24.8% in volleyball players. Heterogeneous PT diagnostic approaches were observed. Higher prevalence values were found when PT diagnoses were made using patient-reported outcomes versus clinical evaluations (P = .004). Conclusion This review demonstrated that PT is a common problem in the male and female sport-active populations. There are twice as many athletes aged ≥18 years than there are <18 years. Volleyball and basketball players are most affected by PT.
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Affiliation(s)
- Sebastiano Nutarelli
- Service of Orthopaedics and
Traumatology, Department of Surgery, EOC, Lugano, Switzerland
- School of Public Health, Physiotherapy
and Sports Science, University College Dublin, Dublin, Ireland
| | | | - Jill L. Cook
- La Trobe University Sport and Exercise
Medicine Research Centre, La Trobe University, Corner of Plenty Road and Kingsbury
Drive, Bundoora, Victoria, Australia
| | - Luca Deabate
- Service of Orthopaedics and
Traumatology, Department of Surgery, EOC, Lugano, Switzerland
| | - Giuseppe Filardo
- Service of Orthopaedics and
Traumatology, Department of Surgery, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences,
Università della Svizzera Italiana, Lugano, Switzerland
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Tayfur A, Şendil A, Sezik AÇ, Jean-François K, Sancho I, Le Sant G, Dönmez G, Duman M, Tayfur B, Pawson J, Uzlaşır S, Miller SC, Screen H, Morrissey D. Self-reported bio-psycho-social factors partially distinguish patellar tendinopathy from other knee problems and explain patellar tendinopathy severity in jumping athletes: A case-control study. Phys Ther Sport 2023; 61:57-65. [PMID: 36898283 DOI: 10.1016/j.ptsp.2023.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/24/2023] [Accepted: 02/26/2023] [Indexed: 03/07/2023]
Abstract
OBJECTIVE To determine what combinations of self-reported factors distinguish patellar tendinopathy (PT) from other knee problems, and explain PT severity variance. DESIGN Case-control study. SETTING Social media, private practice and National Health Service. PARTICIPANTS An international sample of jumping athletes diagnosed with either PT (n = 132; 30.7 ± 8.9 years; 80 males; VISA-P = 61.6 ± 16.0) or another musculoskeletal knee condition (n = 89; 31.8 ± 9.9 years; 47 males; VISA-P = 62.9 ± 21.2) by a clinician in the last 6 months. MAIN OUTCOME MEASURES We considered clinical diagnosis (case = having PT vs control = having other knee problems) as the dependent variable. Severity and sporting impact were defined by VISA-P and availability, respectively. RESULTS A model comprising seven factors distinguished PT from other knee problems; training duration (OR = 1.10), sport type (OR = 2.31), injured side (OR = 2.28), pain onset (OR = 1.97), morning pain (OR = 1.89), condition acceptability (OR = 0.39) and swelling (OR = 0.37). Sports-specific function (OR = 1.02) and player level (OR = 4.11) explained sporting availability. 44% of PT severity variance was explained by quality of life (β = 0.32), sports-specific function (β = 0.38) and age (β = -0.17). CONCLUSION Sports-specific, biomedical and psychological factors partially distinguish PT from other knee problems. Availability is mainly explained by sports-specific factors, while psychosocial factors impact on severity. Adding sports-specific and bio-psycho-social factors into assessments could help better identification and management of jumping athletes with PT.
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Affiliation(s)
- Abdulhamit Tayfur
- Sports and Exercise Medicine, QMUL, UK; Kırşehir Ahi Evran University, School of Physical Therapy and Rehabilitation, Turkey; London Barts Health NHS Trust, UK.
| | - Ateş Şendil
- Cyprus Health and Social Sciences University, School of Physical Education and Sports, Cyprus.
| | - Atilla Çağatay Sezik
- Yuksek Ihtisas University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Turkey.
| | - Kaux Jean-François
- Physical Medicine and Sport Traumatology Department, University and University Hospital of Liège, Belgium.
| | - Igor Sancho
- Sports and Exercise Medicine, QMUL, UK; University of Deusto, Physiotherapy Department, Spain.
| | | | - Gürhan Dönmez
- Hacettepe University, School of Medicine, Sports Medicine, Turkey.
| | - Mehmet Duman
- Republic of Turkey Ministry of Youth and Sports, Turkey.
| | | | | | - Serkan Uzlaşır
- Nevşehir Hacı Bektaş Veli University, School of Sports Science and Technology, Turkey.
| | | | - Hazel Screen
- School of Engineering Material Sciences, QMUL, UK.
| | - Dylan Morrissey
- Sports and Exercise Medicine, QMUL, UK; London Barts Health NHS Trust, UK.
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Jayaseelan DJ, Sault JD, Fernandez-de-Las-Penas C. Manual therapy should not be on the sideline in the game of treating tendinopathy. J Man Manip Ther 2022; 30:309-314. [PMID: 35253631 PMCID: PMC9487951 DOI: 10.1080/10669817.2022.2047269] [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: 10/18/2022] Open
Abstract
Tendinopathy is a common but difficult condition to manage in the orthopedic and sports settings. Despite strong evidence supporting exercise and load-management, a substantial proportion of individuals with the condition do not achieve a satisfactory long-term outcome. Tendinopathy can be associated with a number of impairments, including mobility deficits, muscle performance impairments, pain, and possible altered central pain processing - all of which are indications for manual therapy. Manual therapy has not been well described in the management of tendinopathy, even though its indications match the impairments associated with the condition. In this clinical perspective, the role of manual therapy in the management of tendinopathy is explored, with the intention of expanding possible treatment strategies for this challenging condition.
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Affiliation(s)
- Dhinu J. Jayaseelan
- Department of Health, Human Function and Rehabilitation Sciences, The George Washington University, Washington, DC, USA,CONTACT Dhinu J. Jayaseelan Department of Health, Human Function and Rehabilitation Sciences, The George Washington University, Washington, DC, USA
| | - Josiah D. Sault
- University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
| | - Cesar Fernandez-de-Las-Penas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcon, Spain
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8
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Cushman DM, Petrin Z, Cummings K, Eby SF, English J, Teramoto M. Sonographic Screening of Distance Runners for the Development of Future Achilles and Patellar Tendon Pain. Clin J Sport Med 2022; 32:493-500. [PMID: 34759186 PMCID: PMC9085961 DOI: 10.1097/jsm.0000000000000984] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 09/30/2021] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The 2 primary aims of this study were to identify ultrasonographic tendon abnormalities in asymptomatic runners and to examine the likelihood of developing pain in runners with ultrasound abnormalities compared with those without abnormalities. DESIGN Longitudinal, prospective cohort study. SETTING 2019 Salt Lake City Marathon. PARTICIPANTS Recreational half-marathon and full-marathon runners. ASSESSMENT OF RISK FACTORS The Achilles and patellar tendons of asymptomatic runners were examined with ultrasound imaging before a running event. Runners were monitored for self-reported outcomes of pain in the examined tendons at 1, 3, 6, and 12 months after the event. MAIN OUTCOME MEASURES Development of pain based on the presence of asymptomatic tendon abnormalities. RESULTS One hundred thirty-eight runners (36.2 ± 12.0 years, 49.3% men, and 31.2% full-marathon runners) were included. Ultrasound abnormalities of the Achilles and patellar tendons were identified in 24.6% and 39.1% of the runners before the race, respectively. Ultrasound abnormalities were significantly associated with approximately a 3-fold increase [hazard ratio (HR) = 2.55, P = 0.004] in the hazard of developing pain in the Achilles tendon and patellar tendon (HR = 1.67, P = 0.042) over the year after the race. Positive and negative predictive values of developing pain over the year were 34.1% and 87.2%, respectively, for abnormal findings in the Achilles tendon, and 22.9% and 85.0%, respectively, for the patellar tendon. CONCLUSIONS The presence of ultrasonographic abnormalities is associated with increased development of pain in the Achilles and patellar tendons within 1 year of a marathon or half marathon.
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Affiliation(s)
- Daniel M Cushman
- Division of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, Utah
| | - Ziva Petrin
- Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Bellevue, Washington
| | - Keith Cummings
- Proliance Orthopaedics & Sports Medicine, Bellevue, Washington; and
| | - Sarah F Eby
- Division of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, Utah
| | - Joy English
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
| | - Masaru Teramoto
- Division of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, Utah
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9
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Patellar Tendon Injury: A Bibliometric Analysis of the Most-Cited Articles Demonstrates Relatively High Overall Level of Evidence. Arthrosc Sports Med Rehabil 2022; 4:e1747-e1757. [DOI: 10.1016/j.asmr.2022.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 06/29/2022] [Indexed: 11/19/2022] Open
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10
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Young JL, Schroeder JD, Westrick RB, Nowak M, Rhon DI. A Population-Level Summary of Health Care Utilization for the Management of Patellar Tendinopathy in the Military Health System. J Knee Surg 2022; 35:1071-1078. [PMID: 35850134 DOI: 10.1055/s-0042-1751266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Patellar tendinopathy (PT) is a common nontraumatic orthopaedic disorder of the knee suffered by many service members. Understanding the make-up of usual care for PT at the system level can better frame current clinical gaps and areas that need improvement. Exercise therapy is recommended as a core treatment for PT, but it is unclear how often it is used as a part of usual care for PT within the Military Health System (MHS). The purpose of the study was to identify interventions used in the management of PT and the timing of these interventions. A secondary purpose was to determine if exercise therapy use was associated with reduced recurrence of knee pain. In total, 4,719 individuals aged 17 to 50 years in the MHS diagnosed with PT between 2010 and 2011 were included. Pharmacological and nonpharmacological interventions, visits to specialty providers, and imaging services were captured. Descriptive statistics were used to report the findings. Interventions were further categorized as being part of initial care (within the first 7 days), the initial episode of care (within the first 60 days), or the 2-year time period after diagnosis. Linear regression assessed the relationship between the number of exercise therapy visits in the initial episode of care and recurrences of knee pain. In total, 50.6% of this cohort had no more than one medical visit total for PT. Exercise therapy (18.2%) and nonsteroidal anti-inflammatory drugs (4.3%) were the two most used interventions in the initial episode of care. Radiographs were ordered for 23.1% of the cohort in the initial episode of care. The number of exercise therapy visits a patient received during the initial episode of care was not associated with recurrences of knee pain. Half of the individuals received no further care beyond an initial visit for the diagnosis of PT. Exercise therapy was the most common intervention used during the initial episode of care, but exercise therapy did not influence the recurrence of knee pain.
