Treatment Of Tendinopathy Research Articles (Page 1)

Background and objective: Heterotopic ossification (HO) of the plantar fascia is an exceptionally rare condition, with only a few cases mentioned in the literature. In comparison, calcification of the fascia occurs more frequently, especially in cases of chronic plantar fasciitis. Tenex™, a percutaneous ultrasonic tenotomy system initially designed for tendinopathy treatment, may offer a minimally invasive alternative to conventional surgery in selected cases of HO. So, the aim of this case report was to assess the improvement in the pain and in the foot function after a percutaneous ultrasonic debridement. Case presentation: We present the case of an 82-year-old male with a history of hypertension and hyperuricemia, who reported a two-year history of mechanical-type plantar pain described as “walking on a stone.” Radiographs and MRI confirmed heterotopic ossification at the central component of the plantar fascia. Pain and function were assessed with the Foot Function Index (FFI). Under ultrasound and fluoroscopic guidance, percutaneous ultrasonic debridement with Tenex™ was performed following tibial and sural nerve block and conscious sedation. The procedure was completed in 6 min and 29 s of cutting time. After surgery, the patient wore a protective shoe for 3 weeks, followed a relative rest protocol, and received NSAIDs for 5 days. At 48–72 h, the patient reported noticeable pain relief, with significant functional improvement after 1 month. Conclusions: This case shows how Tenex™ effectively treats plantar fascia HO. It led to quick symptom relief and functional recovery. The ultrasonic percutaneous debridement with Tenex™ was a safe and effective option compared to open surgery for this patient. However, more research is needed to set standardized treatment protocols and assess long-term results.

Background: Tendons are among the most frequently affected structures in musculoskeletal disorders. Polynucleotides (PNs) have been proposed to promote tendon regeneration by enhancing collagen synthesis and reducing inflammation. This retrospective clinical study aimed to evaluate the clinical effects of PNs injections in patients with different kinds of tendinopathy (mostly gluteal tendinopathy, biceps brachii tendinopathy and Achilles tendinopathy), focusing on pain reduction and functional improvement. Methods: Sixty-eight patients with clinically diagnosed tendinopathy received three peritendinous injections of a PNs-based medical device at baseline (T0), two weeks (follow-up 1), and four weeks (follow-up 2) post-T0. Follow-up assessments were conducted at follow-up 1, follow-up 2-, eight- and 24-weeks post-follow-up 2. The primary outcome was pain reduction measured by the numerical rating scale (NRS). Secondary outcomes included pain-related functional limitation (VAS-function), the Clinical Global Impression-Improvement scale, and patient satisfaction on a 5-point Likert scale. Results: A mean NRS and VAS-function reduction of, respectively, -1.76 ± 0.08 and -1.74 ± 0.07 were found per follow-up, with statistically significant improvements over time. At the final follow-up, 88% of patients reported being "satisfied" or "very satisfied" with the treatment. Conclusions: The results support the efficacy and safety of PNs treatment in patients with tendinopathies, as it led to significant improvements in pain and function. Further high-quality clinical studies are needed to validate these findings.

Sulforaphane modulates macrophage polarization via JAK1/STAT1 inhibition to promote tendon repair in tendinopathy.

The October 2025 Foot & Ankle Roundup360 looks at: Immediately better results: weightbearing after ankle fracture fixation; Total ankle arthroplasty in rheumatoid arthritis: important gains in those with poorer overall outcomes; Can a minimally invasive osteotomy really solve Achilles insertional tendinopathy?; Satisfactory sesamoid reduction: an easy cue for first metatarsal pronation; Mental health disorders linked to poorer subjective outcomes and higher complications after total ankle arthroplasty; A viable alternative to the Bostrom procedure for lateral ankle instability?; Platelet-rich plasma offers no meaningful benefit over placebo in Achilles tendinopathy treatment; Minimally invasive surgery outperforms extensile lateral approach in reducing wound complications after calcaneal fracture repair.

Modern approaches in the treatment of Achilles tendinopathy: future technologies and standards of modern therapy

Background:Injections of compound betamethasone (BT) combined with lidocaine (LD) have been applied for the treatment of rotator cuff tendinopathy; however, their effects on human rotator cuff tendon cells remain unknown.Purpose:To explore the cytocompatibility of BT and LD on degenerative human rotator cuff tendon cells.Study Design:Controlled laboratory study.Methods:BT and LD were diluted in cell culture medium (Dulbecco’s modified Eagle medium) to match their common clinical concentrations, and degenerative rotator cuff tendon cells were cultured with the drugs for 24 hours. Cell morphology and density were monitored for 21 days after the treatment. To identify the safe concentrations, the viability, apoptosis, proliferation, and cytoskeleton of tendon cells were investigated. An enzyme-linked immunosorbent assay was performed to analyze the influence of the selected concentrations on extracellular matrix expressions.Results:When treated with the common clinical concentrations of 0.7 mg/mL BT and 0.5% LD, or their combination, tendon cells exhibited significant changes in cell morphology, along with reduced cell viability. Higher concentration, particularly LD concentration, exacerbated these side effects. In contrast, treatment with lower concentrations of BT, LD, or their combination did not induce notable cytotoxicity or alterations in cell morphology and extracellular matrix composition, indicating a potential safety threshold for clinical application. Compared with the effects of BT or LD alone, the combination of BT and LD enhanced cytotoxicity, which was primarily driven by LD. Based on in vitro cytocompatibility assays, the relatively safe concentrations were determined to be 0.175 mg/mL for BT, 0.05% for LD, and a combination of 0.175 mg/mL BT + 0.025% LD.Conclusion:BT and LD demonstrate concentration-dependent cytotoxicity in degenerative rotator cuff tendon cells, with the combined treatment of BT and LD enhancing this effect, wherein LD plays a predominant role. The relatively safe concentrations for BT, LD, and their combination resulted in only transient alterations, with complete recovery of cell morphology and viability observed.Clinical Relevance:This finding can serve as a potential reference for the safer clinical application of BT and LD, especially in the treatment of degenerative rotator cuff tendinopathy.

