Tendinopathy in Sport

Abstract

Context: Tendinopathy is increasing in prevalence and accounts for a substantial part of all sports injuries and occupational disorders. Despite the magnitude of the disorder, high-quality scientific data on etiology and available treatments have been limited. Evidence Acquisition: The authors conducted a MEDLINE search on tendinopathy, or “tendonitis” or “tendinosis” or “epicondylitis” or “jumpers knee” from 1980 to 2011. The emphasis was placed on updates on epidemiology, etiology, and recent patient-oriented Level 1 literature. Results: Repetitive exposure in combination with recently discovered intrinsic factors, such as genetic variants of matrix proteins, and metabolic disorders is a risk factor for the development of tendinopathy. Recent findings demonstrate that tendinosis is characterized by a fibrotic, failed healing response associated with pathological vessel and sensory nerve ingrowth. This aberrant sensory nerve sprouting may partly explain increased pain signaling and partly, by release of neuronal mediators, contribute to the fibrotic alterations observed in tendinopathy. The initial nonoperative treatment should involve eccentric exercise, which should be the cornerstone (basis) of treatment of tendinopathy. Eccentric training combined with extracorporeal shockwave treatment has in some reports shown higher success rates compared to any therapies alone. Injection therapies (cortisone, sclerosing agents, blood products including platelet-rich plasma) may have short-term effects but have no proven long-term treatment effects or meta-analyses to support them. For epicondylitis, cortisone injections have demonstrated poorer long-time results than conservative physiotherapy. Today surgery is less indicated because of successful conservative therapies. New minioperative procedures that, via the endoscope, remove pathologic tissue or abnormal neoinnervation demonstrate promising results but need confirmation by Level 1 studies. Conclusions: Novel targeted therapies are emerging, but multicenter trials are needed to confirm the results of exercise and mini-invasive treatments.

Tendon and Ligament Tissue Engineering, Healing and Regenerative Medicine

“…The occurrence of Achilles tendon overuse injuries is the highest in middle-and long distance running, orienteering, track and field, tennis and other ball games [53,55]. An annual incidence of Achilles tendon overuse injuries in top level runners has been shown to be of 7 to 9% [55].…”

“…An annual incidence of Achilles tendon overuse injuries in top level runners has been shown to be of 7 to 9% [55]. The most common clinical diagnosis of Achilles overuse injuries is tendinopathy of the main body of the tendon (55 to 65%), followed by insertional problems such as retrocalcaneal bursitis and insertion tendinopathy (20 to 25%) [55]. The etiology of Achilles tendon overuse injuries is multifactorial [1].…”

“…The occurrence of Achilles tendon overuse injuries is the highest in middle-and long distance running, orienteering, track and field, tennis and other ball games [53,55]. An annual incidence of Achilles tendon overuse injuries in top level runners has been shown to be of 7 to 9% [55]. The most common clinical diagnosis of Achilles overuse injuries is tendinopathy of the main body of the tendon (55 to 65%), followed by insertional problems such as retrocalcaneal bursitis and insertion tendinopathy (20 to 25%) [55].…”

Tendinopathy and Sports: Understanding the Problem and Options of Management-perspectives from Physiotherapy, Sports Medicine, and Orthopedics

“…The disorder is characterized by localized tenderness and pain, which is signifi cantly exacerbated when the load on the tendon is increased, resulting in loss of function and performance. 2 Despite its frequent occurrence, the exact etiopathogenesis of the pathological process is still not crystal clear, and researchers and clinicians continue to debate the presence or absence of an infl ammatory component in tendinopathy at all sites. 3 Cook and Purdam 4 proposed the occurrence of tendon pathology in a continuum, describing it as occurring in three overlapping phases.…”

Are There Biologic Factors of Good Prognosis after a Platelet Rich Plasma (PRP) Injection for Tendinopathies ?

“…Several factors can facilitate the onset of the tendinopathy, which can be either intrinsic or extrinsinc [2]. Amongst the former, we can distinguish between those that can be altered (hyperucemia, hypercholesterolemia, chondrocalcinosis, disthyroidis, degenerative rheumatism, infection,...) [3] and those that cannot (age, gender,...). Examples…”