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Acaröz Candan S, Sözen H, Arı E. Electromyographic activity of quadriceps muscles during eccentric squat exercises: implications for exercise selection in patellar tendinopathy. Res Sports Med 2023; 31:517-527. [PMID: 34856831 DOI: 10.1080/15438627.2021.2010200] [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: 04/03/2021] [Accepted: 11/09/2021] [Indexed: 10/19/2022]
Abstract
This study investigated the quadriceps muscle activity during eccentric squat exercises (ESE) with different decline angles and arcs of motion regarding the proper exercise selection for patellar tendinopathy management. Electromyographic activity of the rectus femoris, vastus lateralis, and vastus medialis obliquus (VMO) muscles was measured during ESE on 0°, 5°, 10°, 15°, and 20° decline in 20 recreationally active participants. The eccentric phase was divided into 0-30°, 30-60°, 60-90°, 0-60°, 30-90°, and 0-90° of knee flexion simultaneously via motion-analysis system. The analyses showed that there was a significant decline angle × arc interaction effect on electromyographic activity of all muscles during knee flexion movement. The main effect was found for the arc of motion of knee flexion, and the main effect for the decline angle also was present for each muscle, except for VMO. This study demonstrated that most selective quadriceps eccentric activation occurred during ESE performed on 20° decline throughout 60-90° of knee flexion.
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Affiliation(s)
- Sevim Acaröz Candan
- Faculty of Health Sciences, Department of Physical Therapy and Rehabilitation, Ordu University, Ordu, Turkey
| | - Hasan Sözen
- School of Physical Education and Sport, Ordu University, Ordu, Turkey
| | - Erdal Arı
- School of Physical Education and Sport, Ordu University, Ordu, Turkey
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Burton I, McCormack A. Assessment of the reporting quality of resistance training interventions in randomised controlled trials for lower limb tendinopathy: A systematic review. Clin Rehabil 2022; 36:831-854. [PMID: 35311606 DOI: 10.1177/02692155221088767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES 1. To describe what exercises and intervention variables are used in resistance training interventions in randomised controlled trials for lower limb tendinopathy 2. To assess completeness of reporting as assessed by the Consensus on Exercise Reporting Template (CERT) and the Toigo and Boutellier framework. 3. To assess the implementation of scientific resistance training principles. 4. To assess therapeutic quality of exercise interventions with the i-CONTENT tool. DATA SOURCES We searched MEDLINE, CINAHL, AMED, EMBase, SPORTDiscus, and the Cochrane library databases. REVIEW METHODS Systematic review of randomised controlled trials that reported using resistance exercises for lower limb tendinopathies. RESULTS We included 109 RCTs. Eccentric heel drops were the most common exercise (43 studies), followed by isotonic heel raises (21), and single leg eccentric decline squats (18). Reporting of exercise descriptor items from the Toigo and Boutellier framework ranged from 0-13, with an average score of 9/13, and only 7 studies achieved a full 13/13. Reporting of items from the CERT ranged from 0-18, with an average score of 14/19. No study achieved a full 19/19, however 5 achieved 18/19. Scoring for resistance training principles ranged from 1-10, with only 11 studies achieving 10/10. Reporting across studies for the i-CONTENT tool ranged from 2-7, with an average score of 5 across included studies. A total of 19 studies achieved a full 7/7 score. Less than 50% of studies achieved an overall low risk of bias, highlighting the methodological concerns throughout studies. CONCLUSION The reporting of exercise descriptors and intervention content was generally high across RCTs for lower limb tendinopathy, with most allowing exercise replication. However, reporting for some tendinopathies and content items such as adherence was poor, limiting optimal translation to clinical practice.
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Affiliation(s)
- Ian Burton
- Specialist Musculoskeletal Physiotherapist, MSK Service, Fraserburgh Physiotherapy Department, Fraserburgh Hospital, 1015NHS Grampian, Aberdeen
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Burton I, McCormack A. Resistance Training Interventions for Lower Limb Tendinopathies: A Scoping Review of Resistance Training Reporting Content, Quality, and Scientific Implementation. TRANSLATIONAL SPORTS MEDICINE 2022; 2022:2561142. [PMID: 38655173 PMCID: PMC11023730 DOI: 10.1155/2022/2561142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 01/26/2022] [Accepted: 02/11/2022] [Indexed: 04/26/2024]
Abstract
The objectives of this scoping review were as follows: (1) to describe what exercises and intervention variables are used in resistance training interventions for lower limb tendinopathy, (2) to assess the completeness of reporting as assessed by the Consensus on Exercise Reporting Template (CERT) and the Toigo and Boutellier framework, and (3) to assess the implementation of scientific resistance training principles. We searched MEDLINE, CINAHL, AMED, Embase, SPORTDiscus, and Cochrane Library databases. Randomized controlled trials, cohort studies, case series, case reports, and observational studies that reported using resistance exercises for lower limb tendinopathies were considered for inclusion, with 194 studies meeting the inclusion criteria. Completeness of the reporting of exercise descriptors and programme variables was assessed by the CERT and the Toigo and Boutellier framework. Reporting of exercise descriptor items from the Toigo and Boutellier framework ranged from 0 to 13, with an average score of 9/13, with only 9 studies achieving a full 13/13. Reporting of items from the CERT ranged from 0 to 18, with an average score of 13/19. No study achieved a full 19/19; however, 8 achieved 18/19. Scoring for resistance training principles ranged from 1 to 10, with only 14 studies achieving 10/10. Eccentric heel-drops were the most common exercise (75 studies), followed by isotonic heel raises (38), and single-leg eccentric decline squats (27). The reporting of exercise descriptors and intervention content was high across studies, with most allowing exercise replication, particularly for Achilles and patellar tendinopathy. However, reporting for some tendinopathies and content items such as adherence was poor, limiting optimal translation to clinical practice.
