BackgroundTendinopathy is an overuse tendon injury that occurs in loaded tendons and results in pain and functional impairment. Although many treatments for painful tendons are described, the scientific evidence for most of the conservative and surgical treatments is not always conclusive.ObjectivesThis study was designed to evaluate the efficacy of 3 different interventions in patients with Achilles tendinopathy. The interventions include the combination of 2 physical therapy programs (eccentric training [EC] or passive stretching [PS]) with a supplement containing mucopolisaccharides. The efficacy of the interventions was evaluated depending on the stage of the disease.MethodsFifty-nine patients were randomly assigned to 1 of 3 treatment groups, and classified according to the disease stage: reactive versus degenerative tendinopathy. Treatment groups were EC; EC + a dietary supplement containing mucopolisaccharides, type I collagen, and vitamin C (MCVC); and a passive stretching program + MCVC. Patients were evaluated at baseline, 6 weeks, and 12 weeks with the Victorian Institute of Sports Assessment-Achilles questionnaire for function, a visual analog scale for pain, and ultrasound characterization for the evolution of tendon structure.ResultsA significant improvement in Victorian Institute of Sports Assessment-Achilles questionnaire score, pain at rest, and pain during activity were detected in all 3 treatment groups at 6 and 12 weeks’ follow-up when compared with baseline. In patients with reactive tendinopathy, the reduction in pain at rest was greater in the groups who took the supplemental MCVC than in the EC alone group (P < 0.05).ConclusionsMCVC seems to be therapeutically useful for management of tendinopathies, providing some additional benefit to physical therapy. This is especially evident in early stages of the disease, when the tendon does not present severe matrix and vascular changes.ClinicalTrials.gov identifierNCT01691716.

Background Tendinopathy is an overuse tendon injury that results in pain, decreased exercise tolerance and a reduction in function, being a major problem in sports and occupational medicine. A new pathology model has recently been proposed dividing tendinopathies into different stages according to severity, allowing rational placement of treatments at each different stage. Objectives The aim of this study is to evaluate the efficacy and safety of 3 different interventions: eccentric training (EC), eccentric training + Tendoactive®, a dietary supplement containing Mucopolisaccharides, type I Collagen and Vitamin C (EC+MCV), and passive stretching program + MCV (PS+MCV). It is also studied whether there is different response pattern to the mentioned treatments depending on the pathology stage. Methods In this randomized, controlled, multicenter trial fifty-nine patients were randomly assigned to 1 of 3 treatment groups, and classified in one of two subgroups designed according to the Cook & Purdam pathology model: reactive vs degenerative tendinopathy. Patients were evaluated at baseline, 6 and 12 weeks with the Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire. Pain was evaluated at rest and during activity using a visual analog scale (VAS), and evolution of tendon structure was assessed by ultrasound. Results A significant improvement in VISA-A score, pain at rest and pain during activity were detected in all 3 treatment groups at 6 and 12 weeks follow-up, when compared to baseline. In patients with reactive tendinopathy the reduction on pain at rest was significantly greater in the groups supplemented with MCV than in the EC group (P<0.05), while the VISA-A score tended to obtain a better recovery in the EC+MCV treatment than in the EC alone (P=0.069). In patients with degenerative tendinopathy, a significant reduction of the bilateral thickness and neovascularization degree of the affected tendon, were detected in the PS+MCV group. Conclusions A dietary supplement containing mucopolisaccharides, type I collagen and vitamin C, seems to be safe and effective for management of tendinopathies, providing some additional benefit to the physical therapy. This is especially evident in early stages of the disease, when the tendon doesn't present severe matrix and vascular changes. References Cook J, Purdam C R. Is tendόn pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. Br J Sports Med 2009;43:409-416. Shakibaei M, Buhrmann C, Mobasheri A. Anti-inflammatory and anti-catabolic effects of TENDOACTIVE® on human tenocytes in vitro. Histol Histopathol. 2011 Sep;26(9):1173-85. Nadal F, Bové T, Sanchís D, Martinez-Puig D (2009) Effectiveness of treatment of tendinitis and plantar fasciitis by tendoactive™. Osteoarthritis and Cartilage, Volume 17, Supplement 1, Page S253. Disclosure of Interest : None declared DOI 10.1136/annrheumdis-2014-eular.5533