Causative factors and rehabilitation of patellar tendinopathy: A systematic review

Abstract

BackgroundPatellar tendinopathy (PT) is a common chronic pathology of the knee, with a high prevalence in athletes and the general population.ObjectivesThe objectives of this article were to systematically investigate all the evidence applicable to the intrinsic and extrinsic causative factors and rehabilitation of PT, and then integrate and link rehabilitation with the main causative factors identified.MethodThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Various tools were used to evaluate the methodological quality of the eligible articles. Data were interpreted descriptively, and the causative factors and rehabilitation of PT were analysed.ResultsTwenty studies were included in the review. The distinctive factor responsible for PT is the mechanical theory. Seven intrinsic and four extrinsic risk factors were identified, with the main intrinsic risk factors being muscle flexibility and strength, and extrinsic risk factors being acquisition and level of skills. PT can be treated with numerous different therapeutic modalities, although eccentric muscle training showed exceptional results. The intrinsic and extrinsic risk factors can only be transformed and reduced by rehabilitation, which is inevitable to improve PT pain and function.ConclusionThe essence of an integrated management protocol for PT is to identify the dominant contributing factors, whether intrinsic or extrinsic, and to reduce the load on the patellar tendon by modifying these factors by either rehabilitation intervention or direct modification of the equipment or environment to obtain a positive outcome towards pain management and function.

Effects of isometric, eccentric, or heavy slow resistance exercises on pain and function in individuals with patellar tendinopathy: A systematic review

“…A recent systematic review by Morgan, Vuuren, and Coetzee () investigated the risk factors of PT and found that common contributing factors are reduced quadriceps strength, inappropriately progressed training load and/or duration, reduced lower limb flexibility, reduced skill set in the sport, and an inferiorly displaced patella. Many of these risk factors are thus modifiable and preventable through appropriate physiotherapy programmes.…”

“…Existing systematic reviews have attempted to evaluate the effectiveness of exercises on PT (Larsson, Käll, & Nilsson‐Helander, ; Morgan et al, ; Rabin, ; Visnes & Bahr, ). Although these reviews suggested sufficient evidence for the implementation of eccentric exercises in the management of PT, these reviews only included studies with eccentric exercises or HSR exercises and have not considered the effectiveness of isometric exercise protocols.…”

Proposing a Patellar Tendinopathy Screening tool following a systematic review

“…This ensured that results cross-referenced and that all eligible articles were included in the review. This interval was chosen to be a supplementary addition to a previously published systematic review on the causative risk factors and rehabilitation for PT in which articles were selected only up to October 2015 (Morgan, Janse van Vuuren & Coetzee 2016 ). Clinical Sports Medicine (5th edition) by Brukner and Khan ( 2017 ) was used as a basis to identify the words for the Boolean phrases.…”

Evidence to Practice Review: Best Practices in Patellar Tendinopathy Management

“…2,3 Several risk factors have been identified including an increased training load, decreased hamstring flexibility, an inferiorlyplaced patella, and reduced quadriceps strength. 4,5 The majority of these risk factors are modifiable, suggesting there is a strong likelihood that patients can respond positively to therapeutic intervention. 4,5 Despite the frequency of PT, the pathological sequence and contributing factors to the reports of pain and disability are not universally agreed Copyright upon.…”

“…4,5 The majority of these risk factors are modifiable, suggesting there is a strong likelihood that patients can respond positively to therapeutic intervention. 4,5 Despite the frequency of PT, the pathological sequence and contributing factors to the reports of pain and disability are not universally agreed Copyright upon. Histopathological findings of patients suggest symptoms are not due to the inflammatory response and are rather due to degeneration of the tissue.…”