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Affiliation(s)
- Ian Burton
- MSK Service, Fraserburgh Physiotherapy Department, Fraserburgh Hospital, NHS Grampian, Aberdeen, UK
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Burton I. Interventions for prevention and in-season management of patellar tendinopathy in athletes: A scoping review. Phys Ther Sport 2022; 55:80-89. [DOI: 10.1016/j.ptsp.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 10/18/2022]
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Sánchez-Gómez Á, Jurado-Castro JM, Mata F, Sánchez-Oliver AJ, Domínguez R. Effects of β-Hydroxy β-Methylbutyric Supplementation in Combination with Conservative Non-Invasive Treatments in Athletes with Patellar Tendinopathy: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:471. [PMID: 35010730 PMCID: PMC8744953 DOI: 10.3390/ijerph19010471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/27/2021] [Accepted: 12/29/2021] [Indexed: 02/04/2023]
Abstract
The aim of the present study was to analyze the effect of conservative non-invasive treatments based on eccentric training, stretching and extracorporeal shock wave therapy (ESWT) supplemented with β-Hydroxy β-methylbutyric (HMB) or placebo (PLAC) on body composition, pain and muscular function (jump ability, muscular power and muscular strength) in athletes with patellar tendinopathy (PT). In a double-blind randomized trial, 8 athletes (4 males and 4 females) performed a physical rehabilitation for 4 weeks. They were randomly divided into two experimental groups (two males and two females in each one) that ingested HMB (HMBG) or PLAC (PLACG). In pre- and post-intervention were assessed body composition, pain, countermovement jump (CMJ), back-squat (BS) for analyzing peak power (W) (PPPP), load (kg) associated to PPPP (PPKG) and mean velocity (m/s) (PPMV) in addition to a 5-RM leg extension tests. An interaction intervention·supplementation (p = 0.049; Ƞ2p = 0.774) was observed in the height reached in the CMJ as an intervention effect in PPPP detected for the HMBG (p = 0.049). In addition, an enhancement in PPKG (p = 0.028; Ƞ2p = 0.842) was detected in the intervention, but not in PPMV, as an increase in the intervention in the 5-RM test (p = 0.001; Ƞ2p = 0.981) was observed. No changes were noted on body composition or pain (p > 0.05). The combination of eccentric training with stretching and ESWT increased concentric muscular power and strength after 4 weeks without changes in body lean mass or pain. In addition, HMB supplementation could enhance the power muscular performance in athletes with PT, optimizing the intervention adaptions.
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Affiliation(s)
- Ángela Sánchez-Gómez
- Departamento de Enfermería Farmacología y Fisioterapia, Facultad de Medicina y Enfermería, Universidad de Córdoba, 14004 Córdoba, Spain;
| | - Jose Manuel Jurado-Castro
- Metabolism and Investigation Unit, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, 14004 Córdoba, Spain;
- Centro Adscrito a la Universidad de Sevilla, Escuela Universitaria de Osuna, 41640 Osuna, Spain
| | - Fernando Mata
- Centro de Estudios Avanzados en Nutrición, 14010 Córdoba, Spain;
| | - Antonio Jesús Sánchez-Oliver
- Departamento de Motricidad Humana y Rendimiento Deportivo, Universidad de Sevilla, 41013 Seville, Spain;
- Studies Research Group in Neuromuscular Responses (GEPREN), University of Lavras, Lavras 37200-000, Brazil
| | - Raúl Domínguez
- Departamento de Motricidad Humana y Rendimiento Deportivo, Universidad de Sevilla, 41013 Seville, Spain;
- Studies Research Group in Neuromuscular Responses (GEPREN), University of Lavras, Lavras 37200-000, Brazil
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Niering M, Muehlbauer T. Effects of Physical Training on Physical and Psychological Parameters in Individuals with Patella Tendon Myopathy: A Systematic Review and Meta-Analysis. Sports (Basel) 2021; 9:sports9010012. [PMID: 33477955 PMCID: PMC7835831 DOI: 10.3390/sports9010012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/11/2021] [Accepted: 01/14/2021] [Indexed: 12/12/2022] Open
Abstract
The effectiveness of physical training on physical and psychological parameters in individuals with patella tendinopathy has not been investigated in a systematic review and meta-analysis. The aim of the present study was to determine the effects of physical exercise interventions for measures of physical and psychological performance in subjects with patella tendinopathy. A computerised systematic literature search was conducted in the electronic databases PubMed, Medline, and Web of Science from January 1960 to July 2020. Initially, 506 articles were identified for review of which eleven articles met the inclusion criteria. Our results revealed a small effect (weighted mean standardized mean difference (SMD) = 0.12; nine studies) of physical training on the psychological measure Victorian Institute of Sport Assessment–Patellar tendon scale and a medium effect (weighted mean SMD = 0.61; five studies) on the psychological measure visual analogue scale—both in favour of the intervention group. In contrast, a small effect (weighted mean SMD = −0.05; two studies) in favour of the control group was detected for the physical measure muscle power. Compared to the control condition, physical training seems to be an effective means to improve psychological but not physical parameters in individuals with patella tendinopathy; although conclusions on the latter could have been biased by the small amount of eligible studies (n = 2). In addition, the predetermined cut-off value of ≥6 for the Physiotherapy Evidence Database scale score (i.e., assessment of methodological quality) was only achieved by six out of eleven studies. Thus, further research of high methodological quality is needed to verify whether there is or is not an effect of physical training on physical parameters in persons with patella tendinopathy.
