Treatment of patellar tendinopathy—a systematic review of randomized controlled trials
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Patellar tendinopathy is a common, painful, overuse disorder. Although many different treatment methods have been described, there is no consensus regarding the optimal treatment for this condition. The purpose of this study was to systematically review, summarize, and compare treatments for patellar tendinopathy from published randomized controlled trials.
Database searches were performed for randomized prospective controlled trials comparing treatment methods for patellar tendinopathy. The thirteen articles considered relevant were scrutinized according to quality assessment guidelines and levels of evidence.
Strong evidence was found for the use of eccentric training to treat patellar tendinopathy. Moderate evidence was found for conservative treatment (heavy slow resistance training) as an alternative to eccentric training. Moderate evidence suggests that low-intensity pulsed ultrasound treatment did not influence treatment outcomes. Limited evidence was found for surgery, sclerosing injections, and shockwave therapy.
Physical training, and particularly eccentric training, appears to be the treatment of choice for patients suffering from patellar tendinopathy. However, type of exercise, frequency, load, and dosage must also be analyzed. Other treatment methods, such as surgical treatment, sclerosing injections, and shockwave therapy, must be investigated further before recommendations can be made regarding their use. Ultrasound can likely be excluded as a treatment for patellar tendinopathy. There is a persistent lack of well-designed studies with sufficiently long-term follow-up and number of patients to draw strong conclusions regarding therapy.
Level of evidence
KeywordsEccentric training Evidence-based medicine Jumper's knee
- 2.Bahr R, Fossan B, Loken S, Engebretsen L (2006) Surgical treatment compared with eccentric training for patellar tendinopathy (Jumper’s Knee). A randomized, controlled trial. J Bone Joint Surg Am 88(8):1689–1698Google Scholar
- 4.Coombes BK, Bisset L, Vicenzino B (2010) Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet 376(9754):1751–1767Google Scholar
- 5.Cucurulo T, Louis ML, Thaunat M, Franceschi JP (2009) Surgical treatment of patellar tendinopathy in athletes. A retrospective multicentric study. Orthop Traumatol Surg Res 95(8 Suppl 1):S78–84Google Scholar
- 13.Khan KM, Cook JL, Bonar F, Harcourt P, Astrom M (1999) Histopathology of common tendinopathies. Update and implications for clinical management. Sports Med 27(6):393–408Google Scholar
- 14.Khan RJ, Fick D, Keogh A, Crawford J, Brammar T, Parker M (2005) Treatment of acute achilles tendon ruptures. A meta-analysis of randomized, controlled trials. J Bone Joint Surg Am 87(10):2202–2210Google Scholar
- 23.Sackett DL, Straus SE, Richardson WS, Rosenberg W, Haynes RB (2000) Evidenced-based medicine: how to practice and teach EBM, 2nd edn. Churchill Livingstone, EdingburghGoogle Scholar
- 24.Santander J, Zarba E, Iraporda H, Puleo S (2011) Can arthroscopically assisted treatment of chronic patellar tendinopathy reduce pain and restore function? Clin Orthop Relat Res. doi: 10.1007/s11999-011-1886-y
- 28.Taylor DW, Petrera M, Hendry M, Theodoropoulos JS (2011) A systematic review of the use of platelet-rich plasma in sports medicine as a new treatment for tendon and ligament injuries. Clin J Sport Med 21(4):344–352Google Scholar
- 29.Turk DC, Dworkin RH, Allen RR, Bellamy N, Brandenburg N, Carr DB, Cleeland C, Dionne R, Farrar JT, Galer BS, Hewitt DJ, Jadad AR, Katz NP, Kramer LD, Manning DC, McCormick CG, McDermott MP, McGrath P, Quessy S, Rappaport BA, Robinson JP, Royal MA, Simon L, Stauffer JW, Stein W, Tollett J, Witter J (2003) Core outcome domains for chronic pain clinical trials: IMMPACT recommendations. Pain 106(3):337–345PubMedCrossRefGoogle Scholar
- 34.van Tulder M, Furlan A, Bombardier C, Bouter L (2003) Updated method guidelines for systematic reviews in the cochrane collaboration back review group. Spine (Phila Pa 1976) 28(12):1290–1299Google Scholar