Distinguishing Quadriceps Tendinopathy and Patellar Tendinopathy: Semantics or Significant?

Sprague, Andrew L; Epsley, Scott; Silbernagel, Karin Grävare

doi:10.2519/jospt.2019.0611

Cited by 20 publications

(19 citation statements)

References 24 publications

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“…This is a less common tendinopathy then patellar tendinopathy; it affects the cranial part of the patella. It is considered as part of the jumper knee syndrome and usually it is not differentiated from the patellar tendinopathy, while, as highlighted by Sprague et al, the two tendons have different structures and different treatments [ 44 ]. Quadriceps tendinopathy, due to its low prevalence, has rarely been studied with ultrasound [ 45 ].…”

Section: Resultsmentioning

confidence: 99%

Lower Limb Tendinopathy Tissue Changes Assessed through Ultrasound: A Narrative Review

et al. 2020

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Tendinopathy is a common disease that affects athletes, causing pain and dysfunction to the afflicted tendon. A clinical diagnose is usually combined with imaging and, among all the existing techniques, ultrasound is widely adopted. The aim of this review is to sum up the existing evidence on ultrasound as an imaging tool and guide for treatments in lower limbs tendinopathy. Using three different databases—PubMed, MEDLINE and CENTRAL—a literature search has been performed in May 2020 combining MeSH terms and free terms with Boolean operators. Authors independently selected studies, conducted quality assessment, and extracted results. Ultrasound imaging has a good reliability in the differentiation between healthy and abnormal tendon tissue, while there are difficulties in the identification of tendinopathy stages. The main parameters considered by ultrasound imaging are tendon thickness, hypoechogenicity of tendon structure and neovascularization of the tendon bound tissue. Ultrasound-guide is also used in many tendinopathy treatments and the available studies gave encouraging results, even if further studies are needed in this field.

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Section: Resultsmentioning

confidence: 99%

Lower Limb Tendinopathy Tissue Changes Assessed through Ultrasound: A Narrative Review

et al. 2020

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“…Higher levels of kinesiophobia have been associated with worse recovery of lower extremity function in Achilles tendinopathy [ 27 ]. Additionally, in pilot studies, we found that the majority of patients with patellar tendinopathy have clinically meaningful levels of kinesiophobia [ 28 ]. Scores range from 17 to 68 points, with higher scores indicating a greater fear of movement and re-injury.…”

Section: Methodsmentioning

confidence: 99%

Pain-guided activity modification during treatment for patellar tendinopathy: a feasibility and pilot randomized clinical trial

Sprague

Couppé

Pohlig

et al. 2021

Pilot Feasibility Stud

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Background Activity modification is a key component of patellar tendinopathy treatment but there is a lack of evidence guiding activity modification prescription. Use of activity modification in treatment studies has varied widely and the impact of those recommendations has not been directly investigated or compared. The purpose of this study was to assess (1) the feasibility of using pain-guided activity modification during treatment for patellar tendinopathy and (2) if our outcome measures are responsive to changes in tendon health over the course of treatment. Methods This was an unblinded, randomized two-arm pilot and feasibility study randomized clinical trial with parallel assignment, conducted in Newark, DE. Individuals between the ages of 16 and 40 years old with patellar tendinopathy were included. Participants were randomly assigned to a pain-guided activity (PGA) or pain-free activity (PFA) group using a spreadsheet-based randomization scheme. All participants received standardized treatment using a modified version of the heavy-slow resistance protocol 3×/week for 12 weeks. For the first 6 weeks, the PGA group used the Pain-Monitoring Model to guide activity outside of treatment and the PFA group was restricted from running, jumping, or activities that provoked their patellar tendon pain. Feasibility outcomes included recruitment, enrollment, randomization, compliance, and retention percentages. Clinical evaluations were conducted at baseline, 6, and 12 weeks to assess symptom severity, psychological factors, tendon morphology and mechanical properties, lower extremity function, and quadriceps muscle performance. Results In a ~ 13-month period, 108 individuals were screened, 47/108 (43.5%) were eligible for participation, and 15/47 (32.0%) of those were enrolled (9 PGA, 6 PFA). The recruitment rate was 1.15 participants/month. The mean ± SD compliance with treatment was PGA: 86.1 ± 13.0% and PFA: 67.1 ± 30.7%. There was one missed evaluation session and two adverse events, which were not due to study interventions. Changes exceeding the smallest detectable change were observed for at least one outcome in each domain of tendon health. Conclusions Use of pain-guided activity modification during exercise therapy for patellar tendinopathy was found to be feasible, and the proposed outcome measures appropriate. Computer-based allocation concealment, blinding of evaluators, and greater recruitment of high-level athletes should be implemented in future trials. Trial registration ClinicalTrials.gov identifier: NCT03694730. Registered 3rd of October, 2018.