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Affiliation(s)
- Marc Niering
- Department of Health and Social Affairs, FHM Hannover—University of Applied Sciences, 30163 Hannover, Germany
- Correspondence: ; Tel.: +49-(0)511-533-5880
| | - Thomas Muehlbauer
- Division of Movement and Training Sciences/Biomechanics of Sport, University of Duisburg-Essen, 45141 Essen, Germany;
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Morath O, Beck M, Taeymans J, Hirschmüller A. Sclerotherapy and prolotherapy for chronic patellar tendinopathies - a promising therapy with limited available evidence, a systematic review. J Exp Orthop 2020; 7:89. [PMID: 33165667 PMCID: PMC7652964 DOI: 10.1186/s40634-020-00303-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/23/2020] [Indexed: 12/13/2022] Open
Abstract
Chronic Patellar tendinopathy (CPT) is a frequent overuse disorder in athletes and active people. Sclerotherapy (ST) and prolotherapy (PT) are, among a wide range of conservative treatment options, two promising therapies and have shown positive results in other tendinopathies. Since the treatments' efficacy and safety are still not defined, this review sought to answer questions on recommendations for use in clinical utility, safety, and how to perform the injection in the most effective way. An electronic database search was conducted following the PRISMA guidelines. Inclusion criteria were set up according to the PICOS-scheme. Included were athletes and non-athletes of all ages with diagnosed painful CPT. Studies including patients suffering from patellar tendinopathy which can be originated to any systemic condition affecting the musculoskeletal system (e.g. disorders associated with rheumatism) and animal studies were excluded. Methodological quality (modified Coleman Methodology Score) and risk of bias (Cochrane Risk of Bias Assessment Tool 2.0) were assessed by two independent reviewers, with disagreements resolved with a third reviewer. The search yielded a total of 416 entries. After screening titles, abstracts, and full texts, ten articles were found for qualitative analysis. The mean Coleman Score was 64.57. Three randomized-controlled trials showed positive results with an increase in VISA-P score or a decrease in VAS or NPPS, respectively. The non-randomized studies confirmed the positive results as well. Among all ten studies no serious adverse events were reported. Based on this limited set of studies, there seems to be some evidence that ST and PT may be effective treatment options to treat pain and to improve function in patients with CPT. To strengthen this recommendation, more research is needed with larger volume studies and randomized controlled studies with long term follow up. LEVEL OF EVIDENCE: IV.
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Affiliation(s)
- Oliver Morath
- Institute of Exercise and Occupational Medicine, Department of Medicine, Faculty of Medicince, Medical Center-University of Freiburg, Hugstetter Str. 55, D-79106, Freiburg im Breisgau, Germany.
| | - Manuel Beck
- Clinic for Orthopaedics and Traumatology, Department of Surgery, Faculty of Medicine, Medical Center-University of Freiburg, Hugstetter Str. 55, D-79106, Freiburg im Breisgau, Germany
| | - Jan Taeymans
- Bern University of Applied Sciences - Health, Murtenstrasse 10, CH-3008, Berne, Switzerland
| | - Anja Hirschmüller
- Clinic for Orthopaedics and Traumatology, Department of Surgery, Faculty of Medicine, Medical Center-University of Freiburg, Hugstetter Str. 55, D-79106, Freiburg im Breisgau, Germany
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Nielsen TG, Miller LL, Mygind-Klavsen B, Lind M. High-volume image-guided injection in the chronic recalcitrant non-insertional patellar tendinopathy: a retrospective case series. J Exp Orthop 2020; 7:80. [PMID: 33037952 PMCID: PMC7547937 DOI: 10.1186/s40634-020-00299-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/05/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose To evaluate if High-volume Image-guided Injection (HVIGI)-treatment for chronic Patellar tendinopathy (PT) improve function and reduce pain at 16-months follow-up. Methods Patients with resistant PT who failed to improve after a three-month eccentric loading program were included in the study. Maximal tendon thickness was assessed with ultrasound. All patients were injected with 10 mL of 0.5% Marcaine, 0.5 mL Triamcinolonacetonid (40 mg/mL) and 40 mL of 0.9% NaCl saline solution under real-time ultrasound-guidance and high pressure. All outcome measures were recorded at baseline and at 16 months. A standardised Heavy Slow Resistance rehabilitation protocol was prescribed after HVIGI-treatment. Clinical outcome was assessed with the Victorian Institute of Sports Assessment-Patella tendon questionnaire (VISA-P) and statistically analyses were performed. Results The study included 28 single treatment HVIGI procedures in PT in 23 patients (19 men, 4 women) with a mean age of 30.3 (range 19–52). The mean duration of symptoms before HVIGI was 33 months. The baseline VISA-P score of 43 ± 17 (range 15–76) improved to 76 ± 16 (range 42–95) after 16 months (p < 0.01). Of the 28 HVIGI procedures 12 patients (15 PT) were not satisfied after the initial HVIGI procedure. Of these, 5 patients (5 PT) had additional HVIGI, 2 patients (2 PT) had corticoid injection and 6 patients (8 PT) needed surgery. Of the remaining 11 patients (13 PT), 9 patients had more than a 13-point improvement in the VISA-P score after 16 months. Conclusions In this retrospective case-study, only 9 patients (32%) did benefit of a single HVIGI treatment at 16-months and a 33-point significant improvement was seen on the VISA-P score.
