Advertisement
Review| Volume 23, ISSUE 2, P118-124, February 2020

Non-surgical treatment of patellar tendinopathy: A systematic review of randomized controlled trials

Published:September 13, 2019DOI:https://doi.org/10.1016/j.jsams.2019.09.008

      Abstract

      Study design

      Systematic review of randomized controlled trials.

      Objectives

      To determine the most effective non-surgical treatment interventions for reducing pain and improving function for patients with patellar tendinopathy.

      Methods

      Studies considered for this systematic review were from peer-reviewed journals published between January 2012 and September 2017. All included studies used a visual analogue scale (VAS) to evaluate the participant’s pain. The majority of the included studies also used the Victorian Institute of Sport Assessment Patellar Tendinopathy (VISA-P questionnaire) to assess participant’s symptoms and function.

      Results

      Nine randomized controlled trials fit the inclusion criteria and were analyzed. The results of three studies supported the use of isometric exercise to reduce pain immediately. One study found patellar strapping and sports taping to be effective for reduction in pain during sport and immediately after. Eccentric exercise, Dry Needling (DN) (2 studies), injections with Platelet Rich Plasma (PRP), Autologous Blood Injection (ABI), and saline were found to have a more sustained effect on reducing pain and improving knee function.

      Conclusion

      Isometric exercise, patellar strapping, sports taping, eccentric exercise, injections with PRP, ABI, and saline and DN demonstrated a short-term pain relieving and functional improvement effect in subjects with patellar tendinopathy. Longer term follow up on interventions involving eccentric exercise, DN, and injections with PRP, ABI and saline showed sustained pain reduction and improvement in knee function.

      Level of evidence

      Level 1.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Science and Medicine in Sport
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • de Vries A.
        • Zwerver J.
        • Diercks R.
        • et al.
        Effect of patellar strap and sports tape on pain in patellar tendinopathy: a randomized controlled trial.
        Scand J Med Sci Sport. 2016; 26: 1217-1224
        • Dragoo J.L.
        • Wasterlain A.S.
        • Braun H.J.
        • et al.
        Platelet-rich plasma as a treatment for patellar tendinopathy: a double blind, randomized controlled trial.
        Am J Sport Med. 2014; 42: 610-618
        • Everhart J.S.
        • Cole D.
        • Sojka J.H.
        • et al.
        Treatment options for patellar tendinopathy: a systematic review.
        Arthroscopy. 2017; 33: 861-872
        • Hernandez-Sanchez S.
        • Hidalgo M.D.
        • Gomez A.
        Responsiveness of the VISA-P scale for patellar tendinopathy in athletes.
        Brit J Sports Med. 2014; 48: 453-457
        • Konsgaard M.
        • Kovanen V.
        • Aagaard P.
        • et al.
        Corticosteroid injections, eccentric decline squat training, and heavy slow resistance training in patellar tendinopathy.
        Scand J Med Sci Sport. 2009; 19: 790-802
        • Kvien T.K.
        • Heiberg T.
        • Hagen K.B.
        Minimal clinically important improvement/difference (MCII/MCID) and patient acceptable symptom state (PASS): what do these concepts mean?.
        Ann Rheum Dis. 2007; 66: 40-41
        • Leadbetter W.
        • Buckwater J.
        • Gordon S.
        Failed healing responses, sports-induced inflammation: clinical and basic science concepts.
        American Orthopedic Society for Sport Medicine, Park Ridge1989
        • Lian O.B.
        • Engebretsen L.
        • Bahr R.
        Prevalence of jumper’s knee among elite athletes from different sports: a cross-sectional study.
        Am J Sport Med. 2005; 33: 561-567
        • Malliaras P.
        • Cook J.
        • Purdam C.
        • et al.
        Patellar tendinopathy: clinical diagnosis, load management, and advice for challenging case presentations.
        J Orthop Sports Phys. 2015; 45: 887-898
        • Resteghini P.
        • Khanbhal T.A.
        • Mughal S.
        • et al.
        Double-blind randomized controlled trial: injection of autologous blood in the treatment of chronic patella tendinopathy — a pilot study.
        Clin J Sport Med. 2016; 26: 17-23
        • Rio E.
        • Kidgell D.
        • Purdam C.
        • et al.
        Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy.
        Brit J Sports Med. 2015; 49: 1277-1283
        • Rio E.
        • Moseley L.
        • Purdam C.
        • et al.
        The pain of tendinopathy: physiological or pathophysiological?.
        Sports Med. 2014; 44: 9-23
        • Rio E.
        • van Ark M.
        • Docking S.
        • et al.
        Isometric contractions are more analgesic than isotonic contractions for patellar tendon pain: an in-season randomized clinical trial.
        Clin J Sports Med. 2017; 27: 253-258
        • Scott A.
        • Backman L.J.
        • Speed C.
        Tendinopathy: update on pathophysiology.
        J Orthop Sports Phys. 2015; 45: 833-841
        • Thijs K.M.
        • Zwerver J.
        • Backx F.J.
        • et al.
        Effectiveness of shockwave treatment combined with eccentric training for patellar tendinopathy: a double-blinded randomized study.
        Clin J Sport Med. 2017; 27: 89-96
        • Van Ark M.
        • Cook J.L.
        • Docking S.I.
        • et al.
        Do isometric and isotonic exercise programs reduce pain in athletes with patellar tendinopathy in-season? A randomized clinical trial.
        J Sci Med Sport. 2016; 19: 702-706
        • Van der Worp H.
        • Zwerver M.
        • Hamstra M.
        • et al.
        No difference in effectiveness between focused and radial shockwave therapy for treating patellar tendinopathy: a randomized controlled trial.
        Knee Surg Sport Tr A. 2014; 22: 2026-2032
        • Vetrano M.
        • Castorina A.
        • Vulpiani M.C.
        • et al.
        Platelet-rich plasma versus focused shock waves in the treatment of jumper’s knee in athletes.
        Am J Sport Med. 2013; 41: 795-803
        • Visentini P.J.
        • Khan K.M.
        • Cook J.L.
        • et al.
        The VISA score: an index of severity of symptoms in patients with jumper’s knee (patellar tendinosis). Victorian Institute of Sport Tendon Study Group.
        J Sci Med Sport. 1998; 1: 22-28
        • Visnes H.
        • Hokstrud A.
        • Cook J.
        • et al.
        No effect of eccentric training on jumper’s knee in volleyball players during the competitive season: a randomized clinical trial.
        Clin J Sport Med. 2005; 15: 227-234