Modifiable risk factors for patellar tendinopathy in athletes: a systematic review and meta-analysis

Sprague, Andrew L; Smith, Angela H.; Knox, Patrick J; Pohlig, Ryan T.; Silbernagel, Karin Grävare

doi:10.1136/bjsports-2017-099000

Cited by 75 publications

(87 citation statements)

References 64 publications

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“…13 However, repetitive use often results in overuse injuries such as tendinopathy, which is a common clinical condition characterized by pain during activity, localized tenderness upon palpation, and impaired performance. 27,44 Its histopathologic characteristics include increased cellularity; increased proteoglycans, glycosaminoglycans, and water; hypervascularization; and disorganized collagen. 33 The prevalence of patellar tendinopathy has been reported to be as high as 14% in elite athletes and 9% among recreational athletes, especially within explosive sports.…”

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confidence: 99%

Clinical Outcomes, Structure, and Function Improve With Both Heavy and Moderate Loads in the Treatment of Patellar Tendinopathy: A Randomized Clinical Trial

et al. 2021

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Background: Loading interventions have become a predominant treatment strategy for tendinopathy, and positive clinical outcomes and tendon tissue responses may depend on the exercise dose and load magnitude. Purpose/Hypothesis: The purpose was to investigate if the load magnitude influenced the effect of a 12-week loading intervention for patellar tendinopathy in the short term (12 weeks) and long term (52 weeks). We hypothesized that a greater load magnitude of 90% of 1 repetition maximum (RM) would yield a more positive clinical outcome, tendon structure, and tendon function compared with a lower load magnitude of 55% of 1 RM when the total exercise volume was kept equal in both groups. Study Design: Randomized clinical trial; Level of evidence, 1. Methods: A total of 44 adult participants with chronic patellar tendinopathy were included and randomized to undergo moderate slow resistance (MSR group; 55% of 1 RM) or heavy slow resistance (HSR group; 90% of 1 RM). Function and symptoms (Victorian Institute of Sport Assessment–Patella questionnaire [VISA-P]), tendon pain during activity (numeric rating scale [NRS]), and ultrasound findings (tendon vascularization and swelling) were assessed before the intervention, at 6 and 12 weeks during the intervention, and at 52 weeks from baseline. Tendon function (functional tests) and tendon structure (ultrasound and magnetic resonance imaging) were investigated before and after the intervention period. Results: The HSR and MSR interventions both yielded significant clinical improvements in the VISA-P score (mean ± SEM) (HSR: 0 weeks, 58.8 ± 4.3; 12 weeks, 70.5 ± 4.4; 52 weeks, 79.7 ± 4.6) (MSR: 0 weeks, 59.9 ± 2.5; 12 weeks, 72.5 ± 2.9; 52 weeks, 82.6 ± 2.5), NRS score for running, NRS score for squats, NRS score for preferred sport, single-leg decline squat, and patient satisfaction after 12 weeks, and these were maintained after 52 weeks. HSR loading was not superior to MSR loading for any of the measured clinical outcomes. Similarly, there were no differences in functional (strength and jumping ability) or structural (tendon thickness, power Doppler area, and cross-sectional area) improvements between the groups undergoing HSR and MSR loading. Conclusion: There was no superior effect of exercising with a high load magnitude (HSR) compared with a moderate load magnitude (MSR) for the clinical outcome, tendon structure, or tendon function in the treatment of patellar tendinopathy in the short term. Both HSR and MSR showed equally good, continued improvements in outcomes in the long term but did not reach normal values for healthy tendons. Registration: NCT03096067 (ClinicalTrials.gov identifier)

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confidence: 99%

Clinical Outcomes, Structure, and Function Improve With Both Heavy and Moderate Loads in the Treatment of Patellar Tendinopathy: A Randomized Clinical Trial

et al. 2021

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“…Prevalence of Achilles and patellar tendinopathy have been reported to be as high as 23 and 45% in runners and jumping athletes, with plantar heel pain reported to be found in up to 18% of runners in one cohort (Janssen et al 2018;Sprague et al 2018;Arnold and Moody et al 2018). Despite a recent proliferation in clinical research investigating effectiveness of a range of treatment options for tendinopathy, it remains unclear which treatments are most effective, with exercise-based treatments such as resistance training currently the most recommended (Burton and McCormack 2021;Malliaras et al 2013).…”

Section: Introductionmentioning

confidence: 99%

Reporting of exercise descriptors and variables in resistance training interventions for lower limb tendinopathy: Protocol for a scoping review applying the Consensus on Exercise Reporting Template and Toigo and Boutellier Framework.

Burton¹

2021

Preprint

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Introduction: Musculoskeletal disorders have a significant global burden, with tendinopathies of the lower limb having a high prevalence. Although the use of resistance training interventions as treatment for tendinopathies has become widespread, the reporting and description of these interventions is often poor, preventing translation to clinical practice. Specific exercise description and intervention variables must be reported in order to translate research findings into clinical practice. This scoping review aims to summarise reporting of current resistance training interventions as assessed by the Consensus on Exercise Reporting Template and Toigo and Boutellier Framework.Methods and analysis: The recommended methodological framework described by the Joanna Briggs Institute will be used to structure this review, with reporting in accordance with the PRISMA-ScR. Databases to be searched include MEDLINE, CINAHL, AMED, EMBase, SPORTDiscus, Cochrane library (Controlled trials, Systematic reviews), JBI Evidence Synthesis, and five trial registries. Two independent reviewers will screen studies at title/abstract and full text. Following screening, data will be extracted and charted, then presented as figures and table alongside a narrative synthesis. Dissemination: This scoping review will evaluate current resistance training exercise descriptors and program variables in lower limb tendinopathy using recommended frameworks for the first time in the literature. The results will allow dissemination of the parameters of research exercise interventions to clinical practitioners through peer-reviewed publication and social media outlets, allowing implementation in clinical practice. The review will also outline future research and exercise reporting needs within tendinopathy resistance training interventions.

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“…10 Whereas, prevalence of Achilles and patellar tendinopathy have been reported to be as high as 23 and 45% in runners and elite male volleyball players, respectively. [11][12] A range of common approaches are used in the treatment of tendinopathy including exercise, corticosteroid injections, shockwave therapy, laser therapy, ultrasound, platelet-rich plasma injections and manual therapy. 13 Recent evidence indicates that exercise may be the most effective therapy, particularly heavy load resistance training.…”

Section: Introductionmentioning

confidence: 99%

Autoregulated and individualised resistance training versus predetermined and standardised resistance training in tendinopathy: A systematic review protocol

Burton

McCormack

2021

Musculoskeletal Care

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Modifiable risk factors for patellar tendinopathy in athletes: a systematic review and meta-analysis

Abstract: There is a lack of strong evidence for any potential modifiable risk factors or associated factors. Factors with lower levels of support may be of interest in designing prevention programmes but require further research in high-quality, prospective studies.

Cited by 75 publications

References 64 publications

Clinical Outcomes, Structure, and Function Improve With Both Heavy and Moderate Loads in the Treatment of Patellar Tendinopathy: A Randomized Clinical Trial

Clinical Outcomes, Structure, and Function Improve With Both Heavy and Moderate Loads in the Treatment of Patellar Tendinopathy: A Randomized Clinical Trial

Reporting of exercise descriptors and variables in resistance training interventions for lower limb tendinopathy: Protocol for a scoping review applying the Consensus on Exercise Reporting Template and Toigo and Boutellier Framework.

Autoregulated and individualised resistance training versus predetermined and standardised resistance training in tendinopathy: A systematic review protocol

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