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Affiliation(s)
- Torsten Grønbech Nielsen
- Aarhus University Hospital, Orthopedic Department, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| | - Lene Lindberg Miller
- Aarhus University Hospital, Orthopedic Department, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Bjarne Mygind-Klavsen
- Aarhus University Hospital, Orthopedic Department, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Martin Lind
- Aarhus University Hospital, Orthopedic Department, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
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Kabacinski J, Murawa M, Fryzowicz A, Gorwa J, Dworak LB. Lower Extremities Strength Differences in Female Volleyball Players With Stage 1 Patellar Tendinopathy. J Strength Cond Res 2020; 36:2230-2235. [PMID: 32947571 DOI: 10.1519/jsc.0000000000003812] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Kabacinski, J, Murawa, M, Fryzowicz, A, Gorwa, J, and Dworak, LB. Lower extremities strength differences in female volleyball players with stage 1 patellar tendinopathy. J Strength Cond Res XX(X): 000-000, 2020-The main purpose of the study was to compare the muscle strength between the involved knee (IK) and uninvolved knee (UK) in 12 female volleyball players with stage 1 chronic patellar tendinopathy. Evaluation included the isometric maximal strength to body mass (MS/BM) of the lower extremities extensors for unilateral and bilateral conditions, concentric isokinetic peak torque to body mass (PT/BM) of the hamstrings and quadriceps at 60°·s and 180°·s, IK to UK extensors maximal strength ratio (SR), IK to UK hamstrings (or quadriceps) peak torque ratio (TR), and hamstrings to quadriceps peak TR (H/Q). The results indicated a significantly lower unilateral and bilateral MS/BM of lower extremities extensors for IK than UK (p < 0.001). However, there were no significant differences in SR variable between the unilateral condition and bilateral condition (p = 0.448). Only at the 60°·s velocity, significantly lower quadriceps PT/BM for IK compared with the UK (p < 0.001) and the control group (p < 0.001) were observed. Torque ratio related to the quadriceps group was significantly lower at 60°·s than 180°·s (p = 0.004). Furthermore, significantly higher H/Q for IK compared with UK (p < 0.001) and control group (p = 0.008) only at 60°·s was found. These findings show a significant isometric strength asymmetry for both unilateral and bilateral conditions and a significant concentric strength asymmetry at the low velocity. This study suggests strengthening the weaker quadriceps group and balancing the strength between hamstrings and quadriceps within the knee with patellar tendinopathy.
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Affiliation(s)
- Jaroslaw Kabacinski
- Department of Biomechanics, Poznan University of Physical Education, Poznan, Poland
| | - Michal Murawa
- Department of Biomechanics, Poznan University of Physical Education, Poznan, Poland
| | - Anna Fryzowicz
- Department of Biomechanics, Poznan University of Physical Education, Poznan, Poland
| | - Joanna Gorwa
- Department of Biomechanics, Poznan University of Physical Education, Poznan, Poland
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Association Between Clinical and Imaging Outcomes After Therapeutic Loading Exercise in Patients Diagnosed With Achilles or Patellar Tendinopathy at Short- and Long-Term Follow-up: A Systematic Review. Clin J Sport Med 2020; 30:390-403. [PMID: 29952842 DOI: 10.1097/jsm.0000000000000624] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the association between clinical and imaging outcomes after therapeutic loading exercise in Achilles tendinopathy (AT) and patellar tendinopathy (PT) populations at both short- and long-term follow-up. DATA SOURCES The PUBMED and EMBASE databases were searched (up to June 2017) to identify articles that meet the inclusion criteria: (1) patients diagnosed with AT (insertional or midportion) or PT; (2) rehabilitation based on therapeutic loading exercise; and (3) assessment of clinical outcomes and tendon structure using an imaging modality. MAIN RESULTS Two independent reviewers screened 2894 search results, identifying 21 suitable studies. According to the studies included in this review, clinical results showed significant improvements for patients with AT and PT after eccentric exercise (ECC) and heavy slow resistance (HSR) at short- and long-term follow-up. Imaging outcomes were not consistent. Moderate-to-strong evidence for patients with AT suggested an association between clinical outcomes and imaging outcomes (tendon thickness and tendon neovascularization) after ECC at long-term follow-up. For patients with PT, there was moderate evidence supporting an association between clinical outcomes (questionnaire score and pain) and imaging (tendon thickness and tendon neovascularization) after ECC at short-term follow-up. For both the AT and PT groups, there was moderate evidence for an association between clinical outcomes and tendon thickness and neovascularization after HSR exercise. Results related to the HSR exercise should be interpreted with caution because of the small number of studies. CONCLUSIONS Based on the findings of the present review, the use of imaging outcomes as a complementary examination to the clinical assessment was confirmed. Overall, an improvement in clinical outcomes seems to be associated with a reduction in tendon thickness and tendon neovascularization. Clinicians should be aware that during the interpretation of the imaging outcomes, factors such as tendinopathy location, exercise modality performed, and a follow-up period should be considered.