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Affiliation(s)
- Jodi L Young
- Department of Physical Therapy Program, Bellin College, Green Bay, Wisconsin
| | - Jeremy D Schroeder
- Sports and Exercise Medicine, Madigan Army Medical Center, Tacoma, Washington
| | - Richard B Westrick
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, Massachusetts
| | - Matthew Nowak
- Department of Orthopaedic Surgery, Madigan Army Medical Center, Tacoma, Washington
| | - Daniel I Rhon
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, Massachusetts
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11
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Wheeler PC. Nearly half of patients with chronic tendinopathy may have a neuropathic pain component, with significant differences seen between different tendon sites: a prospective cohort of more than 300 patients. BMJ Open Sport Exerc Med 2022; 8:e001297. [PMID: 35965784 PMCID: PMC9301817 DOI: 10.1136/bmjsem-2021-001297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2022] [Indexed: 11/04/2022] Open
Abstract
ObjectivesIdentifying the prevalence of neuropathic pain components in patients with chronic tendinopathy conditions using the Self-Administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) questionnaire.MethodsPatients with chronic tendinopathy and ‘tendon-like’ conditions treated within a single hospital outpatient clinic specialising in tendinopathy were identified. Pain scores, plus global function patient-reported outcome measures (5-Level version of EuroQol-5 Dimension and Musculoskeletal Health Questionnaire (MSK-HQ)), were completed and compared with the S-LANSS questionnaireResults341 suitable patients with chronic tendinopathy and potentially similar conditions were identified. Numbers: lateral elbow tendinopathy (39), greater trochanteric pain syndrome (GTPS; 112), patellar tendinopathy (11), non-insertional Achilles tendinopathy (40), insertional Achilles tendinopathy (39), plantar fasciopathy (100). 68% were female, with a mean age of 54.0±11.3 years and a mean symptom duration of 38.1±33.7 months.There was a mean S-LANSS score of 11.4±6.4. Overall, 47% of patients scored 12 or greater points on S-LANSS, indicating the possible presence of neuropathic pain. The highest proportion was in patients with plantar fasciopathy (61%), the lowest in those with GTPS (33%). Weak correlations were found between the S-LANSS score and MSK-HQ score, the numerical rating scale (0–10) values for ‘average pain’ and for ‘worst pain’, but not with the MSK-HQ %health value.ConclusionS-LANSS identified nearly half of patients with chronic tendinopathy as possibly having a neuropathic pain component. This is of unclear clinical significance but worth further study to see if/how this may relate to treatment outcomes. These results are from a single hospital clinic dealing with patients with chronic tendinopathy, without a control group or those with shorter symptom duration. However, this reinforces the probability of neuropathic pain components in at least some patients with chronic tendinopathy.
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Affiliation(s)
- Patrick C Wheeler
- Department of Sport and Exercise Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
- SSEHS, Loughborough University, Loughborough, UK
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12
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Nuhmani S, Ahsan M, Bari MA, Malhotra D, Al Muslem WH, Alsaadi SM, Muaidi QI. Patellar Tendinopathy—Does Injection Therapy Have a Role? A Systematic Review of Randomised Control Trials. J Clin Med 2022; 11:jcm11072006. [PMID: 35407614 PMCID: PMC8999520 DOI: 10.3390/jcm11072006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 03/06/2022] [Accepted: 03/31/2022] [Indexed: 02/04/2023] Open
Abstract
Injection treatment is one of the most widely used methods for the conservative management of patellar tendinopathy. The objective of this systematic review was to synthesise data from randomised control trails on the effectiveness of various injections used in the management of patellar tendinopathy. An electronic search was conducted in the Web of Science, Scopus, PubMed, and SPORTDiscus databases. To be included in the current systematic review, the study had to be an RCT conducted on human participants that investigated the effect of at least one injection treatment on the management of patellar tendinopathy. Selected studies were required to report either patient-reported outcomes or biological and clinical markers of the tendon healing. The methodological quality of the studies was appraised using the revised Cochrane risk of bias tool for RCTs (RoB 2.0). Nine RCTs on seven types of injections were included in this review, with an overall positive outcome. Pain intensity was measured in all the studies. The VISA P score was the most used outcome measure (n = 8). A wide variety of interventions were compared with injection therapy, including eccentric training, extracorporeal shockwave, and arthroscopy. It can be concluded that the injection treatments can produce promising results in the management of patellar tendinopathy. However, because of the limited number of studies and the disparities in the study populations and protocols, it is not possible to make a firm conclusion on the efficacy of these injection methods, and these results should be inferred with care.
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Affiliation(s)
- Shibili Nuhmani
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia; (M.A.); (W.H.A.M.); (S.M.A.); (Q.I.M.)
- Correspondence: ; Tel.: +966-554-270-531
| | - Mohammad Ahsan
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia; (M.A.); (W.H.A.M.); (S.M.A.); (Q.I.M.)
| | - Mohd Arshad Bari
- Department of Physical Education, Aligarh Muslim University, Aligarh 202002, India;
| | - Deepak Malhotra
- Department of Rehabilitation Sciences, School of Nursing Science and Allied Health (SNSAH), Jamia Hamdard, New Delhi 110062, India;
| | - Wafa Hashem Al Muslem
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia; (M.A.); (W.H.A.M.); (S.M.A.); (Q.I.M.)
| | - Saad Mohammed Alsaadi
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia; (M.A.); (W.H.A.M.); (S.M.A.); (Q.I.M.)
| | - Qassim Ibrahim Muaidi
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia; (M.A.); (W.H.A.M.); (S.M.A.); (Q.I.M.)
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13
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Magosch A, Urhausen AP, Mouton C, Tischer T, Seil R. Das Knie im Spitzensport. ARTHROSKOPIE 2022. [DOI: 10.1007/s00142-022-00517-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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14
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Kvist J, Silbernagel KG. Fear of Movement and Reinjury in Sports Medicine: Relevance for Rehabilitation and Return to Sport. Phys Ther 2022; 102:6480895. [PMID: 34971375 DOI: 10.1093/ptj/pzab272] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 10/21/2021] [Accepted: 11/15/2021] [Indexed: 11/14/2022]
Abstract
Athletes are defined by their ability to move and are often accustomed to pain as it relates to their sports and exercise regime. The forced movement restriction and pain associated with an acute or overuse injury has a profound effect not only on their physical abilities but also on their psychological well-being and social context. With the goal of returning to sport, the rehabilitation focus historically has been on recovery of physical attributes, but more recent research is addressing the psychological factors. This Perspective proposes that-according to the current evidence in sports medicine-the fear that affects choice of treatment, rehabilitation, and return to sports is intertwined with physical capacity and recovery of function. Past injury is also 1 of the main risk factors for a sports injury; therefore, fear of reinjury is not irrational. For an athlete, the fear related to a sports injury encompasses the fear of reinjury along with fear of not being able to return to the sport at their highest performance level-and the fear of having lifelong debilitating pain and symptoms. This Perspective reviews the evidence for the influence of fear of movement and reinjury on choice of treatment, rehabilitation, and return to sport and provides suggestions on how to address this fear during the continuum of treatment and return to sports.
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Affiliation(s)
- Joanna Kvist
- Unit of Physiotherapy, Department of Health, Medicine, and Caring Science, Linköping University, Linköping, Sweden.,Stockholm Sports Trauma Research Center, Dept of Molecular Medicine & Surgery, Karolinska Institute, Stockholm, Sweden
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15
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Current understanding of the diagnosis and management of the tendinopathy: An update from the lab to the clinical practice. Dis Mon 2022; 68:101314. [PMID: 34996610 DOI: 10.1016/j.disamonth.2021.101314] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Tendinopathy is labeled by many authors as a troublesome, common pathology, present in up to 30% medical care consultations involving musculoskeletal conditions. Despite the lasting interest for addressing tendon pathology, current researchers agree that even the exact definition of the term tendinopathy is unclear. Tendinopathy is currently diagnosed as a clinical hypothesis based on the patient symptoms and physical context. One of the main goals of current clinical management is to personalize treatment approaches to adapt them to the many different needs of the population. Tendons are complex structures that unite muscles and bones with two main objectives: to transmit forces and storage and release energy. Regarding the tensile properties of the tendons, several authors argued that tendons have higher tensile strength compared with muscles, however, are considered less flexible. Tendinopathy is an accepted term which is used to indicated a variety of tissue conditions that appear in injured tendons and describes a non-rupture damage in the tendon or paratendon, which is intensified with mechanical loading Even when the pathoetiology of tendinopathy is unclear, there is a wide array of treatments available to treat and manage tendinopathy. Although tendinitis usually debuts with an inflammatory response, the majority of chronic tendinopathies do not present inflammation and so the choosing of treatment should vary depending on severity, compliance, pain and duration of symptoms. The purpose of this article is to review and provide an overview about the currently research of the tendon diagnosis, management and etiology.
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16
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Management of Patellar Tendinopathy Through Monitoring, Load Control, and Therapeutic Exercise: A Systematic Review. J Sport Rehabil 2021; 31:337-350. [PMID: 34942594 DOI: 10.1123/jsr.2021-0117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 09/28/2021] [Accepted: 10/06/2021] [Indexed: 11/18/2022]
Abstract
CONTEXT Patellar tendinopathy presents with persistent tendon pain located in the lower pole of the patella and loss of function related to mechanical load. Although its pathogenesis is not completely clear, conservative treatment including exercise is the main intervention of patellar tendinopathy treatment. OBJECTIVE To describe the efficacy of patellar tendinopathy management through therapeutic exercise, and control and monitoring of loads. EVIDENCE ACQUISITION MEDLINE, WoS, Cochrane Plus, PEDro, and the gray literature were searched from inception to July 2021. Based on the PICO strategy, the inclusion criteria were clinical trials published in English or Spanish; outcomes of function, pain, and strength; patients with patellar tendinopathy with no age or gender limitations; using an active intervention; and at least a methodological quality equal to or greater than 3 points on the Jadad scale. All data were analyzed by 2 independent reviewers (P.N.-M. and D.H.-G.). Studies were qualitatively synthesized using a descriptive synthesis. The methodological quality and risk of bias assessment were performed with the PEDro and Jadad scale, respectively. EVIDENCE SYNTHESIS A total of 136 articles were identified, of which 12 met the eligibility criteria. All of them were regarded as presenting a moderate risk of bias and their methodological quality was considered acceptable to good. Recovering patellar tendinopathy with therapeutic exercise seems to significantly improve function, pain, and strength after intervention and even lasted over time. CONCLUSION A treatment based on load monitoring and physical exercise has proven to be effective in rehabilitating patellar tendinopathy, with positive results in the short and medium term.
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17
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Rosen AB, Wellsandt E, Nicola M, Tao MA. Current Clinical Concepts: Clinical Management of Patellar Tendinopathy. J Athl Train 2021; 57:621-631. [PMID: 34623447 DOI: 10.4085/1062-6050-0049.21] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patellar tendinopathy is a common, yet misunderstood pathoetiology afflicting a variety of patient populations. This lack of unified understanding affects the capability of clinicians to provide effective treatment interventions. Patients with tendinopathy often report long-term and low to moderate levels of pain, diminished flexibility, and strength, as well as decreased physical function. Load-management strategies combined with exercise regimens focused on progressive tendon loading are the most effective treatment option for patients with patellar tendinopathy. This review will provide an evidence-based approach to patellar tendinopathy, including its pathoetiology, evaluation, and treatment strategies.
