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The Tendinopathy game changers: five papers from the last five years that just might change how you manage tendons

Review written by Dr. Adam Loiacono info

Key Points

  1. Platelet-rich plasma, regardless of leukocyte concentration, appears ineffective for treating patellar tendinopathy.
  2. High-volume injections do not offer added benefits and are ineffective in treating mid-portion Achilles tendinopathy compared to usual care.
  3. Patients with gluteal tendinopathy who received education and exercise were associated with better patient-specific function, increased pain self-efficacy, and reduced pain constancy.

BACKGROUND & OBJECTIVE

This editorial, published in a dedicated issue of JOSPT, focuses on ground-breaking research papers from 2019 to 2023 following the Fifth International Scientific Tendinopathy Symposium in 2019. This editorial aimed to update the clinical and scientific community on the latest findings and methodologies in tendinopathy management.

The article's objective was to highlight these methodologically robust studies, which address clinically relevant questions about exercise, education, and injection therapies. The authors encourage the community to engage in discussions about these findings and to anticipate further research that could continue to shape tendinopathy treatment in the future.

This editorial aimed to update the clinical and scientific community on the latest findings and methodologies in tendinopathy management.
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For treating patellar tendinopathy, progressive tendon-loading exercise is more effective than eccentric exercise therapy.

METHODS

The authors meticulously selected a key paperfrom each year (from 2019 to 2023), which they believed could revolutionize tendon treatment approaches. These papers cover a range of topics including the effectiveness of platelet-rich plasma (PRP) for patellar tendinopathy (PT), high-volume injections for Achilles tendinopathy (AT), progressive tendon-loading exercise therapy, the role of education and exercise in treating gluteal tendinopathy (GT), and the relationship between tendon load and movement-evoked pain in AT.

CLINICAL IMPLICATIONS

  • (2019) Platelet-Rich Plasma for Patellar Tendinopathy: A Randomized Controlled Trial of Leukocyte-Rich PRP or Leukocyte-Poor PRP Versus Saline in the American Journal of Sports Medicine by Prof. Alex Scott (1)

This study on patellar tendinopathy found no significant difference in tendon-related disability, pain, or perceived improvement among patients treated with leukocyte-rich PRP, leukocyte-poor PRP, or a placebo saline injection. The results were consistent at both 12 weeks and 12 months post-injection. The clinical implication is that PRP, regardless of leukocyte concentration, appears ineffective for treating patellar tendinopathy.

  • (2020) Effectiveness of a high-volume injection as treatment for chronic Achilles tendinopathy: randomised controlled trial in the British Medical Journal by Dr. Arco van der Vlist (2)

The clinical study on ATshowed no significant differences in tendon-related disability, satisfaction, or return to sport between patients receiving high-volume saline injections without corticosteroids and those receiving placebo injections. This outcome was consistent across various timepoints. The key clinical implication is that high-volume injections do not offer added benefits and are ineffective in treating mid-portion AT compared to usual care, such as exercise programs.

  • (2021) Effectiveness of progressive tendon-loading exercise therapy in patients with patellar tendinopathy: a randomised clinical trial in the British Journal of Sports Medicine by Dr Stephan Breda (3)

In a study of patellar tendinopathy treatment, progressive tendon-loading exercise demonstrated superiority over eccentric exercise in improving pain and tendon-related disability. Additionally, there was a trend towards a higher rate of return to sports among those undergoing progressive tendon-loading exercise. The clinical implication is clear: for treating patellar tendinopathy, progressive tendon-loading exercise is more effective than eccentric exercise therapy, suggesting it should be the preferred treatment approach.

  • (2022) Mediators and Moderators of Education Plus Exercise on Perceived Improvement in Individuals With Gluteal Tendinopathy: An Exploratory Analysis of a 3-Arm Randomized Trial in the Journal of Orthopaedic and Sports Physical Therapy by Dr Rebecca Mellor (4)

This clinical study on gluteal tendinopathy found that improvements in those receiving education and exercise were associated with better patient-specific function, increased pain self-efficacy, and reduced pain constancy. The critical clinical implication is the importance of considering these individual factors—patient-specific function, pain self-efficacy, and pain constancy—when managing gluteal tendinopathy. These factors significantly influence the outcomes related to tendon-related disability and pain, thus playing a key role in effective treatment strategies.

  • (2023) Patterns of movement-evoked pain during tendon loading and stretching tasks in Achilles tendinopathy: A secondary analysis of a randomized controlled trial in Clinical Biomechanics by Dr. Adam Janowski (5)

The study on Achilles tendinopathy found that increased tendon load exacerbates pain intensity, and this pain is closely linked to morning stiffness and fear of movement. Clinically, this implies that when managing Achilles tendinopathy, especially through exercise and education interventions, it is crucial to consider the potential for increased tendon load to provoke symptoms. Additionally, addressing factors like morning stiffness and fear of movement is important, as they significantly influence pain intensity and the overall effectiveness of treatment strategies.

+STUDY REFERENCE

Murphy M, Rio E (2023) The Tendinopathy Game Changers: Five papers from the last five years that just might change how you manage tendons. J Orthop Sports Phys Ther,54(1):1-3.

SUPPORTING REFERENCE

  1. Scott A, LaPrade RF, Harmon KG, et al. Platelet-Rich Plasma for Patellar Tendinopathy: A Randomized Controlled Trial of Leukocyte-Rich PRP or Leukocyte-Poor PRP Versus Saline. Am J Sports Med. 2019;47(7):1654-1661.
  2. Van der Vlist AC, van Oosterom RF, van Veldhoven PLJ, et al. Effectiveness of a high volume injection as treatment for chronic Achilles tendinopathy: randomised controlled trial. BMJ.
  3. Breda SJ, Oei EHG, Zwerver J, et al. Effectiveness of progressive tendon-loading exercise therapy in patients with patellar tendinopathy: a randomised clinical trial. British journal of sports medicine. 2021;55(9):501-509.
  4. Mellor R, Kasza J, Grimaldi A, et al. Mediators and Moderators of Education Plus Exercise on Perceived Improvement in Individuals With Gluteal Tendinopathy: An Exploratory Analysis of a 3-Arm Randomized Trial. The Journal of orthopaedic and sports physical therapy. 2022;52(12):826-836.
  5. Janowski AJ, Post AA, Heredia-Rizo AM, et al. Patterns of movement-evoked pain during tendon loading and stretching tasks in Achilles tendinopathy: A secondary analysis of a randomized controlled trial. Clin Biomech (Bristol, Avon). 2023;109:106073.
The Tendinopathy game changers:… By Dr. Adam Loiacono