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Davi SM, Lepley AS, Denegar CR, DiStefano LJ, Edgar CM, Lepley LK. Quadriceps Inhibition After Naturally Occurring Patellar Tendon Damage and Pain. J Athl Train 2020; 55:608-614. [PMID: 32348153 DOI: 10.4085/1062-6050-27-19] [Citation(s) in RCA: 9] [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
CONTEXT After knee-joint injury, pain, effusion, and mechanoreceptor damage alter afferent signaling, which can result in quadriceps inhibition and subsequent weakness. The individual contributions of each factor to inhibition remain unclear due to confounding knee-joint injuries and indirect experimental models. OBJECTIVE To characterize the influence of naturally occurring knee damage and pain on quadriceps neuromuscular function in individuals with patellar tendinopathy. DESIGN Cross-sectional study. SETTING Research laboratory. PATIENTS OR OTHER PARTICIPANTS Twenty participants who self-reported patellar tendinopathy (PT) and 10 healthy control individuals underwent ultrasonic tendon assessment. Injured participants were dichotomized by an orthopaedic surgeon into groups with (1) pain and structural tendon abnormality and (2) regional pain alone. MAIN OUTCOME MEASURE(S) Quadriceps inhibition was assessed with the Hoffman reflex and the central activation ratio via the superimposed-burst technique. Normally distributed measures were analyzed using a 1-way analysis of variance and post hoc independent t tests. Kruskal-Wallis tests with post hoc Mann-Whitney U tests were used to analyze nonnormally distributed data. An a priori α level of P ≤ .05 was set. RESULTS Control participants presented with more spinal-reflex excitability (0.37 ± 0.23) than the PT (0.10 ± 0.06; P = .03) and regional-pain (0.18 ± 0.05; P = .02) groups. Knee-extension strength was greater in the control (3.37 ± 0.59 Nm/kg) than in the PT (2.41 ± 0.67 Nm/kg; P = .01) group but not the regional-pain group (3.05 ± 0.66 Nm/kg; P = .24). Control individuals presented with more quadriceps activation (97.93% ± 3.12) than the PT (84.44% ± 16.98; P < .01) and regional-pain (91.17% ± 10.56; P = .01) groups. No differences were present for any measures between the PT and regional-pain groups (P values > .05). CONCLUSIONS Deficits in spinal-reflex excitability, quadriceps activation, and strength were present in both the PT and regional-pain groups. A combination of pain and structural damage appeared to have the greatest negative effect on quadriceps function, as only the PT group presented with neuromuscular outcomes that failed to meet clinical thresholds.
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Affiliation(s)
- Steven M Davi
- Department of Kinesiology, University of Connecticut, Storrs
| | - Adam S Lepley
- School of Kinesiology, University of Michigan, Ann Arbor
| | - Craig R Denegar
- Department of Kinesiology, University of Connecticut, Storrs
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Basas Á, Cook J, Gómez MA, Rafael MA, Ramirez C, Medeiros B, Lorenzo A. Effects of a strength protocol combined with electrical stimulation on patellar tendinopathy: 42 months retrospective follow-up on 6 high-level jumping athletes. Phys Ther Sport 2018; 34:105-112. [PMID: 30265995 DOI: 10.1016/j.ptsp.2018.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 09/11/2018] [Accepted: 09/11/2018] [Indexed: 12/31/2022]
Abstract
STUDY DESIGN A retrospective study. INTRODUCTION Patellar tendinopathy (PT) or jumper's knee (JK) in elite athletes is a challenging condition for sports medicine professionals. This study analyzes the development of a protocol using eccentric, isometric, concentric exercises, and electrostimulation to treat elite athletes suffering from JK. The semiannual strength protocol was completed during a total of 36 months by six high-level jumping athletes with chronic painful JK. Pain during patellar tendon loading activity was evaluated on a visual analogue pain scale (VAS). Upon protocol completion, promising clinical results were evidenced by significant pain reduction during tendon loading activity. MATERIAL AND METHODS Six high level jumping athletes with chronic painful JK completed a semiannual strength program using eccentric, isometric, concentric and electrical stimulation exercises. The protocol was done 12 weeks in the winter pre-season and 10 weeks in the summer pre-season, for altogether 36 months, with an interruption of the protocol at 24 months for 6 months. Pain during patellar tendon loading activity was evaluated on a visual analogue pain scale (VAS), before the first session and then every 6 months, coinciding with the competitive phase, the time of maximum pain. RESULTS There was a significant (p < 0.01) decrease in the VAS from start to the 18, 24 and 48 months follow-ups. CONCLUSIONS In a small group of high level jumping athletes with chronic painful JK, a strength protocol combined with electrical stimulation showed promising clinical results with significant pain reduction during tendon loading activity.
