Abstract
ObjectivesTo assess the associations between: 1) baseline patellar tendon stiffness and clinical outcome after exercise therapy in athletes with patellar tendinopathy and 2) the change in patellar tendon stiffness and clinical outcome during progressive tendon-loading exercise therapy and eccentric exercise therapy. DesignRandomized controlled trial. MethodsAthletes with patellar tendinopathy aged 18-35 years, playing tendon-loading sports at least 3 times per week were randomized in a 1:1 ratio between progressive tendon-loading exercise therapy and eccentric exercise therapy for 24 weeks. Patellar tendinopathy was diagnosed clinically, and confirmed by ultrasound. Patellar tendon stiffness (kilopascal, kPa) was assessed using shear-wave elastography. Clinical outcome was assessed using the validated Victorian Institute of Sports Assessment (VISA-P; range 0-100) questionnaire. Both were assessed at baseline, 12 and 24 week follow-up. Adjusted general linear, mixed-linear models and Generalized Estimating Equations were used. ResultsWe included 76 athletes (58 men, mean age 24 ± 4 years). No association was found between baseline stiffness and VISA-P after 24 weeks (p = 0.52). Decreased stiffness (adjusted mean difference = 10 kPa (95% CI: 4-15) was significantly associated with improved clinical outcome at 12 weeks in all athletes (p = 0.02), and at both 12 and 24 weeks (p = 0.01) in athletes allocated to progressive tendon-loading exercise therapy. ConclusionsPatellar tendon stiffness, assessed with shear-wave elastography, is unsuitable to use as a single predictive measurement for clinical outcome. Decreasing stiffness during the course of exercise therapy is associated with improved clinical outcome in athletes recovering from patellar tendinopathy.
Highlights
Decreasing stiffness during the course of exercise therapy is associated with improved clinical outcome in athletes recovering from Patellar tendinopathy (PT)
272 athletes were screened for eligibility and 76 athletes with clinically diagnosed and ultrasound-confirmed PT were consecutively included between January 2017 and June 2019
Among athletes allocated to progressive tendon-loading exercises (PTLE), we found a significant association between decrease in patellar tendon stiffness over time and improved VISA-P score after both 12 weeks
Summary
Patellar tendinopathy (PT) is an overuse injury of the patellar tendon, which commonly occurs in athletes performing sports that involve repetitive jumping and landing (e.g. basketball, volleyball). PT results in load-related anterior knee pain and often affects sports participation and performance. participation in physically demanding work is reduced in 58% of the patients with PT. Recently, the concerns, frustrations, impact on quality of life and daily functioning in individuals with tendinopathy have been well described.4The diagnosis of PT is based on load-related pain localized at the inferior patellar pole. The role of imaging, mostly ultrasound, is to confirm the clinical diagnosis by assessing alterations in tendon morphology. The treatment of PT consists of strengthening exercises and aims to improve tendon symptoms, function and structure. Heavy-load eccentric exercise therapy (EET) is regarded as preferential treatment. the role of EET is controversial because EET is painful to perform and studies have found that and EET is ineffective when applied in the competitive season. A novel approach is progressive tendon-loading exercise therapy (PTLE) that is performed within the limits of pain.. Patellar tendinopathy (PT) is an overuse injury of the patellar tendon, which commonly occurs in athletes performing sports that involve repetitive jumping and landing (e.g. basketball, volleyball).. PT results in load-related anterior knee pain and often affects sports participation and performance.. The diagnosis of PT is based on load-related pain localized at the inferior patellar pole.. The role of imaging, mostly ultrasound, is to confirm the clinical diagnosis by assessing alterations in tendon morphology.. The treatment of PT consists of strengthening exercises and aims to improve tendon symptoms, function and structure.. Heavy-load eccentric exercise therapy (EET) is regarded as preferential treatment.. The role of EET is controversial because EET is painful to perform and studies have found that and EET is ineffective when applied in the competitive season.. A novel approach is progressive tendon-loading exercise therapy (PTLE) that is performed within the limits of pain.
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