Current trends in tendinopathy: consensus of the ESSKA basic science committee. Part II: treatment options

Abstract

The treatment of painful chronic tendinopathy is challenging. Multiple non-invasive and tendon-invasive methods are used. When traditional non-invasive treatments fail, the injections of platelet-rich plasma autologous blood or cortisone have become increasingly favored. However, there is little scientific evidence from human studies supporting injection treatment. As the last resort, intra- or peritendinous open or endoscopic surgery are employed even though these also show varying results. This ESSKA basic science committee current concepts review follows the first part on the biology, biomechanics and anatomy of tendinopathies, to provide a comprehensive overview of the latest treatment options for tendinopathy as reported in the literature.

Different Frequency of Cyclic Tensile Strain Relates to Anabolic/Catabolic Conditions Consistent with Immunohistochemical Staining Intensity in Tenocytes

“…Conversely, the microcracks of the tendon induced by repetitive mechanical overloads can accelerate catabolic changes, resulting in tendinopathy [4]. Clinically, the treatment of painful chronic tendinopathy still remains challenging due to the high failure rate of conservative treatment [5,6]. Acute inflammation and mechanical overloads reportedly cause degenerative damages to tendon structure because of qualitative and quantitative tenocyte alterations [7,8].…”

Mechanisms of Action of Multipotent Mesenchymal Stromal Cells in Tendon Disease

“…Treatment of tendinopathy still represents an unsolved challenge. Mainly, the use of strict rehabilitation exercise regimens is sufficiently evidence based [17,18]. Anti-inflammatory drugs are frequently used, but they do not only counteract the active inflammation but also its resolution [19].…”

“…Anti-inflammatory drugs are frequently used, but they do not only counteract the active inflammation but also its resolution [19]. Biologicals such as platelet rich plasma have also received much attention, but clinical evidence is not convincing [17,20,21]. Research also focuses on the potential of endogenous tendon progenitor cells [22], which may be a promising strategy but will not be addressed in this review.…”

Comparison of ultrasound-guided versus blind interventions for supraspinatus tendinopathy: a cadaveric study.

“…The current literature advocates for multidisciplinary work among physicians, physiotherapists and rehabilitators to treat this pathology (1,2). Invasive therapies (in which the injured tendon is punctured) either for the application of galvanic currents (3,4), biological therapies (4,5) or analgesics (6,7,8) are a widespread therapeutic tool today. The supraspinatus tendon insertion area (SSP) at the level of footprint is the area most frequently affected in a rotator cuff (RC) injury (Figure 1).…”

“…Literature already reports that infiltrations that are not properly done in some areas may worsen the symptoms or make the applied therapy ineffective (12,13). Multiple treatments have been described that may be useful in the treatment of supraspinatus tendinopathy (4). The main basis of most of these treatments is that the product or technique to be applied must be administered in a specific area of the tendon (area of injury).…”