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Affiliation(s)
- Ángel Basas
- Royal Spanish Athletics Federation's Medical Department, Madrid, Spain.
| | - Jill Cook
- La Trobe Sport and Exercise Research Centre, La Trobe University, Melbourne, Australia.
| | - Miguel A Gómez
- Faculty of Physical Activity and Sport Science, Polytechnic University of Madrid, Spain
| | - Manuel A Rafael
- Royal Spanish Athletics Federation's Medical Department, Madrid, Spain
| | | | | | - Alberto Lorenzo
- Faculty of Physical Activity and Sport Science, Polytechnic University of Madrid, Spain
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Cairns G, Owen T, Kluzek S, Thurley N, Holden S, Rathleff MS, Dean BJF. Therapeutic interventions in children and adolescents with patellar tendon related pain: a systematic review. BMJ Open Sport Exerc Med 2018; 4:e000383. [PMID: 30167318 PMCID: PMC6109948 DOI: 10.1136/bmjsem-2018-000383] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2018] [Indexed: 12/19/2022] Open
Abstract
Objective Evaluate effectiveness and harms of interventions for patellar tendon related pain in children and adolescents. Design Systematic review and meta-analysis. Data sources Medline via Pubmed, Embase via OVID, CINAHL via Ebsco, SportDiscus up until 24 November 2017 were searched. Eligibility criteria for selecting studies Inclusion criteria were (1) controlled or randomised controlled clinical trials (RCTs), (2) participants with diagnosis of patellar tendon related disorder, (3) participants≤18 years of age at enrolment and (4) published in a peer-reviewed English or Scandinavian language journal. Results Of 530 studies identified, eight were included after screening, with three included in data synthesis. To be included in data synthesis, we required studies to have included (and have data available for) a minimum of 10 participants under 18 years. All studies were rated as being at high risk of bias. For adolescents with patellar tendinopathy, one RCT compared eccentric exercises to usual care and found no difference between groups. In adolescents with Osgood-Schlatter disease (OSD), injection of local anaesthetic with dextrose proved superior to either usual care or local anaesthetic alone (three armed RCTs). In a retrospective case controlled study in adolescents with OSD, surgery provided no benefit over conservative management in terms of persistent symptoms and had a higher complication rate. Conclusion There is weak evidence to support the use of dextrose injection with local anaesthetic and no evidence to support the use of specific types of exercises to treat children/adolescents with OSD/patellar tendinopathy. Until further evidence arises, clinicians should include load modification and advise on a return to sport based on symptoms.
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Affiliation(s)
- George Cairns
- Bristol Medical School, University of Bristol Medical School, Bristol, UK
| | - Timothy Owen
- Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Stefan Kluzek
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Botnar Research Centre, University of Oxford, Oxford, UK.,Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Neal Thurley
- Bristol Medical School, University of Bristol Medical School, Bristol, UK.,Bodleian Health Care Libraries, Cairns Library, John Radcliffe Hospital, Oxford, UK
| | - Sinead Holden
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Michael Skovdal Rathleff
- Research Unit for General Practice in Aalborg, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Benjamin John Floyd Dean
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Botnar Research Centre, University of Oxford, Oxford, UK.,Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Lim HY, Wong SH. Effects of isometric, eccentric, or heavy slow resistance exercises on pain and function in individuals with patellar tendinopathy: A systematic review. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2018; 23:e1721. [PMID: 29972281 DOI: 10.1002/pri.1721] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 01/15/2018] [Accepted: 05/06/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this study is to evaluate current evidence and provide a review on the effects of isometric, eccentric, or heavy slow resistance (HSR) exercises on pain and function in individuals with patellar tendinopathy (PT). METHODS Academic journals from CINAHL, Embase, MEDLINE, Scopus, SPORTDiscus™, and The Cochrane Library were searched from inception to August 2017. Screening of reference lists was also performed. Human interventional studies investigating outcomes of pain and function in PT using either isometric, eccentric, or HSR training exercises were included. The McMaster Critical Review Form-Quantitative Studies was used to assess for risk of bias. Levels of evidence were obtained using the National Health and Medical Research Council (NHMRC) evidence hierarchy. The NHMRC Body of Evidence Framework was utilized to formulate recommendations for clinical practice. Extraction of data was performed by two independent reviewers according to predefined data criterion, data were then tabulated, and a descriptive, qualitative data synthesis was performed. RESULTS Fifteen studies (3 isometric, 2 HSR, and 10 eccentric) were included for this review. Mean quality score across all studies was 81.6% (range 70% to 93%). Nine studies were of high quality, whereas six studies were of moderate quality. Nine studies were randomized controlled trials, which provided good Level II evidence; four studies were of satisfactory Level III evidence; and two studies were case series (Level IV evidence). CONCLUSIONS Findings from isometric exercises can be trusted to guide clinical practice (Grade A), whereas eccentric exercises can be trusted to guide clinical practice in most clinical situations (Grade B). It is recommended that HSR exercises should be applied carefully to individual clinical circumstances (Grade C) and interpreted with care. Isometric exercises appear to be more effective during competitive seasons for short-term pain relief, whereas HSR or eccentric exercises are more suitable for long-term pain reduction and improvement in knee function.