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“…111,112 Tendon pathology ranges from acute tears to chronic degenerative overuse. 113,114 Treatment is largely determined by the specific tendons involved, location (intratendinous versus myotendinous), and timing (acute versus chronic). 115 In the setting of acute tears, treatment is aimed at promoting cellular proliferation and healing, whereas chronic tendinopathy is managed by targeting inflammatory mediators and inhibiting matrix-degrading proteinases to improve healing (Table 5).…”

Section: Tendon Pathology Brief Overviewmentioning

confidence: 99%

Nonoperative and Operative Soft-Tissue and Cartilage Regeneration and Orthopaedic Biologics of the Knee: An Orthoregeneration Network (ON) Foundation Review

Knapik

Evuarherhe

Frank

et al. 2021

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Orthoregeneration is defined as a solution for orthopedic conditions that harnesses the benefits of biology to improve healing, reduce pain, improve function, and optimally, provide an environment for tissue regeneration. Options include: drugs, surgical intervention, scaffolds, biologics as a product of cells, and physical and electro-magnetic stimuli. The goal of regenerative medicine is to enhance the healing of tissue after musculoskeletal injuries as both isolated treatment and adjunct to surgical management, using novel therapies to improve recovery and outcomes. Various orthopaedic biologics (orthobiologics) have been investigated for the treatment of pathology involving the knee, including symptomatic osteoarthritis and chondral injuries, as well as injuries to tendon, meniscus, and ligament, including the anterior cruciate ligament. Promising and established treatment modalities include hyaluronic acid (HA) in liquid or scaffold form; platelet-rich plasma (PRP); bone marrow aspirate (BMA) comprising mesenchymal stromal cells (MSCs), hematopoietic stem cells, endothelial progenitor cells, and growth factors; connective tissue progenitor cells (CTPs) including adipose-derived mesenchymal stem cells (AD-MSCs) and tendon-derived stem cells (TDSCs); matrix cellebased therapy including autologous chondrocytes or allograft; vitamin D; and fibrin clot. Future investigations should standardize solution preparations, because inconsistent results reported may be due to heterogeneity of HA, PRP, BMAC, or MSC preparations and regimens, which may inhibit meaningful comparison between studies to determine the true efficacy and safety for each treatment.T he goal of regenerative medicine in orthopaedic surgery is to incorporate solutions aimed at enhancing musculoskeletal healing and or modify symptoms after injury or degeneration to reduce pain and improve function by modulating the biologic environment to promote tissue restoration. 1 The use of these techniques seeks to improve symptoms either by augmenting the healing of tissues that possess relatively poor intrinsic healing capabilities, including cartilage, menisci, tendon, and ligament, or by inhibiting biochemical pathways that might be associated with symptom generation. 1 Orthobiologic therapies are current used for the treatment of symptomatic focal chondral defects, 2,3 osteoarthritis (OA), 4-7 meniscal

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Distinguishing Quadriceps Tendinopathy and Patellar Tendinopathy: Semantics or Significant?

Cited by 20 publications

References 24 publications

Lower Limb Tendinopathy Tissue Changes Assessed through Ultrasound: A Narrative Review

Lower Limb Tendinopathy Tissue Changes Assessed through Ultrasound: A Narrative Review

Pain-guided activity modification during treatment for patellar tendinopathy: a feasibility and pilot randomized clinical trial

Nonoperative and Operative Soft-Tissue and Cartilage Regeneration and Orthopaedic Biologics of the Knee: An Orthoregeneration Network (ON) Foundation Review

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