TOPICAL GLYCERYL TRINITRATE FOR THE TREATMENT OF TENDINOPATHIES: A SYSTEMATIC REVIEW

BACKGROUND & OBJECTIVE

Despite advances in tendinopathy management, it remains a challenging pathology to treat. Load management and progressive rehabilitation are considered gold standard and yet around 35% of people will still have symptoms at 5 year follow up even with this approach (Silbernagel et al. 2010). This suggests that for a significant percentage of people there may be ongoing symptoms and a need for alternative treatments beyond exercise-based rehab.

One such option under consideration is topical Glyceryl Trinitrate (GTN) which is thought to enhance new tissue synthesis and aid the healing process of the injured tendon. This is not a new treatment for tendinopathy (its potential benefits were first reported over 20 years ago), but to date there has been little clear guidance regarding its efficacy. The aim of this study was to systematically review the best available evidence on the effectiveness of topical GTN (and its side effects) to help inform future guidelines.

METHODS

Key data sources (MEDLINE, Embase etc) were systematically searched to identify research published up to January 2018. Studies were included if they were randomised controlled trials (RCTs) on adults with tendinopathy with at least one treatment group receiving topical GTN and a control group (receiving placebo/alternative treatment). Study quality and risk of bias was assessed.

RESULTS

Ten eligible RCTs were identified and included a total of 584 participants. The reviewed studies included tendinopathy in the rotator cuff, achilles, patellar tendon and lateral elbow. Meta-analysis of the data was not possible. Overall, improvements in pain, strength and

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