Neovascularity in patellar tendinopathy and the response to eccentric training: A case report using Power Doppler ultrasound

McCreesh, Karen; Riley, Sara J.; Crotty, James M.

doi:10.1016/j.math.2012.09.001

Cited by 9 publications

(7 citation statements)

References 19 publications

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“…McCreesh et al . ( 2013 ) clarified that the mechanism of action of EE is to resolve the neovascularity in the patellar tendon.…”

Section: Resultsmentioning

confidence: 99%

“…This happens when EE lengthens the tendon, which is responsible for ‘squeezing out’ the flow of neovessels (McCreesh et al . 2013 ). Doppler ultrasound imaging after a period of EE indicated a minimal improvement in tendon echogenicity and a substantial decline in tendon neovascularity, with a dramatic improvement in the symptoms and pain in the tendon (Da Cunha et al .…”

Section: Discussionmentioning

confidence: 99%

“…The frequency and repetitions of performing EE differed in the reviewed articles, but generally included three sets of 15, one or twice daily and 5–7 days a week (Goldman & Lentz 2010 ; McCreesh et al . 2013 ; Van der Worp et al . 2011c ).…”

Section: Discussionmentioning

confidence: 99%

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Causative factors and rehabilitation of patellar tendinopathy: A systematic review

Morgan

Vuuren

Coetzee

2016

South African Journal of Physiotherapy

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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.

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“…McCreesh et al . ( 2013 ) clarified that the mechanism of action of EE is to resolve the neovascularity in the patellar tendon.…”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Causative factors and rehabilitation of patellar tendinopathy: A systematic review

Morgan

Vuuren

Coetzee

2016

South African Journal of Physiotherapy

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“…McCreesh examined the vascular changes associated with an eccentric exercise program in a case report and determined that a reduction of vascularization and accompanying nerve fibers actually improved the patient's function. 26 In an orthopedic physical therapy setting, the impact of concentric and eccentric exercise on tendon physiology can guide therapy choices for patient populations such as muscle str engthening using concentric exercises or treating tendonitis using high force eccentric exercises. In a sports or training setting it is also important to understand tendon response as it relates to muscle performance and exercise to determine appropriate protocol.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Functional Activities on Structural Changes of the Inferior Patellar Pole

McKinney

Wallmann

Stalcup

et al. 2017

Intl J Sports Phys Ther

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Background: It is well known that eccentric and concentric exercise produce varied amounts of stress on the connective tissues. Diagnostic ultrasound has been used to measure these structural changes by observing fascicle length, angle, and thickness; however, there is a lack of evidence comparing the structural changes as it relates to eccentric, concentric, and stretching protocols. Purpose: The purpose of this study was to compare the acute effects of static stretching, eccentric, concentric, and a combination of eccentric/concentric exercises on structural changes of the muscle tendon unit at the inferior patellar pole utilizing the diagnostic ultrasound. Study Design: A repeated measures 2 x 4 within factorial study design with repeated measures on both factors was used to determine the differences in patellar tendon thickness within and between groups. Methods: Forty-seven healthy subjects were screened for any lower extremity deficits or orthopaedic pathology. Forty-four (N=44) subjects completed all four protocols; the attrition was due to injuries to the lower extremity, occurring unrelated to the study. A baseline measurement of the anterior inferior patellar tendon was performed with the diagnostic ultrasound prior to each participant completing one of the four interventions per week over a four-week period. Interventions completed by each participant included static stretching, concentric, eccentric, and combined concentric and eccentric exercises. Immediately following each intervention, a post-intervention inferior patellar tendon measurement was recorded using the diagnostic ultrasound. Results: Significant differences in anterior to posterior tendon thickness of the inferior patellar tendon were observed between pre (4.983±0.041mm) and post (5.198±0.055mm) measurements (p<0.0005) for the main effect of time. However, no differences in tendon thickness were noted comparing each intervention to one another (p=0.351). Conclusion: Differences in tendon thickness were noted acutely for pre-to post measurements across all interventions. Further research is needed to determine if differences in tendon thickness exist with a longer duration of exercise over time and with different types of intervention.

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“…To identify neovascularity, tendons were assessed at the same three locations using power Doppler imaging (gain = 25) and images were captured if neovascularization was observed. Neovascularity was defined as visual evidence of red, pulsatile coloration indicating blood flow within the boundaries of the tendon 20 . To optimize the reliability and accuracy for the measurements of tendon morphology and neovascularity, all image acquisition was performed by the same trained investigator who applied minimal pressure to the patellar tendon during ultrasound imaging examination 20 .…”

Section: Methodsmentioning

confidence: 99%

Patellar tendon morphology in trans-tibial amputees utilizing a prosthesis with a patellar-tendon-bearing feature

Harty

Kellogg

et al. 2019

Sci Rep

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A patellar-tendon-bearing (PTB) bar is a common design feature used in the socket of trans-tibial prostheses to place load on the pressure-tolerant tissue. As the patellar tendon in the residual limb is subjected to the perpendicular compressive force not commonly experienced in normal tendons, it is possible for tendon degeneration to occur over time. The purpose of this study was to compare patellar tendon morphology and neovascularity between the residual and intact limbs in trans-tibial amputees and healthy controls. Fifteen unilateral trans-tibial amputees who utilized a prosthesis with a PTB feature and 15 age- and sex- matched controls participated. Sonography was performed at the proximal, mid-, and distal portions of each patellar tendon. One-way ANOVAs were conducted to compare thickness and collagen fiber organization and a chi-square analysis was used to compare the presence of neovascularity between the three tendon groups. Compared to healthy controls, both tendons in the amputees exhibited increased thickness at the mid- and distal portions and a higher degree of collagen fiber disorganization. Furthermore, neovascularity was more common in the tendon of the residual limb. Our results suggest that the use of a prosthesis with a PTB feature contributes to morphological changes in bilateral patellar tendons.

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Neovascularity in patellar tendinopathy and the response to eccentric training: A case report using Power Doppler ultrasound

Cited by 9 publications

References 19 publications

Causative factors and rehabilitation of patellar tendinopathy: A systematic review

Causative factors and rehabilitation of patellar tendinopathy: A systematic review

Comparison of Functional Activities on Structural Changes of the Inferior Patellar Pole

Patellar tendon morphology in trans-tibial amputees utilizing a prosthesis with a patellar-tendon-bearing feature

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