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Affiliation(s)
- Adam B Rosen
- Associate Professor, School of Health and Kinesiology, University of Nebraska at Omaha
| | - Elizabeth Wellsandt
- Assistant Professor, Division of Physical Therapy Education, University of Nebraska Medical Center
| | - Mike Nicola
- Assistant Athletic Director, Department of Athletics, University of Nebraska at Omaha
| | - Matthew A Tao
- Assistant Professor, Department of Orthopaedic Surgery, University of Nebraska Medical Center
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18
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19
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Tayfur A, Haque A, Salles JI, Malliaras P, Screen H, Morrissey D. Are Landing Patterns in Jumping Athletes Associated with Patellar Tendinopathy? A Systematic Review with Evidence Gap Map and Meta-analysis. Sports Med 2021; 52:123-137. [PMID: 34554424 PMCID: PMC8761156 DOI: 10.1007/s40279-021-01550-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2021] [Indexed: 11/25/2022]
Abstract
Background Patellar tendinopathy (PT) is common and debilitating for jumping athletes. Intriguingly, despite its high prevalence and many research studies, a causal explanation for PT presence remains elusive. Objective Our objective was to investigate whether landing biomechanics among jumping athletes are associated with PT and can predict onset. Methods We conducted a systematic review with evidence gap map and meta-analysis. We searched three databases from inception to May 2021 for observational studies or trials evaluating landing biomechanics in jumping athletes with PT (JPTs). We assessed quality with a modified Downs and Black checklist, risk of bias with the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool, and evidence levels with van Tulder’s criteria and provided an evidence gap map. Results One prospective cohort (moderate quality), one cross-sectional cohort (moderate quality), and 14 case–control (four high-, seven moderate-, and three low-quality) studies, including 104 JPTs, 14 with previous PT, 45 with asymptomatic patellar tendon abnormality (PTA), and 190 controls were retained. All studies had a high risk of bias. Meta-analysis showed an association between lower ankle dorsiflexion and the presence of tendinopathy during drop and spike landings, and JPTs had reduced knee joint power and work during volleyball approach or drop landings (moderate evidence). Limited evidence suggested that JPTs had lower patellar tendon loads during drop landings. Strong or moderate evidence showed no relation between PT and sagittal plane peak knee and hip angles or range of motion; hip, knee, or ankle angles at initial contact (IC); knee angular velocities, peak trunk kinematics, or trunk angles at IC; sagittal plane hip, knee, or ankle moments; and peak vertical ground reaction force (vGRF) and vGRF impulse. Identified gaps were that no study simultaneously investigated athletes with previous PT, current PT, and PTA, and studies of joint angular velocities at IC, ankle and hip angular velocities after touchdown, leg stiffness, loading rate of forces, and muscle activation are lacking. Conclusion Despite the voluminous literature, large number of participants, multitude of investigated parameters, and consistent research focus on landing biomechanics, only a few associations can be identified, such as reduced ankle dorsiflexion–plantarflexion range. Further, the quality of the existing literature is inadequate to draw strong conclusions, with only four high-quality papers being found. We were unable to determine biomechanical factors that predicted PT onset, as longitudinal/prospective studies enabling causal inference are absent. The identified gaps indicate useful areas in which to explore causal relationships to inform intervention development. Therefore, high-quality prospective studies are essential to definitively determine whether landing biomechanics play a part in the development, recurrence, or management of PT and represent a potential therapeutic or preventive target alongside non-biomechanical factors. Supplementary Information The online version contains supplementary material available at 10.1007/s40279-021-01550-6.
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Affiliation(s)
- Abdulhamit Tayfur
- Sports and Exercise Medicine, William Harvey Research Institute, QMUL, London, UK.,Barts Health NHS Trust, London, UK
| | - Arman Haque
- Sports and Exercise Medicine, William Harvey Research Institute, QMUL, London, UK
| | - Jose Inacio Salles
- Sports and Exercise Medicine, William Harvey Research Institute, QMUL, London, UK
| | - Peter Malliaras
- Department of Physiotherapy, Monash University, Melbourne, Australia
| | - Hazel Screen
- School of Engineering Material Sciences, QMUL, London, UK
| | - Dylan Morrissey
- Sports and Exercise Medicine, William Harvey Research Institute, QMUL, London, UK. .,Barts Health NHS Trust, London, UK.
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20
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Firminger CR, Haider IT, Bruce OL, Wannop JW, Stefanyshyn DJ, Edwards WB. Are subject-specific models necessary to predict patellar tendon fatigue life? A finite element modelling study. Comput Methods Biomech Biomed Engin 2021; 25:729-739. [PMID: 34514910 DOI: 10.1080/10255842.2021.1975683] [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: 10/20/2022]
Abstract
Patellar tendinopathy is an overuse injury that occurs from repetitive loading of the patellar tendon in a scenario resembling that of mechanical fatigue. As such, fatigue-life estimates provide a quantifiable approach to assess tendinopathy risk and may be tabulated using nominal strain (NS) or finite element (FE) models with varied subject-specificity. We compared patellar tendon fatigue-life estimates from NS and FE models of twenty-nine athletes performing countermovement jumps with subject-specific versus generic geometry and material properties. Subject-specific patellar tendon material properties and geometry were obtained using a data collection protocol of dynamometry, ultrasound, and magnetic resonance imaging. Three FE models were created for each subject, with: subject-specific (hyperelastic) material properties and geometry, subject-specific material properties and generic geometry, and generic material properties and subject-specific geometry. Four NS models were created for each subject, with: subject-specific (linear elastic) material properties and moment arm, generic material properties and subject-specific moment arm, subject-specific material properties and generic moment arm, and generic material properties and moment arm. NS- and FE-modelled fatigue-life estimates with generic material properties were poorly correlated with their subject-specific counterparts (r2≤0.073), while all NS models overestimated fatigue life compared to the subject-specific FE model (r2≤0.223). Furthermore, FE models with generic tendon geometry were unable to accurately represent the heterogeneous strain distributions found in the subject-specific FE models or those with generic material properties. These findings illustrate the importance of incorporating subject-specific material properties and FE-modelled strain distributions into fatigue-life estimations.
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Affiliation(s)
- Colin R Firminger
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Biomedical Engineering Graduate Program, University of Calgary, Calgary, Alberta, Canada.,McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
| | - Ifaz T Haider
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
| | - Olivia L Bruce
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Biomedical Engineering Graduate Program, University of Calgary, Calgary, Alberta, Canada.,McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
| | - John W Wannop
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Darren J Stefanyshyn
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Biomedical Engineering Graduate Program, University of Calgary, Calgary, Alberta, Canada
| | - W Brent Edwards
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Biomedical Engineering Graduate Program, University of Calgary, Calgary, Alberta, Canada.,McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
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21
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Sagittal patellar flexion angle measurement determines greater incidence of patella alta in patellar tendinopathy patients. Knee Surg Sports Traumatol Arthrosc 2021; 29:3115-3123. [PMID: 33219821 DOI: 10.1007/s00167-020-06372-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 11/05/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The objective of this study was to compare patellar height and patella alta between a control cohort and patients with patellar tendinopathy by the sagittal patellar flexion angle (SPFA) measurement. METHODS Magnetic resonance imaging (MRI) scans of the knee were obtained from a sports imaging facility and screened to select patients with anterior knee pain. This symptomatic group was divided into two patient cohorts: those with and without MRI features of patellar tendinopathy. Lateral knee radiographs were reviewed and SPFA, knee flexion angle and Insall-Salvati ratio (IS) were measured from the radiographs by two independent reviewers. RESULTS A total of 99 patients consisting of 48 patellar tendinopathy patients and 51 control patients were included. There was a significantly higher mean patellar height (p = 0.002, d = 0.639) and a greater patella alta incidence in the patellar tendinopathy cohort (25.0%) compared to the controls (3.9%) (p = 0.022, d = 0.312). Insall-Salvati ratio measurements showed no difference in patella alta incidence between tendinopathy and control cohorts. There was excellent inter- and intra-observer reliability of SPFA measurements (ICC 0.99). CONCLUSION This is the first study to demonstrate a greater incidence of patella alta in patellar tendinopathy patients compared to controls. A greater patella alta incidence amongst patellar tendinopathy patients as defined by SPFA was found to be clinically relevant, as it suggests these patients may comprise the recalcitrant patient subgroup who do not improve with current surgical intervention and may therefore benefit from a biomechanical surgical solution. LEVEL OF EVIDENCE III.
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22
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Olesen JL, Hansen M, Turtumoygard IF, Hoffner R, Schjerling P, Christensen J, Mendias CL, Magnusson PS, Kjaer M. No Treatment Benefits of Local Administration of Insulin-like Growth Factor-1 in Addition to Heavy Slow Resistance Training in Tendinopathic Human Patellar Tendons: A Randomized, Double-Blind, Placebo-Controlled Trial With 1-Year Follow-up. Am J Sports Med 2021; 49:2361-2370. [PMID: 34138667 DOI: 10.1177/03635465211021056] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Heavy slow resistance (HSR) training is currently recommended as part of the treatment of patellar tendon tendinopathy. However, treatment success is not reached in all patients, and combinations of different treatments could be beneficial. Local administration of insulin-like growth factor-1 (IGF-1) in humans has been shown to quickly stimulate tendon collagen synthesis. PURPOSE To study whether IGF-1 injections combined with HSR training enhance tendon synthesis, tissue structure, and patient satisfaction versus saline injection combined with HSR training in patients with patellar tendinopathy. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS Forty patients (age 18-50 years) with unilateral patellar tendinopathy undertook HSR training (3 times a week for 12 weeks) and received intratendinous IGF-1 injections (1 mg IGF-1 per dose) or isotonic saline injections (sham injections) at baseline and after 1 and 2 weeks of training. The primary outcome was collagen synthesis parameters after 12 weeks (primary endpoint). The secondary outcomes were patient-reported outcomes (scores on the Victorian Institute of Sport Assessment-Patella [VISA-P] and visual analog scale [VAS] for pain) and structural changes before the initiation of treatment and at week 3, week 12, and 1 year after the initiation of treatment. RESULTS Analysis of the patellar tendon biopsy specimens at 12 weeks showed that collagen mRNA and total RNA were increased in the tendinopathic tendons compared with the contralateral healthy tendons regardless of treatment with IGF-1 or saline. Similarly, no difference between the groups was seen in tendon thickness and Doppler activity at week 12 or at 1-year follow-up. The combination of HSR training and IGF-1 injections significantly improved VISA-P and VAS pain scores after 3 weeks, whereas the overall responses after 12 weeks and at 1-year follow-up were identical in the 2 groups. CONCLUSION Although a small, immediate clinical response to IGF-1 injections was seen when combined with training, no additional long-term effect of intratendinous IGF-1 was observed on structural and clinical outcomes in patients with patellar tendinopathy. REGISTRATION NCT01834989 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Jens L Olesen
- Center for General Practice at Aalborg University, Aalborg, Denmark
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery M81, Bispebjerg Hospital, Copenhagen, Denmark
| | - Mette Hansen
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery M81, Bispebjerg Hospital, Copenhagen, Denmark
- Section of Sport Science, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Ida F Turtumoygard
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery M81, Bispebjerg Hospital, Copenhagen, Denmark
| | - Rikke Hoffner
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery M81, Bispebjerg Hospital, Copenhagen, Denmark
- Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Peter Schjerling
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery M81, Bispebjerg Hospital, Copenhagen, Denmark
- Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jan Christensen
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Christopher L Mendias
- Hospital for Special Surgery, New York, New York, USA
- Department of Physiology and Biophysics, Weill Cornell Medical College, New York, New York, USA
| | - Peter S Magnusson
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery M81, Bispebjerg Hospital, Copenhagen, Denmark
- Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Michael Kjaer
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery M81, Bispebjerg Hospital, Copenhagen, Denmark
- Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Looney AM, Fortier LM, Leider JD, Bryant BJ. Bioinductive Collagen Implant Augmentation for the Repair of Chronic Lower Extremity Tendinopathies: A Report of Two Cases. Cureus 2021; 13:e15567. [PMID: 34277189 PMCID: PMC8272520 DOI: 10.7759/cureus.15567] [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] [Accepted: 06/10/2021] [Indexed: 11/14/2022] Open
Abstract
In this report, we present two cases of refractory chronic lower extremity tendinopathies treated with collagen bioinductive implant augmentation: a 20-year-old male football player with chronic patellar tendinopathy and a 40-year-old active female with chronic proximal hamstring tendinopathy. We demonstrate that bioaugmentation may represent an effective strategy in the surgical treatment of chronic tendinopathies. Both patients were able to return to their pre-injury activity levels at an accelerated rate.