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Affiliation(s)
- Hui Yin Lim
- School of Physiotherapy, Division of Health Sciences, University of South Australia, Adelaide, South Australia, Australia.,Department Physiotherapy, Rehabilitative Services, Changi General Hospital, Singapore
| | - Shi Hui Wong
- School of Physiotherapy, Division of Health Sciences, University of South Australia, Adelaide, South Australia, Australia.,Department Physiotherapy, Rehabilitative Services, Changi General Hospital, Singapore
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15
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The Influence of Exercise Dosing on Outcomes in Patients With Knee Disorders: A Systematic Review. J Orthop Sports Phys Ther 2018; 48:146-161. [PMID: 29320945 DOI: 10.2519/jospt.2018.7637] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Systematic review. Background Therapeutic exercise is commonly used to treat individuals with knee disorders, but dosing parameters for optimal outcomes are unclear. Large variations exist in exercise prescription, and research related to specific dosing variables for knee osteoarthritis, patellar tendinopathy, and patellofemoral pain is sparse. Objectives To identify specific doses of exercise related to improved outcomes of pain and function in individuals with common knee disorders, categorized by effect size. Methods Five electronic databases were searched for studies related to exercise and the 3 diagnoses. Means and standard deviations were used to calculate effect sizes for the exercise groups. The overall quality of evidence was assessed using the Physiotherapy Evidence Database scale. Results Five hundred eighty-three studies were found after the initial search, and 45 were included for analysis after screening. Physiotherapy Evidence Database scale scores were "fair" quality and ranged from 3 to 8. For knee osteoarthritis, 24 total therapeutic exercise sessions and 8- and 12-week durations of exercise were parameters most often associated with large effects. An exercise frequency of once per week was associated with no effect. No trends were seen with exercise dosing for patellar tendinopathy and patellofemoral pain. Conclusion This review suggests that there are clinically relevant exercise dosing variables that result in improved pain and function for patients with knee osteoarthritis, but optimal dosing is still unclear for patellar tendinopathy and patellofemoral pain. Prospective studies investigating dosing parameters are needed to confirm the results from this systematic review. Level of Evidence Therapy, level 1a. J Orthop Sports Phys Ther 2018;48(3):146-161. Epub 10 Jan 2018. doi:10.2519/jospt.2018.7637.
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16
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COMPARISON OF FUNCTIONAL ACTIVITIES ON STRUCTURAL CHANGES OF THE INFERIOR PATELLAR POLE. Int J Sports Phys Ther 2017; 12:1095-1102. [PMID: 29234561 DOI: 10.26603/ijspt20171095] [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: 11/18/2022] Open
Abstract
Background It is well known that eccentric and concentric exercise produce varied amounts of stress on the connective tissues. Diagnostic ultrasound has been used to measure these structural changes by observing fascicle length, angle, and thickness; however, there is a lack of evidence comparing the structural changes as it relates to eccentric, concentric, and stretching protocols. Purpose The purpose of this study was to compare the acute effects of static stretching, eccentric, concentric, and a combination of eccentric/concentric exercises on structural changes of the muscle tendon unit at the inferior patellar pole utilizing the diagnostic ultrasound. Study Design A repeated measures 2 × 4 within factorial study design with repeated measures on both factors was used to determine the differences in patellar tendon thickness within and between groups. Methods Forty-seven healthy subjects were screened for any lower extremity deficits or orthopaedic pathology. Forty-four (N=44) subjects completed all four protocols; the attrition was due to injuries to the lower extremity, occurring unrelated to the study. A baseline measurement of the anterior inferior patellar tendon was performed with the diagnostic ultrasound prior to each participant completing one of the four interventions per week over a four-week period. Interventions completed by each participant included static stretching, concentric, eccentric, and combined concentric and eccentric exercises. Immediately following each intervention, a post-intervention inferior patellar tendon measurement was recorded using the diagnostic ultrasound. Results Significant differences in anterior to posterior tendon thickness of the inferior patellar tendon were observed between pre (4.983 ± 0.041mm) and post (5.198 ± 0.055mm) measurements (p<0.0005) for the main effect of time. However, no differences in tendon thickness were noted comparing each intervention to one another (p=0.351). Conclusion Differences in tendon thickness were noted acutely for pre- to post measurements across all interventions. Further research is needed to determine if differences in tendon thickness exist with a longer duration of exercise over time and with different types of intervention.
