Comparative study of treatment interventions for patellar tendinopathy: a protocol for a randomised controlled trial

Abstract

IntroductionPatellar tendinopathy is a degenerative disease of the patellar tendon, which affects athletes from a variety of sports, and is especially predominant in sports involving high-impact jumping. The aim of this study is to determine the additional effect of two interventions combined with eccentric exercise and compare which one is the most effective at short-term and long-term follow-up for patients with patellar tendinopathy.Methods and analysisThis study is a randomised controlled trial with blinded participants. Measurements will be carried out by a specially trained blinded assessor. A sample of 57 patients with a medical diagnosis of patellar tendinopathy will participate in this study and will be divided into three treatment groups. Eligible participants will be randomly allocated to receive either: (a) treatment group with percutaneous needle electrolysis, (b) treatment group with dry needling or (c) treatment group with placebo needling. In addition, all groups will perform eccentric exercise. Functionality and muscle strength parameters, pain, ultrasound appearances and patient perceived quality of life shall be evaluated using the Victorian Institute of Sports Assessment for patellar (VISA-P), jump tests, Visual Analogue Scale, ultrasound images and Short Form-36 (SF-36), respectively. Participants will be assessed at baseline, at 10 weeks and at 22 weeks after baseline. The expected findings will allow us to advance in the treatment of this injury, as they will help determine whether a needling intervention has additional effects on an eccentric exercise programme and whether any of the needling modalities is more effective than the other.Ethics and disseminationThis protocol has been approved by the Ethics Committee of Aragon (N° PI15/0017). The trial will be conducted in accordance with the Declaration of Helsinki.Trial registration numberNCT02498795

The Effectiveness of Minimally Invasive Techniques in the Treatment of Patellar Tendinopathy: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials

“…However, it is necessary to develop RCTs analyzing not only the effect but also comparing the effectiveness between different MIT such as DN and PNE. Fortunately, this review found two high quality protocols published that aim to compare the effects of PNE and DN in PT [ 41 ] and plantar heel pain [ 48 ], although results are not available yet.…”

“…On the one hand, MIT that do not infiltrate any substances such as DN or PNE showed a high increase of studies in the last years, although the studies published are still of low quality except for the one published by Dragoo et al [ 21 ]. However, there was a protocol published by Lopez-Royo et al [ 41 ] analyzing the additional effects of both DN and PNE over EE whose results have not published yet, but that will increase the knowledge in this field. On the other hand, other therapies including the infiltration of substances, such as PRP therapy, were associated with a significant improvement in functionality and pain at posttreatment [ 21 , 34 – 37 ] and at follow-up measurements [ 21 , 35 – 37 ] and a significant decrease in hypoechogenicity and tear size at 6 months [ 37 ] in patients with PT, with no significant differences between one or two PRP injections.…”

Case Study: The Conservative Management and Rehabilitation of Insertional Patella Tendinopathy in an Elite Footballer

“…Progressive loading from isometric to eccentric strength work without exacerbating the patients pain has been shown to be more successful in the treatment and management of patella tendinopathy, without the addition of other manual therapy techniques 2,4,21,26 . This was successfully demonstrated within the present case study.…”

“…Evidence suggests that this added supplementation facilitates tissue repair by increasing amino acid levels within the blood, with no side effects noted 28,29 . In addition to this to modulate pain and enhance function, glyceryl trinitrate (GTN) patches were utilised 4,30,31 . GTN patches consistently used within the patient's tolerance levels with a structured rehabilitation programme have exhibited very good patient outcomes within tendinopathy cases 32 .…”

“…Patella Tendinopathy is a chronic condition of the patella tendon, which can affect athletes of all ages who partake in sport, particularly in activities that involve high impact movements or stop start actions 1,2,3,4 . The patella tendon can be disrupted in both the central portion and para-tendon, where repeated stress and load effect the collagen proteins within the tendon leading to pain and reduced function [5][6][7] .…”