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Affiliation(s)
- Austin M Looney
- Department of Orthopaedic Surgery, Georgetown University Medical Center, Washington, DC, USA
| | - Luc M Fortier
- Department of Orthopaedic Surgery, Georgetown University School of Medicine, Washington, DC, USA
| | - Joseph D Leider
- Department of Orthopaedic Surgery, Georgetown University School of Medicine, Washington, DC, USA
| | - Brandon J Bryant
- Department of Orthopaedics, Sports Medicine Division, Inova Fairfax Hospital, Falls Church, USA
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Delorme JP, Jibri Z. The association of patellar tendinosis with patellar maltracking and Hoffa's fat pad impingement: A case-control MRI study. Clin Imaging 2021; 76:180-188. [PMID: 33957384 DOI: 10.1016/j.clinimag.2021.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/05/2021] [Accepted: 04/18/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To assess whether proximal or distal patellar tendinosis is associated with patellar maltracking parameters and superolateral Hoffa's fat pad impingement. METHODS Institutional radiology database was reviewed for knee MRI scans performed over a 7-year period identifying cases of unequivocal patellar tendinosis, which were separated into 2 groups: proximal and distal tendinosis. For each group of proximal and distal patellar tendinosis, a control group of age and gender matched subjects was assigned. The scans were evaluated for patellar maltracking parameters including patellar alta, tibial tuberosity lateralization, trochlear dysplasia and lateral patellar tilt and for presence of superolateral Hoffa's fat pad edema. These parameters were compared between the case and control groups. RESULTS Out of 9852 MRI scans, 94 patellar tendinosis cases were included (65 proximal and 29 distal tendinosis) and matched with equal numbers of controls. In the proximal patellar tendinosis group, more subjects had patella alta (22 versus 6, p = 0.0006), lateralization of tibial tuberosity (16 versus 7, p = 0.0495) and superolateral Hoffa's fat pad edema (16 versus 4, p = 0.0073) compared to the control group. In the distal patellar tendinosis group, there was no significant difference in the prevalence of any maltracking indicator or superolateral Hoffa's fat pad edema compared to the control group. CONCLUSION Proximal patellar tendinosis was associated with patellar maltracking parameters including patella alta, lateralized tibial tuberosity and superolateral Hoffa's fat pad impingement. No association was demonstrated between distal patellar tendinosis and patellar maltracking indicators or superolateral Hoffa's fat pad impingement.
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Affiliation(s)
- Jean-Philippe Delorme
- Department of Radiology, University of Ottawa, Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario K1H 8L6, Canada
| | - Zaid Jibri
- Department of Radiology, University of Ottawa, Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario K1H 8L6, Canada.
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Jayaseelan DJ, T Faller B, H Avery M. The utilization and effects of filiform dry needling in the management of tendinopathy: a systematic review. Physiother Theory Pract 2021; 38:1876-1888. [PMID: 33904812 DOI: 10.1080/09593985.2021.1920076] [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] [Indexed: 12/27/2022]
Abstract
Background: Tendinopathy is frequently associated with pain, soft tissue impairments and muscle performance limitations. Dry needling (DN) incorporates a fine filiform needle to penetrate the skin and underlying soft tissue in an effort to decrease pain and improve function. While injectable interventions and gauged-needle tendon fenestration for tendinopathy has been reviewed, DN for tendinopathy has yet to be synthesized.Objective: To systematically review the utilization and effects of DN for tendinopathy.Methods: Six electronic databases (PubMed, CINAHL, Scopus, SportDiscus, PEDro and the Cochrane Library) were searched from inception through August 15, 2020, using appropriate keywords and relevant synonyms.Results: After screening 462 articles, 10 studies met inclusion criteria. Study designs included case reports, case series, and randomized clinical trials. DN was used in isolation in 3/10 studies and as part of a multimodal approach in 7/10 studies. DN was associated with improved pain, function, muscle performance and perceived improvement in each study evaluating the relevant outcome. Conflicting results were found in comparative studies evaluating DN.Conclusions: DN may be a useful adjunctive treatment in the conservative management of tendinopathy, although its discrete effect is unclear. Very Low-quality evidence and methodological limitations suggest further investigation is warranted.
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Affiliation(s)
- Dhinu J Jayaseelan
- Department of Health, Human Function and Rehabilitation Sciences, Program in Physical Therapy, George Washington University, . Washington DC, USA
| | - Brian T Faller
- Department of Health, Human Function and Rehabilitation Sciences, Program in Physical Therapy, George Washington University, . Washington DC, USA
| | - Melinda H Avery
- International Spine Pain and Performance Center, Washington DC, USA
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26
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Pietrosimone LS, Blackburn JT, Wikstrom EA, Berkoff DJ, Docking SI, Cook J, Padua DA. Differences in Biomechanical Loading Magnitude During a Landing Task in Male Athletes with and without Patellar Tendinopathy. J Athl Train 2021; 57:464343. [PMID: 33887762 PMCID: PMC9875712 DOI: 10.4085/1062-6050-0548.20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
CONTEXT Prior research has not established if overloading or underloading movement profiles are present in symptomatic and asymptomatic athletes with patellar tendon structural abnormality (PTA) compared to healthy athletes. OBJECTIVE The purpose was to compare involved limb landing biomechanics between male athletes with and without patellar tendinopathy. DESIGN Cross-sectional study Setting: Laboratory Patients or Other Participants: 43 males were grouped based on patellar tendon pain & ultrasound imaging of the proximal patellar tendon: symptomatic with PTA (SYM-PTA; n=13; 20±2yrs; 1.8±0.1m; 84±5kg), asymptomatic with PTA (ASYM-PTA; n=15; 21±2yrs; 1.8±0.1m; 82±13kg), and healthy control (CON; n=15; 20±2yrs; 1.8±0.1m; 79±12kg). MAIN OUTCOME MEASURES 3D biomechanics were collected during double-limb jump-landing. Kinematic (knee flexion angle (KF)) and kinetic (vertical ground reaction force (VGRF); internal knee extension moment (KEM); patellar tendon force (FPT)) variables were analyzed as continuous waveforms during the stance phase for the involved limb. Mean values were calculated for each 1% of stance, normalized over 202 data points (0-100%), and plotted with 95% confidence intervals. Statistical significance was defined as a lack of 95% CI overlap for ≥ 6 consecutive data points. RESULTS SYM-PTA had lesser KF than CON throughout the stance phase. ASYM-PTA had lesser KF than CON in the early and late stance phase. SYM-PTA group had lesser KEM and FPT than CON in early stance, as well as ASYM-PTA in mid-stance. CONCLUSIONS Male athletes with SYM-PTA demonstrated a patellar tendon load-avoidance profile compared to ASYM-PTA and CON athletes. ASYM-PTA did not show evidence of overloading compared to CON. Our findings support the need for individualized treatments for athletes with tendinopathy to maximize load-capacity. TRIAL REGISTRY ClinicalTrials.gov (#XXX).
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Affiliation(s)
| | - J. Troy Blackburn
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Department of Orthopaedics, University of North Carolina at Chapel Hill
| | - Erik A. Wikstrom
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - David J. Berkoff
- Department of Orthopaedics, University of North Carolina at Chapel Hill
| | - Sean I. Docking
- La Trobe Sports and Exercise Research Centre, La Trobe University, Bundoora, Australia
| | - Jill Cook
- La Trobe Sports and Exercise Research Centre, La Trobe University, Bundoora, Australia
| | - Darin A. Padua
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Department of Orthopaedics, University of North Carolina at Chapel Hill
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Persson Krogh T, Kaae Astrup J, Kyed C, Fredberg U. Extracorporeal shockwave therapy in the treatment of patellar tendinopathy: A randomized, double‐blind, placebo‐controlled trial. TRANSLATIONAL SPORTS MEDICINE 2021. [DOI: 10.1002/tsm2.246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Thøger Persson Krogh
- Diagnostic Centre University Research Clinic for Innovative Patient PathwaysSilkeborg Regional Hospital Silkeborg Denmark
- Center for Sports Medicine Regional Hospital of Northern Denmark Hjørring Denmark
| | - Jacob Kaae Astrup
- Diagnostic Centre University Research Clinic for Innovative Patient PathwaysSilkeborg Regional Hospital Silkeborg Denmark
| | - Charlotte Kyed
- Diagnostic Centre University Research Clinic for Innovative Patient PathwaysSilkeborg Regional Hospital Silkeborg Denmark
| | - Ulrich Fredberg
- Diagnostic Centre University Research Clinic for Innovative Patient PathwaysSilkeborg Regional Hospital Silkeborg Denmark
- Center for Sports Medicine Regional Hospital of Northern Denmark Hjørring Denmark
- Research Unit of Rheumatology Department of Clinical Research University of Southern DenmarkOdense University Hospital Odense Denmark
- Institute of Sports Medicine Copenhagen Bispebjerg Hospital Copenhagen Denmark
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28
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Pownder SL, Hayashi K, Lin BQ, Meyers KN, Caserto BG, Breighner RE, Potter HG, Koff MF. Differences in the magnetic resonance imaging parameter T2* may be identified during the course of canine patellar tendon healing: a pilot study. Quant Imaging Med Surg 2021; 11:1234-1246. [PMID: 33816163 DOI: 10.21037/qims-20-684] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Previous studies have utilized ultrashort echo (UTE) magnetic resonance imaging (MRI), and derived T2* maps, to evaluate structures with highly ordered collagen structures such as tendon. T2* maps may provide a noninvasive means to assess tendon damage and healing. This pilot study evaluated the longitudinal relationship of an induced mechanical strain on the patellar tendon with corresponding UTE T2* metrics, histologic and biomechanical evaluation at two post-operative time points. Methods A total of 27 patellar tendons in male Beagles were surgically subjected to stretching by a small diameter (SmD) or a large diameter (LgD) diameter rod to induce damage due to strain, and evaluated at 4- and 8-week intervals using quantitative MRI (qMRI), biomechanical testing, and histology. A separate set of 16 limbs were used as controls. Results The tendons experienced a 67% and 17% prolongation of short T2* values as compared to controls at 4 and 8 weeks post-operatively, respectively. Histologic analysis displayed a trend of increased collagen disruption at 4 weeks followed by presence of greater organization at 8 weeks. Biomechanical evaluation found a reduction of tendon modulus and failure strain at both time points, and an increase in cross-sectional area at 4 weeks as compared to controls. Conclusions These findings display tendon healing in response to an imposed strain and present the utility of qMRI to evaluate longitudinal differences of patellar tendon T2* values in a model of induced subclinical tendon damage. The qMRI technique of UTE provides a means to non-invasively evaluate the healing process of a mechanically damaged tendon.