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Abat F, Alfredson H, Cucchiarini M, Madry H, Marmotti A, Mouton C, Oliveira JM, Pereira H, Peretti GM, Romero-Rodriguez D, Spang C, Stephen J, van Bergen CJA, de Girolamo L. Current trends in tendinopathy: consensus of the ESSKA basic science committee. Part I: biology, biomechanics, anatomy and an exercise-based approach. J Exp Orthop 2017; 4:18. [PMID: 28560707 PMCID: PMC5449348 DOI: 10.1186/s40634-017-0092-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 05/12/2017] [Indexed: 12/05/2022] Open
Abstract
Chronic tendinopathies represent a major problem in the clinical practice of sports orthopaedic surgeons, sports doctors and other health professionals involved in the treatment of athletes and patients that perform repetitive actions. The lack of consensus relative to the diagnostic tools and treatment modalities represents a management dilemma for these professionals. With this review, the purpose of the ESSKA Basic Science Committee is to establish guidelines for understanding, diagnosing and treating this complex pathology.
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Affiliation(s)
- F Abat
- Department of Orthopaedic Sports Medicine, ReSport Clinic, Passeig Fabra i Puig 47, 08030, Barcelona, Spain.
| | - H Alfredson
- Sports Medicine Unit, University of Umeå, Umeå, Sweden.,Alfredson Tendon Clinic Inc, Umeå, Sweden.,Pure Sports Medicine Clinic, ISEH, UCLH, London, UK
| | - M Cucchiarini
- Molecular Biology, Center of Experimental Orthopaedics, Saarland University Medical Center, Kirrbergerstr Bldg 37, 66421, Homburg/Saar, Germany
| | - H Madry
- Lehrstuhl für Experimentelle Orthopädie und Arthroseforschung, Universität des Saarlandes, Gebäude 37, Kirrbergerstr 1, 66421, Homburg, Germany
| | - A Marmotti
- Department of Orthopaedics and Traumatology, San Luigi Gonzaga Hospital, Orbassano, University of Turin, Turin, Italy
| | - C Mouton
- Department of Orthopedic Surgery, Clinique d'Eich-Centre Hospitalier de Luxembourg, 76, rue d'Eich, L-1460, Luxembourg, Luxembourg
| | - J M Oliveira
- 3B's Research Group - Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Zona Industrial da Gandra, 4805-017, Barco, GMR, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga, Guimarães, Portugal
| | - H Pereira
- 3B's Research Group University of Minho, ICVS/3B's-PT Government Associate Laboratory, Braga, Guimarães, Portugal.,Orthopedic Department Centro Hospitalar Póvoa de Varzim, Vila do Conde, Portugal.,Ripoll y De Prado Sports Clinic - FIFA Medical Centre of Excellence, Murcia, Madrid, Spain
| | - G M Peretti
- IRCCS Istituto Ortopedico Galeazzi, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - D Romero-Rodriguez
- Department of Physical Therapy and Sports Rehabilitation, ReSport Clinic Barcelona, Barcelona, Spain.,EUSES Sports Science, University of Girona, Girona, Spain
| | - C Spang
- Department of Integrative Medical Biology, Anatomy Section, Umeå University, Umeå, Sweden
| | - J Stephen
- Fortius Clinic, 17 Fitzhardinge St, London, W1H 6EQ, UK.,The Biomechanics Group, Department of Mechanical Engineering, Imperial College, London, UK
| | - C J A van Bergen
- Department of Orthopedic Surgery, Amphia Hospital Breda, Breda, The Netherlands
| | - L de Girolamo
- Orthopaedic Biotechnology Laboratory, Galeazzi Orthopaedic Institute, Milan, Italy
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18
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Gual G, Fort-Vanmeerhaeghe A, Romero-Rodríguez D, Tesch PA. Effects of In-Season Inertial Resistance Training With Eccentric Overload in a Sports Population at Risk for Patellar Tendinopathy. J Strength Cond Res 2016; 30:1834-42. [DOI: 10.1519/jsc.0000000000001286] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Cenni MHF, Silva TDM, do Nascimento BF, de Andrade RC, Júnior LFBP, Nicolai OP. Patellar tendinopathy: late-stage results from surgical treatment. Rev Bras Ortop 2015; 50:550-5. [PMID: 26535202 PMCID: PMC4610993 DOI: 10.1016/j.rboe.2015.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 09/02/2014] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate the late-stage results from surgical treatment of patellar tendinopathy (PT), using the Visa score (Victorian Institute of Sport Tendon Study Group) and the Verheyden method. Methods This was a retrospective study in which the postoperative results from 12 patients (14 knees) who were operated between July 2002 and February 2011 were evaluated. The patients included in the study presented patellar tendinopathy that was refractory to conservative treatment, without any other concomitant lesions. Patients who were not properly followed up during the postoperative period were excluded. Results Using the Verheyden method, nine patients were considered to have very good results, two had good results and one had poor results. In relation to Visa, the mean was 92.4 points and only two patients had scores less than 70 points (66 and 55 points). Conclusion When surgical treatment for patellar tendinopathy is correctly indicated, it has good long-term results.
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20
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Cenni MHF, Silva TDM, Nascimento BFD, Andrade RCD, Júnior LFBP, Nicolai OP. Tendinopatia patelar: resultados tardios do tratamento cirúrgico. Rev Bras Ortop 2015. [DOI: 10.1016/j.rbo.2014.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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