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Affiliation(s)
- Sarah L Pownder
- MRI Laboratory, Hospital for Special Surgery, New York, NY, USA
| | - Kei Hayashi
- Cornell University College of Veterinary Medicine, Ithaca, NY, USA
| | - Bin Q Lin
- MRI Laboratory, Hospital for Special Surgery, New York, NY, USA
| | | | | | | | - Hollis G Potter
- MRI Laboratory, Hospital for Special Surgery, New York, NY, USA
| | - Matthew F Koff
- MRI Laboratory, Hospital for Special Surgery, New York, NY, USA
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29
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Firminger CR, Edwards WB. Effects of cyclic loading on the mechanical properties and failure of human patellar tendon. J Biomech 2021; 120:110345. [PMID: 33735631 DOI: 10.1016/j.jbiomech.2021.110345] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/18/2021] [Accepted: 02/22/2021] [Indexed: 12/31/2022]
Abstract
Patellar tendinopathy is a common overuse injury in sports such as volleyball, basketball, and long-distance running. Microdamage accumulation, in response to repetitive loading of the tendon, plays an important role in the pathophysiology of patellar tendinopathy. This damage presents mechanically as a reduction in Young's modulus and an increase in residual strain. In this study, 19 human patellar tendon samples underwent cyclic testing in load control until failure, segmented by four ramped tests where digital image correlation (DIC) was used to assess anterior surface strain distributions. Ramped tests were performed prior to cyclic testing and at timepoints corresponding to 10%, 20%, and 30% of cyclic stiffness reduction. Young's modulus significantly decreased and cyclic energy dissipation significantly increased over the course of cyclic testing. The DIC analysis illustrated a heterogeneous strain distribution, with strain concentrations increasing in magnitude and size over the course of cyclic testing. Peak stress and initial peak strain magnitudes significantly correlated with the number of cycles to failure (r2 = 0.65 and r2 = 0.57, respectively, p < 0.001); however, the rates of peak cyclic strain and modulus loss displayed the highest correlations with the number of cycles to failure (r2 = 96% and r2 = 86%, respectively, p < 0.001). The high correlation between the rates of peak cyclic strain and modulus loss suggest that non-invasive methods to continuously monitor tendon strain may provide meaningful predictions of overuse injury in the patellar tendon.
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Affiliation(s)
- Colin R Firminger
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Canada; Biomedical Engineering Graduate Program, University of Calgary, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Canada.
| | - W Brent Edwards
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Canada; Biomedical Engineering Graduate Program, University of Calgary, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Canada
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Mónico JL, Silva F, Marques JP, Cardoso J, Mónico L, Fonseca F. Study on Overload Injuries during Periods of Intense Physical Activity Complemented by Isokinetic Dynamometry Evaluation. Rev Bras Ortop 2020; 55:681-686. [PMID: 33364644 PMCID: PMC7748940 DOI: 10.1055/s-0040-1712137] [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: 11/21/2019] [Accepted: 03/02/2020] [Indexed: 11/29/2022] Open
Abstract
Objective
The present study aims to measure the incidence of overload injuries in training soldiers, who are subjected to intense physical exercise, and to compare it with a control group. Next, it intends to verify whether there is any relationship between overload injuries and some neuromuscular function parameters.
Methods
Analytical, prospective observational study. Both the observational and the control group consisted of soldiers from the Portuguese Army. Clinical evaluation was performed by medical interview in the week prior to the beginning of a military parachuting course and in the week immediately after its completion. The neuromuscular performance was assessed by isokinetic dynamometry during the medical interview.
Results
With 44 of the 57 military personnel in training complaining of pain, the observational group had significantly more injuries than the control group (
p
< 0.001). Five complaints had traumatic origin and 39 were overload injuries. Of the 39 military personnel with overload injuries, 21 reported limited sports performance. However, isokinetic dynamometry showed no statistically significant differences in neuromuscular performance (
p
= 0.223 and
p
= 0.229).
Conclusion
Military personnel in training are prone to overload injuries, with an incidence rate > 70%. The implementation of strategies for injury monitoring and prevention is critical to promote health and physical capacity.
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Affiliation(s)
| | | | | | | | - Lisete Mónico
- Faculdade de Psicologia e de Ciências da Educação da Universidade de Coimbra, Coimbra, Portugal
| | - Fernando Fonseca
- Serviço de Ortopedia e Traumatologia do Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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IN-SEASON REHABILITATION PROGRAM USING BLOOD FLOW RESTRICTION THERAPY FOR TWO DECATHLETES WITH PATELLAR TENDINOPATHY: A CASE REPORT. Int J Sports Phys Ther 2020; 15:1184-1195. [PMID: 33344034 DOI: 10.26603/ijspt20201184] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background and Purpose Patellar tendinopathy is an overuse injury experienced primarily by athletes; especially athletes who participate in sports that involve frequent jumping. Therapeutic exercise is the primary conservative treatment for patients with this condition. However, some patients with patellar tendinopathy may be unable to tolerate the loading that occurs during exercise. The use of blood flow restriction (BFR) therapy for patients with patellar tendinopathy may allow the athlete to exercise with a lower load while still experiencing the physiological benefits associated with training at a higher intensity. The purpose of this case report was to detail the outcomes from a rehabilitation program utilizing BFR for two collegiate decathletes with patellar tendinopathy. Study Design Case ReportCase Descriptions and Interventions: Two NCAA Division III freshmen collegiate decathletes with a history of left knee pain prior to college and who had been complaining of increasing pain during the initial month of track practices. Findings from the musculoskeletal examinations included left sided lower extremity weakness, pain during functional testing, pain when palpating the left patellar tendon, and VISA-P scores less than 80. Ultrasound imaging at baseline revealed thickened tendons on the left with hypoechoic regions. Both athletes participated in 20 therapy sessions consisting of therapeutic exercises performed with BFR. Outcomes Both athletes experienced improvements in pain scores, increases in lower extremity strength, improved functional test performance, higher VISA-P scores, and improvements in tendon size and appearance as measured by diagnostic ultrasound. Conclusion Both athletes experienced improvements with the BFR-based therapeutic exercise program and were able to compete throughout the track season. The use of BFR may allow patients who are unable to tolerate exercise due to pain an alternative approach during rehabilitation. Future research should compare therapeutic exercise programs for this condition with and without BFR. Level of Evidence Level V.
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Muaidi QI. Rehabilitation of patellar tendinopathy. JOURNAL OF MUSCULOSKELETAL & NEURONAL INTERACTIONS 2020; 20:535-540. [PMID: 33265081 PMCID: PMC7716685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 05/07/2020] [Indexed: 11/02/2022]
Abstract
Patellar tendinopathy is a common musculoskeletal disorder characterized by progressive activity-related anterior knee pain and patellar tendon dysfunction. It is highly prevalent in sports which involve running and jumping. Various treatment methods are used in the management of PT including rest, activity modification, anti-inflammatory medication, injection therapies, taping, eccentric exercises, extra corporeal shock wave therapy, percutaneous electrolysis, and surgery. Even though various treatment options are available for patellar tendinopathy, no single method has proven to result in a consistent and near complete recovery in patients. Conservative management is considered to be the first line of treatment. This study presents an overview of the current practice about the management of patellar tendinopathy with an emphasis on rehabilitation. This review can act as a guide to sports medicine and rehabilitation professionals' decision making in the management of this disorder.
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Affiliation(s)
- Qassim I. Muaidi
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, K.SA
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33
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Aicale R, Oliviero A, Maffulli N. Management of Achilles and patellar tendinopathy: what we know, what we can do. J Foot Ankle Res 2020; 13:59. [PMID: 32993702 PMCID: PMC7523300 DOI: 10.1186/s13047-020-00418-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/28/2020] [Indexed: 02/07/2023] Open
Abstract
Tendinopathies are challenging conditions frequent in athletes and in middle-aged overweight patients with no history of increased physical activity. The term “tendinopathy” refers to a clinical condition characterised by pain, swelling, and functional limitations of tendons and nearby structures, the effect of chronic failure of healing response. Tendinopathies give rise to significant morbidity, and, at present, only limited scientifically proven management modalities exist. Achilles and patellar tendons are among the most vulnerable tendons, and among the most frequent lower extremity overuse injuries. Achilles and patellar tendinopathies can be managed primarily conservatively, obtaining good results and clinical outcomes, but, when this approach fails, surgery should be considered. Several surgical procedures have been described for both conditions, and, if performed well, they lead to a relatively high rate of success with few complications. The purpose of this narrative review is to critically examine the recent available scientific literature to provide evidence-based opinions on these two common and troublesome conditions.
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Affiliation(s)
- Rocco Aicale
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084, Baronissi, Italy.,Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, 84131, Salerno, Italy
| | - Antonio Oliviero
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084, Baronissi, Italy.,Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, 84131, Salerno, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084, Baronissi, Italy. .,Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, 84131, Salerno, Italy. .,Centre for Sports and Exercise Medicine, Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England. .,Institute of Science and Technology in Medicine, Keele University, School of Medicine, Guy Hilton Research Centre, Thornburrow Drive, Hartshill, Stoke-on-Trent, ST4 7QB, England.
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Mitham K, Mallows A, Debenham J, Seneviratne G, Malliaras P. Conservative management of acute lower limb tendinopathies: A systematic review. Musculoskeletal Care 2020; 19:110-126. [PMID: 32979021 DOI: 10.1002/msc.1506] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 08/18/2020] [Accepted: 08/21/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Most knowledge regarding conservative management for lower limb tendinopathy (LLT) is for persistent symptoms, with less known about conservative management of acute LLT. Sub-optimal management of acute LLT is detrimental in many regards, not least the likely conversion to persistent symptoms. OBJECTIVES To synthesise existing literature on conservative management of acute LLTs. DESIGN Systematic review of relevant literature (PROSPERO [ID: CRD42018117882]). METHOD A search was made of multiple databases (MEDLINE, CINAHL and EMBASE) using relevant search terms. Titles, abstracts and then full texts were filtered to find articles that met the strict inclusion/exclusion criteria. Searching, data extraction and quality assessment, using the Grading of Recommendations Assessment, Development and Evaluation, were done independently by two authors. To understand how the interventions impacted the duration of reported symptoms, results were split into three time points: short-term (<4 weeks), medium-term (4-12 weeks) and long-term (>12 weeks). RESULTS Thirteen studies (n = 534) met the criteria for inclusion. There was very low level of certainty for the effectiveness of interventions at short-term, medium-term and long-term follow ups. However, there were large effects seen across a number of different treatments on pain intensity and disability in LLTs. CONCLUSIONS This review demonstrates that limited evidence currently exists to guide the management of acute LLT, and the quality of the existing evidence is collectively low. These findings inform the discussion of different treatment options with patients in a shared decision-making process to empower and enable the patient.
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Affiliation(s)
| | - Adrian Mallows
- School of Sport, Rehabilitation & Exercise Sciences, University of Essex, Colchester, UK
| | - James Debenham
- School of Physiotherapy, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | | | - Peter Malliaras
- Physiotherapy Department, School of Primary and Allied Health Care, Monash University, Clayton, Victoria, Australia
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Tamura K, Resnick PB, Hamelin BP, Oba Y, Hetzler RK, Stickley CD. The effect of Kinesio-tape® on pain and vertical jump performance in active individuals with patellar tendinopathy. J Bodyw Mov Ther 2020; 24:9-14. [PMID: 32826014 DOI: 10.1016/j.jbmt.2020.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 02/17/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Patellar tendinopathy is a common inflammatory condition in athletes who undergo large volumes of running and jumping. Kinesio-tape® (KT) is proposed to provide pain relief; however, its effect has not been examined on patellar tendinopathy. OBJECTIVE To examine the effects of KT on pain modulation for active individuals with patellar tendinopathy during functional activities. METHODS Thirteen symptomatic knees from seven college-aged females (6 bilateral; 1 unilateral) were included. Participants underwent three data collection sessions with KT, sham, and no tape (NT) in a randomized order. During the session, participants performed a maximum vertical jump, single-leg squats and isometric knee extension. The KT intervention was applied according to the KT manual and the sham utilized the same pattern without tension. Pain level was evaluated using the numeric pain scale before, during and after each activity. Function was assessed as maximum vertical jump height and maximum isometric strength. A separate repeated measures ANOVA was used to compare each dependent variable (pain level, vertical jump height, and isometric strength) among the conditions. RESULTS Reported pain scores were significantly lower (p = 0.05) during the maximal vertical jump test for KT (3.38 ± 1.26) compared to NT (4.54 ± 2.22). Significantly lower jump heights were found under KT (17.73 ± 3.06in) during the maximum vertical jump test compared to sham (18.65 ± 2.17in, p = 0.000) and NT (18.18 ± 2.93in, p = 0.008). CONCLUSIONS The use of the KT tape with a tendon corrective strip and muscle facilitative strip was effective for decreasing pain associated with patellar tendinopathy during jump landing but led to decreased maximum jump height. CLINICAL TRIAL IDENTIFIER NCT04153877.
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Affiliation(s)
- Kaori Tamura
- Department of Kinesiology and Rehabilitation Science, University of Hawaii at Manoa, 1337 Lower Campus Road, PE/A Complex, Honolulu, HI, 96822, USA.
| | - Portia B Resnick
- Department of Kinesiology, California State University, Long Beach, 1250 Bellflower Boulevard, Long Beach, CA, 90804, USA.
| | - Bruce P Hamelin
- Department of Athletics, Florida Atlantic University, 777 Glades Rd, Boca Raton, FL, 33431, USA.
| | - Yukiya Oba
- Department of Kinesiology and Rehabilitation Science, University of Hawaii at Manoa, 1337 Lower Campus Road, PE/A Complex, Honolulu, HI, 96822, USA.
| | - Ronald K Hetzler
- Department of Kinesiology and Rehabilitation Science, University of Hawaii at Manoa, 1337 Lower Campus Road, PE/A Complex, Honolulu, HI, 96822, USA.
| | - Christopher D Stickley
- Department of Kinesiology and Rehabilitation Science, University of Hawaii at Manoa, 1337 Lower Campus Road, PE/A Complex, Honolulu, HI, 96822, USA.
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36
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Kubo K, Yajima H, Takayama M, Takakura N. Comparison of changes in blood circulation of patellar and Achilles tendons during and after acupuncture. TRANSLATIONAL SPORTS MEDICINE 2020. [DOI: 10.1002/tsm2.182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Keitaro Kubo
- Department of Life Science The University of Tokyo Meguro, Tokyo Japan
| | - Hiroyoshi Yajima
- Department of Acupuncture and Moxibustion Tokyo Ariake University of Medical and Health Science Tokyo Japan
| | - Miho Takayama
- Department of Acupuncture and Moxibustion Tokyo Ariake University of Medical and Health Science Tokyo Japan
| | - Nobuari Takakura
- Department of Acupuncture and Moxibustion Tokyo Ariake University of Medical and Health Science Tokyo Japan
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Holshouser C, Jayaseelan DJ. Multifaceted Exercise Prescription in the Management of an Overhead Athlete with Suspected Distal Biceps Tendinopathy: A Case Report. J Funct Morphol Kinesiol 2020; 5:E56. [PMID: 33467271 PMCID: PMC7739288 DOI: 10.3390/jfmk5030056] [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: 06/21/2020] [Revised: 07/26/2020] [Accepted: 07/27/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND PURPOSE Distal biceps brachii tendinopathy is an uncommon diagnosis. Various exercise prescriptions have demonstrated efficacy in the management of tendinopathy, although studies frequently focus on the effects of a specific type of muscular contraction (i.e., concentric, isometric, or eccentric). Currently, there is limited research guiding the conservative management of distal biceps tendinopathy, particularly with overhead athletes, and even less evidence reporting a multifaceted exercise prescription for individuals with tendinopathy. The purpose of this case report is to describe the integration of various modes of therapeutic exercise into a rehabilitation program for an overhead athlete with suspected distal biceps brachii tendinopathy. CASE DESCRIPTION A 19-year-old male collegiate baseball pitcher presented to an outpatient physical therapy clinic via direct access for left antecubital pain, which began 6 weeks prior to the evaluation while pitching during try-outs. Following physical examination, distal biceps tendinopathy was the likely clinical diagnosis. Interventions focused on early eccentric exercise eventually progressing to concentric and plyometric activity for return to sport. OUTCOMES The patient was seen five times over the course of 4 weeks. He had significant improvements of pain, patient-reported functional outcomes, global rating of change, strength, tenderness, and provocation testing. The patient was able to return to an off-season pitching program. DISCUSSION An impairment-based and task-specific exercise prescription was effective for this patient with distal biceps tendinopathy. Understanding the biomechanical demands of an individual's functional limitation, in this case baseball pitching, may assist the decision-making process and optimize outcomes. Additional research into the most effective exercise prescriptions for individuals with uncommon tendinopathies is warranted.
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Affiliation(s)
| | - Dhinu J. Jayaseelan
- Department of Health Human Function and Rehabilitation Sciences, The George Washington University, Washington, DC 20006, USA;
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Irby A, Gutierrez J, Chamberlin C, Thomas SJ, Rosen AB. Clinical management of tendinopathy: A systematic review of systematic reviews evaluating the effectiveness of tendinopathy treatments. Scand J Med Sci Sports 2020; 30:1810-1826. [PMID: 32484976 DOI: 10.1111/sms.13734] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 05/18/2020] [Accepted: 05/25/2020] [Indexed: 12/11/2022]
Abstract
While the pathoetiology is disputed, a wide array of treatments is available to treat tendinopathy. The most common treatments found in the literature include therapeutic modalities, exercise protocols, and surgical interventions; however, their effectiveness remains ambiguous. The purpose of this study was to perform a systematic review of systematic reviews to determine the ability of therapeutic interventions to improve pain and dysfunction in patients with tendinopathy regardless of type or location. Five databases were searched for systematic reviews containing only randomized control trials to determine the effectiveness of treatments for tendinopathies based on pain and patient-reported outcomes. Systematic reviews were assessed via the Assessment of Multiple Systematic Reviews (AMSTAR) for methodological quality. From the database search, 3,295 articles were found, 107 passed the initial inclusion criteria. After further review, 25 systematic reviews were included in the final qualitative analysis. The AMSTAR scores were relatively high (8.8 ± 1.0) across the 25 systematic reviews. Eccentric exercises were the most common and consistently effective treatment for tendinopathy across systematic reviews. Low-level laser therapy and extracorporeal shockwave therapy demonstrated moderate effectiveness, while platelet-rich plasma injections demonstrated inconclusive evidence on their ability to decrease tendinopathy-related pain and improve function. Corticosteroids also showed some effectiveness for short-term pain, but for the long-term use deemed ineffective and at times contraindicated. Regarding surgical options, minimally invasive procedures were more effective compared to open surgical interventions. When treating tendinopathy regardless of location, eccentric exercises were the best treatment option to improve tendinopathy-related pain and improve self-reported function.
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Affiliation(s)
- Alyssa Irby
- School of Health and Kinesiology, University of Nebraska at Omaha, Omaha, Nebraska, USA
| | - Jacqueline Gutierrez
- School of Health and Kinesiology, University of Nebraska at Omaha, Omaha, Nebraska, USA
| | - Claressa Chamberlin
- School of Health and Kinesiology, University of Nebraska at Omaha, Omaha, Nebraska, USA
| | - Stephen J Thomas
- Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, Pennsylvania, USA
| | - Adam B Rosen
- School of Health and Kinesiology, University of Nebraska at Omaha, Omaha, Nebraska, USA
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Tayfur A, Salles JI, Miller SC, Screen H, Morrissey D. Patellar tendinopathy outcome predictors in jumping athletes: feasibility of measures for a cohort study. Phys Ther Sport 2020; 44:75-84. [PMID: 32460219 DOI: 10.1016/j.ptsp.2020.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 04/27/2020] [Accepted: 05/10/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The main aim was to assess feasibility by testing data collection procedures for a cohort study. Measurements validity and reliability were secondary objectives. DESIGN Feasibility study. SETTING Combination of remote contact, assessment in clinic and biomechanical evaluation. PARTICIPANTS 36 jumping athletes (female:17, male:19) equally spread between those with patellar tendinopathy, other knee problems and controls. MAIN OUTCOME MEASURES Measurements validity, reliability and feasibility. RESULTS There was no systematic difference between administration methods for patient reported outcome measures and miscellaneous questions (range of d = -0.32 to 0.26) without any order effect (all p > 0.05) except KOOS-PF (p = 0.02). Questionnaires' inter-session reliability was moderate to excellent (ICCs = 0.68-0.93). Pain maps were 94% matched between methods. Training load recall percentage decreased until week-3 with only 20% maintaining a training diary completing the full 6 weeks. The graded loaded challenge was clinically applicable, biomechanically valid with increasing load through progression and reliable (ICCs = 0.63-0.98). CONCLUSION The tested questionnaires were valid and reliable for online use, therefore being suitable for clinical and research purposes. A shorter survey to reduce burden and collecting training load using shorter recall duration should improve feasibility. Biomechanical measures were valid and reliable, and a graded loaded challenge, suitable for further testing, has been defined.
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Affiliation(s)
- A Tayfur
- Sports and Exercise Medicine, QMUL, UK; Barts Health NHS trust, London, UK
| | | | | | - H Screen
- School of Engineering Material Sciences, QMUL, UK
| | - D Morrissey
- Sports and Exercise Medicine, QMUL, UK; Barts Health NHS trust, London, UK.
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Skovlund SV, Aagaard P, Larsen P, Svensson RB, Kjaer M, Magnusson SP, Couppé C. The effect of low‐load resistance training with blood flow restriction on chronic patellar tendinopathy — A case series. TRANSLATIONAL SPORTS MEDICINE 2020. [DOI: 10.1002/tsm2.151] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Sebastian V. Skovlund
- Department of Orthopaedic Surgery M Faculty of Health and Medical Sciences Bispebjerg Hospital and Center for Healthy Aging Institute of Sports Medicine University of Copenhagen Copenhagen Denmark
- Department of Physical and Occupational Therapy Bispebjerg Hospital Kobenhavn Denmark
| | - Per Aagaard
- Muscle Physiology and Biomechanics Research Unit Department of Sports Sciences and Clinical Biomechanics University of Southern Denmark Odense Denmark
| | - Patricia Larsen
- Department of Orthopaedic Surgery M Faculty of Health and Medical Sciences Bispebjerg Hospital and Center for Healthy Aging Institute of Sports Medicine University of Copenhagen Copenhagen Denmark
- Department of Physical and Occupational Therapy Bispebjerg Hospital Kobenhavn Denmark
| | - Rene B. Svensson
- Department of Orthopaedic Surgery M Faculty of Health and Medical Sciences Bispebjerg Hospital and Center for Healthy Aging Institute of Sports Medicine University of Copenhagen Copenhagen Denmark
| | - Michael Kjaer
- Department of Orthopaedic Surgery M Faculty of Health and Medical Sciences Bispebjerg Hospital and Center for Healthy Aging Institute of Sports Medicine University of Copenhagen Copenhagen Denmark
| | - Stig P. Magnusson
- Department of Orthopaedic Surgery M Faculty of Health and Medical Sciences Bispebjerg Hospital and Center for Healthy Aging Institute of Sports Medicine University of Copenhagen Copenhagen Denmark
- Department of Physical and Occupational Therapy Bispebjerg Hospital Kobenhavn Denmark
| | - Christian Couppé
- Department of Orthopaedic Surgery M Faculty of Health and Medical Sciences Bispebjerg Hospital and Center for Healthy Aging Institute of Sports Medicine University of Copenhagen Copenhagen Denmark
- Department of Physical and Occupational Therapy Bispebjerg Hospital Kobenhavn Denmark
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Effects of a patellar strap on knee joint kinetics and kinematics during jump landings: an exploration using a statistical parametric mapping and Bayesian approach. SPORT SCIENCES FOR HEALTH 2019. [DOI: 10.1007/s11332-019-00589-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Keefer Hutchison M, Patterson C, Cuddeford T, Dudley R, Sorenson E, Brumitt J. Low prevalence of patellar tendon abnormality and low incidence of patellar tendinopathy in female collegiate volleyball players. Res Sports Med 2019; 28:155-167. [PMID: 31663370 DOI: 10.1080/15438627.2019.1683559] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The prevalence of patellar tendinopathy has been reported to be as high as 50% in elite male volleyball (VB) players; however, the rate of injury in female collegiate VB athletes is unknown. The purpose of this study was to 1) identify the prevalence of ultrasonographic evidence of patellar tendon abnormality at the start of the preseason in female collegiate VB players; 2) report the incidence of tendinopathy during the season; and 3) determine if the preseason presence of tendon abnormality is associated with onset of disease. One hundred and six female collegiate VB players had both patellar tendons imaged. Incidence of patellar tendinopathy was tracked during the course of the 4-month season. Twenty-two athletes presented with ultrasonographic evidence of patellar tendon abnormality in at least one knee at the start of the preseason. The incidence of time-loss patellar tendinopathy was 0.26 (95% CI: 0.04, 0.85) per 1000 athletic exposures. This study was unable to determine if preseason presence of tendon abnormality was associated with a greater risk of tendinopathy due to power. The prevalence of tendon abnormality in the preseason and the incidence of patellar tendinopathy in female collegiate VB players are lower than that observed in other populations.
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Affiliation(s)
| | | | - Tyler Cuddeford
- School of Physical Therapy, George Fox University, Newberg, OR, USA
| | | | | | - Jason Brumitt
- School of Physical Therapy, George Fox University, Newberg, OR, USA
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Abstract
BACKGROUND Patellar tendinopathy is an overuse condition that commonly affects athletes. Surgery is usually offered if medical and physical therapies fail to treat it effectively. There is variation in the type of surgery performed for the condition. OBJECTIVES To assess the benefits and harms of surgery for patellar tendinopathy in adults. SEARCH METHODS We searched the following databases, to 17 July 2018: the Cochrane Central Register of Controlled Trials (CENTRAL) via the Cochrane Library, OVID MEDLINE, OVID Embase, clinical trial registries (www.ClinicalTrials.gov) and the WHO trials portal (www.who.int/ictrp/en/). SELECTION CRITERIA We included all randomised controlled trials (RCTs) that compared surgical techniques (open or arthroscopic) with non-operative treatment (including placebo surgery, exercise or other non-surgical modalities) in adults with patellar tendinopathy.Major outcomes assessed were knee pain, function, quality of life, participant global assessment of success, withdrawal rate, proportion with adverse events and proportion with tendon rupture. DATA COLLECTION AND ANALYSIS Two review authors selected studies for inclusion, extracted trial characteristics and outcome data, assessed the risk of bias and assessed the quality of the evidence using GRADE. MAIN RESULTS Two trials (92 participants) met our inclusion criteria. Participants in both trials were followed for 12 months. Neither trial compared surgery to placebo surgery. One trial (40 randomised participants) compared open surgical excision with eccentric exercises, and the other compared arthroscopic surgery with sclerosing injections (52 randomised participants). Due to the nature of the interventions, neither the participants or the investigators were blinded to the group allocation, resulting in the potential for performance and detection bias. Some outcomes were selectively not recorded, leading to reporting bias. Overall, the certainty of the evidence from these studies was low for all outcomes due to the potential for bias, and imprecision due to small sample sizes.Compared with eccentric exercises, low-certainty evidence indicates that open surgical excision provides no clinically important benefits with respect to knee pain, function or global assessment of success. At 12 months, mean knee pain - measured by pain with standing jump on a 10-point scale (lower scores indicating less pain) - was 1.7 points (standard deviation (SD) 1.6) in the eccentric training group and 1.3 (SD 0.8) in the surgical group (one trial, 40 participants). This equates to an absolute pain reduction of 4% (ranging from 4% worse to 12% better, the minimal clinically important difference being 15%) and a relative reduction in pain of 10% better (ranging from 30% better to 10% worse) in the treatment group. At 12 months, function on the zero- to 100-point Victorian Institute of Sport Assessment (VISA) scale was 65.7 (SD 23.8) in the eccentric training group and 72.9 (SD 11.7) in the surgical group (one trial, 40 participants). This equates to an absolute change of 7% better function (ranging from 4% worse to 19% better) and relative change of 25% better (ranging from 15% worse to 65% better, the minimal clinically important difference being 13%). Participant global assessment of success was measured by the number of people with no pain at 12 months: 7/20 participants in the eccentric training group reported no pain, compared with 5/20 in the open surgical group (risk ratio (RR) 0.71 (95% CI 0.27 to 1.88); one trial, 40 participants). There were no withdrawals, but five out of 20 people from the eccentric exercise group crossed over to open surgical excision. Quality of life, adverse events and tendon ruptures were not measured.Compared with sclerosing injection, low-certainty evidence indicates that arthroscopic surgery may provide a reduction in pain and improvement in participant global assessment of success, however further studies are likely to change these results. At 12 months, mean pain with activities, measured on a 100-point scale (lower scores indicating less pain), was 41.1 (SD 28.5) in the sclerosing injection group and 12.8 (SD 19.3) in the arthroscopic surgery group (one trial, 52 participants). This equates to an absolute pain reduction of 28% better (ranging from 15% to 42% better, the minimal clinically important difference being 15%), and a relative change of 41% better (ranging from 21% to 61% better). At 12 months, the mean participant global assessment of success, measured by satisfaction on a 100-point scale (scale zero to 100, higher scores indicating greater satisfaction), was 52.9 (SD 32.6) in the sclerosing injection group and 86.8 (SD 20.8) in the arthroscopic surgery group (one trial, 52 participants). This equates to an absolute improvement of 34% (ranging from 19% to 49%). In both groups, one participant (4%) withdrew from the study. Functional outcome scores, including the VISA score, were not reported. Quality-of-life assessment, adverse events, and specifically the proportion with a tendon rupture, were not reported.We did not perform subgroup analysis to assess differences in outcome between arthroscopic or open surgical excision, as we did not identify more than one study with a common comparator. AUTHORS' CONCLUSIONS We are uncertain if surgery is beneficial over other therapeutic interventions, namely eccentric exercises or injectables. Low-certainty evidence shows that surgery for patellar tendinopathy may not provide clinically important benefits over eccentric exercise in terms of pain, function or participant-reported treatment success, but may provide clinically meaningful pain reduction and treatment success when compared with sclerosing injections. However, further research is likely to change these results. The evidence was downgraded two levels due to the small sample sizes and susceptibility to bias. We are uncertain if there are additional risks associated with surgery as study authors failed to report adverse events. Surgery seems to be embedded in clinical practice for late-stage patella tendinopathy, due to exhaustion of other therapeutic methods rather than evidence of benefit.
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Affiliation(s)
- Michael Dan
- University of New South WalesLiverpoolAustralia
| | - Alfred Phillips
- University of New South WalesHunter New England Health DistrictLiveroolNSWAustralia2170
| | - Renea V Johnston
- Monash UniversityMonash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive MedicineMelbourneAustralia
| | - Ian A Harris
- South Western Sydney Clinical School, University of New South WalesIngham Institute for Applied Medical ResearchElizabeth StreetLiverpoolNew South WalesAustralia2170
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Hutchison MK, Houck J, Cuddeford T, Dorociak R, Brumitt J. Prevalence of Patellar Tendinopathy and Patellar Tendon Abnormality in Male Collegiate Basketball Players: A Cross-Sectional Study. J Athl Train 2019; 54:953-958. [PMID: 31424974 DOI: 10.4085/1062-6050-70-18] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Patellar tendinopathy (PT) is a degenerative condition known to affect athletes who participate in sports such as basketball and volleyball. Patellar tendinopathy is a challenging condition to treat and may cause an athlete to prematurely retire from sport. The prevalence of PT in male collegiate basketball players is unknown. OBJECTIVE To determine the prevalence of PT and patellar tendon abnormality (PTA) in a population of male collegiate basketball players. DESIGN Cross-sectional study. SETTING National Collegiate Athletic Association Divisions II and III, National Association of Intercollegiate Athletics, and Northwest Athletic Conference male collegiate basketball teams were assessed in a university laboratory setting. PATIENTS OR OTHER PARTICIPANTS Ninety-five male collegiate basketball players (age = 20.0 ± 1.7 years). MAIN OUTCOME MEASURE(S) A diagnostic ultrasound image of an athlete's patellar tendon was obtained from each knee. Patellar tendinopathy was identified based on a player's symptoms (pain with palpation) and the presence of a hypoechoic region on an ultrasonographic image. RESULTS A majority of participants, 53 of 95 (55.8%), did not present with pain during palpation or ultrasonographic evidence of PTA. Thirty-two basketball players (33.7%) displayed ultrasonographic evidence of PTA in at least 1 knee; 20 of those athletes (21.1%) had PT (pain and tendon abnormality). Nonstarters were 3.5 times more likely to present with PTA (odds ratio = 3.5, 95% confidence interval = 1.3, 9.6; P = .017) and 4 times more likely to present with PT (odds ratio = 4.0, 95% confidence interval = 1.1, 14.8; P = .038) at the start of the season. CONCLUSIONS One in 3 male collegiate basketball players presented with either PT or PTA. Sports medicine professionals should evaluate basketball athletes for PT and PTA as part of a preseason screening protocol.
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Affiliation(s)
| | - Jeff Houck
- School of Physical Therapy, George Fox University, Newberg, OR
| | - Tyler Cuddeford
- School of Physical Therapy, George Fox University, Newberg, OR
| | - Robin Dorociak
- School of Physical Therapy, George Fox University, Newberg, OR.,Northwest Biomechanics, LLC, Portland, OR
| | - Jason Brumitt
- School of Physical Therapy, George Fox University, Newberg, OR
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46
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van Ark M, Rabello LM, Hoevenaars D, Meijerink J, van Gelderen N, Zwerver J, van den Akker-Scheek I. Inter- and intra-rater reliability of ultrasound tissue characterization (UTC) in patellar tendons. Scand J Med Sci Sports 2019; 29:1205-1211. [PMID: 31033002 DOI: 10.1111/sms.13439] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 04/02/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE Ultrasound tissue characterization (UTC) is used in research and clinical practice to quantify tendon structure of the patellar tendon. This is the first study to investigate the inter- and intra-rater reliability for UTC of the patellar tendon on a large scale. METHOD Fifty participants (25 patellar tendinopathy, 25 asymptomatic) were recruited. The affected patellar tendons in symptomatic and right tendons in asymptomatic participants were scanned with UTC twice by one researcher and once by another. The same was done for contour marking (needed to analyze a UTC scan) of the tendon. Intraclass correlation coefficient (ICC (2,1)) for echo-types I, II, III, IV, aligned fibrillar structure (echo-types I + II), and disorganized structure (echo-types III + IV) were calculated. This was done for UTC scans as well as solely marking contours. RESULTS Inter-rater reliability showed fair to good ICC values for echo-types I (0.65) and II (0.46) and excellent ICC values for echo-type III (0.81), echo-type IV (0.83), aligned fibrillar structure (0.82), and disorganized structure (0.82). Intra-rater reliability showed excellent ICC values for echo-types I (0.76), III (0.88), IV (0.85), aligned fibrillar structure (0.88), and disorganized fibrillar structure (0.88) and a fair to good value for echo-type II (0.61). Contour marking showed excellent ICC values for all echo-types. CONCLUSION This study showed that UTC scans for patellar tendons have overall good intra-rater and inter-rater reliability. To optimize reliability of UTC scans of the patellar tendon, using the same rater and using aligned fibrillar structure (echo-types I + II combined) and disorganized structure (echo-types III + IV combined) as outcome measures can be considered.
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Affiliation(s)
- Mathijs van Ark
- Department of Physiotherapy, Hanze University of Applied Sciences Groningen, Groningen, The Netherlands.,Peescentrum, Centre of Expertise Primary Care Groningen (ECEZG), Groningen, The Netherlands
| | - Lucas Maciel Rabello
- Department of Sport and Exercise Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Dirk Hoevenaars
- Department of Sport and Exercise Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Joost Meijerink
- Department of Physiotherapy, Hanze University of Applied Sciences Groningen, Groningen, The Netherlands.,Department of Sport and Exercise Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Niels van Gelderen
- Department of Physiotherapy, Hanze University of Applied Sciences Groningen, Groningen, The Netherlands.,Department of Sport and Exercise Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Johannes Zwerver
- Department of Sport and Exercise Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Inge van den Akker-Scheek
- Department of Sport and Exercise Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Orthopedics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Efficacy of platelet-rich plasma injections for treating Achilles tendonitis. DER ORTHOPADE 2019; 48:784-791. [DOI: 10.1007/s00132-019-03711-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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48
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Potential Nervous System Sensitization in Patients With Persistent Lower Extremity Tendinopathies: 3 Case Reports. J Orthop Sports Phys Ther 2019; 49:272-279. [PMID: 30759356 DOI: 10.2519/jospt.2019.8600] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Tendinopathy is a condition often associated with pain and functional and sport performance limitations. While targeted exercise prescriptions are often effective, many patients with tendinopathy develop persistent symptoms. Emerging evidence suggests a possible link between nervous system sensitization and tendinopathy. If so, identifying and treating specific pain mechanisms may improve outcomes. CASE DESCRIPTION Three patients were seen in physical therapy for complaints of ongoing chronic tendon pain and self-reported disability, despite being treated previously and receiving evidence-informed care. Upon examination, each patient demonstrated signs consistent with possible dysfunction of central pain mechanisms. Joint mobilization, pain neuroscience education, and aerobic exercise were primary interventions in each case to decrease pain and improve function. OUTCOMES The 3 patients were treated for 5 sessions over the course of 8 weeks. Clinically significant improvement was noted in measures of pain, self-reported function, and pressure pain thresholds. At discharge, all patients were able to run without symptoms, and improvement was maintained at 1-year follow-up. DISCUSSION Tendinopathy, while often described as local pain and dysfunction, may be associated with dysfunction of the nervous system. Identifying and treating pain mechanisms in addition to relevant impairments may be an appropriate intervention approach for individuals with tendinopathy. LEVEL OF EVIDENCE Therapy, level 4. J Orthop Sports Phys Ther 2019;49(4):272-279. Epub 13 Feb 2019. doi:10.2519/jospt.2019.8600.
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Torgbenu EL, Ashigbi EYK, Opoku MP, Banini S, Prempeh EBA. Rehabilitation and management outcomes of musculoskeletal injuries in a major referral hospital in Ghana. BMC Musculoskelet Disord 2019; 20:40. [PMID: 30678681 PMCID: PMC6346525 DOI: 10.1186/s12891-019-2423-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 01/18/2019] [Indexed: 01/07/2023] Open
Abstract
Background The devastating impact of musculoskeletal injury (MSI) on human lives, the economy, and health services cannot be overemphasised. This has ignited discussion at international fora, as countries have been exhorted to prioritise management of MSI in order to maintain a healthy society. In the Ghanaian context, the knowledge base management of MSI is very low, which has provided the impetus to explore the management of MSI and the rehabilitation systems at a tertiary hospital in Ghana. Methods The study was a retrospective cross-sectional study, using the consecutive sampling method to recruit patients who were discharged after admission at the accident and emergency unit, as well as patients undergoing orthopaedic review, at the St. Joseph’s Orthopaedic Hospital in Koforidua over a six-month period. Results A total of 269 musculoskeletal injury patients were recruited for the study. Half of the participants (51%) had had surgery in addition to pain medication. The overall mean recovery days were 26.81 ± 33.94 days, and the average disability days spent in the hospital were estimated at 16.54 ± 27.97 days. Individuals reported financial constraints as a major challenge to their full participation in rehabilitation. Conclusion The findings of this study have implications for policymaking in Ghana. Particularly, the need to improve health facilities to enable MSI patients to seek treatment is highlighted. Also, the need to train health professionals who will be able to administer appropriate medication for MSI patients is discussed extensively.
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Affiliation(s)
- Eric Lawer Torgbenu
- Department of Physiotherapy and Rehabilitation Sciences, University of Health and Allied Sciences, School of Allied Health Sciences, Ho, Ghana.
| | - Evans Yayra Kwaku Ashigbi
- Department of Physiotherapy and Rehabilitation Sciences, University of Health and Allied Sciences, School of Allied Health Sciences, Ho, Ghana
| | | | - Sandra Banini
- Department of Physiotherapy, Volta Regional Hospital, Ho, Ghana
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Cristi-Sánchez I, Danes-Daetz C, Neira A, Ferrada W, Yáñez Díaz R, Silvestre Aguirre R. Patellar and Achilles Tendon Stiffness in Elite Soccer Players Assessed Using Myotonometric Measurements. Sports Health 2019; 11:157-162. [PMID: 30601077 PMCID: PMC6391548 DOI: 10.1177/1941738118820517] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background: Tendon overuse injuries are an issue in elite footballers (soccer players) and may affect tendon function. Achilles and patellar tendinopathy are the most frequent pathologies. Tendon stiffness, the relationship between the force applied to a tendon and the displacement exerted, may help represent tendon function. Stiffness is affected by training and pathology. Nevertheless, information regarding this mechanical property is lacking for elite soccer athletes. Hypothesis: Achilles and patellar tendon stiffness assessed using myotonometric measurements will be greater in elite soccer athletes than in control participants. Study Design: Cross-sectional study. Level of Evidence: Level 4. Methods: Forty-nine elite soccer athletes and 49 control participants were evaluated during the 2017 preseason. A handheld device was used to measure Achilles and patellar tendon stiffness. Dominant and nondominant limbs were assessed for both groups. Results: A significantly stiffer patellar tendon was found for both the dominant and the nondominant limb in the elite soccer athletes compared with the control group. Nevertheless, no differences were found in Achilles tendon stiffness between groups. When comparing between playing positions in soccer athletes, no significant differences were found for both tendons. Conclusion: Greater patellar tendon stiffness may be related to an improvement in force transmission during muscle contraction. On the other hand, it seems that after years of professional training, Achilles tendon stiffness does not change, conserving the storing-releasing function of elastic energy. The nonsignificant differences between positions may be attributable to the years of homogeneous training that the players underwent. Clinical Relevance: The present study shows another technique for measuring mechanical properties of tendons in soccer athletes that could be used in clinical settings. In the future, this technique may help clinicians choose the best exercise protocol to address impairments in tendon stiffness.
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Affiliation(s)
- Iver Cristi-Sánchez
- Escuela de Kinesiología, Facultad de Ciencias, Universidad Mayor, Santiago, Chile
| | - Claudia Danes-Daetz
- Laboratorio Integrativo de Biomecánica y Fisiología del Esfuerzo, Escuela de Kinesiología, Facultad de Medicina, Universidad de los Andes, Santiago, Chile
| | - Alejandro Neira
- Escuela de Kinesiología, Facultad de Ciencias, Universidad Mayor, Santiago, Chile
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