Introduction. Eccentric and concentric exercises are fundamental components of resistance training in orthopedic rehabilitation. Differences in contraction mechanics influence their clinical application – eccentric contractions generate greater force at a lower metabolic cost, whereas concentric exercises are better tolerated during the early stages of therapy. This review aimed to compare the effectiveness of eccentric and concentric exercises in orthopedic rehabilitation and to formulate practical therapeutic recommendations for use in this context. Methods. A total of 40 publications from 1998 to 2024 were analyzed, covering tendinopathies, rehabilitation following total knee arthroplasty (TKA) and total hip arthroplasty (THA), older adult populations, and data on muscular adaptations and safety. Outcomes included pain reduction, strength gains, functional improvements, and exercise tolerance. Results. Eccentric exercises demonstrated superior efficacy in reducing pain and improving function in chronic tendinopathies (Achilles, patellar, rotator cuff, and lateral epicondyle). In post-TKA and THA rehabilitation, eccentric training was more effective in restoring muscle strength and dynamic function compared to concentric protocols. Among older adults, eccentric exercise improved muscle strength and balance with good tolerance. Electromyographic analyses confirmed the greater neuromuscular efficiency of eccentric training, and its safety has been well-documented in multiple clinical trials. Conclusions. Eccentric exercises show greater clinical effectiveness than concentric exercises in the treatment of tendinopathies and post-operative rehabilitation following TKA and THA – particularly in terms of strength restoration, functional recovery, and pain reduction. In older populations, eccentric training enhances balance and physical performance with lower metabolic demands. When appropriately dosed, eccentric training is both safe and effective. A progressive strategy that integrates both contraction types, tailored to the rehabilitation phase and patient capabilities, yields the most favorable outcomes.

Valdecoxib Ameliorates Apoptosis and Ferroptosis in Tenocytes via the SIRT6/NRF2-Mediated Suppression of Oxidative Stress.

Tenogenic potential of tendon-derived mesenchymal stem cells isolated post-mortem: Impact of cryopreservation.

Purpose The purpose of this study is to improve understanding of which perioperative variables may influence outcomes and return to activity after arthroscopic debridement of patellar tendinopathy. Methods A keyword search was performed in the PubMed, Embase, CINAHL, Scopus, and Cochrane databases for prospective articles published from 2000 to March, 2024 that studied arthroscopic intervention for refractory patellar tendinopathy. 1885 articles were screened using PRISMA guidelines. Outcomes included subjective Success, Return to Sport (RTS) and patient reported outcomes measures (PROMs). Variables included operative techniques of patellar bony work (PBW), Hoffa’s fat pad debridement (HFPD), peripatellar denervation (DNRV), pre-operative duration of symptoms (DOS), and post-operative immobilization (POI). Data were analyzed descriptively and plotted with I2 and 95% confidence intervals where appropriate. Results Eight prospective arthroscopic studies with a total of 260 patients were included in analysis, with mean follow-up 45.2 months (range 6-79). Average success and RTS rates were 90.2% (range 80-100%) and 90.6% (range 85.7-100%), respectively. There was a weak negative correlation between subjective success rate and DOS (R2=0.14). Studies reported RTS times ranging from 2.2 months to 4.96 months from the day of surgery. Conclusions For refractory patellar tendinopathy, arthroscopic debridement of the patellar tendon is a safe and effective procedure that allows rapid return to sport. Surgeons may elect to forgo patellar bony work and Hoffa’s fat pad debridement in favor of a conservative approach for athletes seeking to return to sport quickly. However, these decisions should always be considered in the circumstances of the individual patient and intraoperative findings.

Tendinopathy treatment is hindered by persistent inflammation and irreversible matrix degradation, with current therapies offering transient symptom relief without addressing disease progression. Here, we developed an mRNA-based anti-inflammatory strategy utilizing SM102 lipid nanoparticles (LNPs) to deliver interleukin-1 receptor antagonist (Il1rn) mRNA for tendon repair. SM102-LNPs demonstrated efficient transfection of primary tendon stem cells, sustaining IL-1RA protein expression for over 72 h and neutralizing IL-1β-induced inflammatory cascades. In vitro, IL-1RA suppressed pro-inflammatory cytokines (TNF-α, IL-6, iNOS), restored collagen I/III balance, and enhanced cell migration. In collagenase-induced tendinopathy mice, a single SM102-Il1rn mRNA injection attenuated inflammation, reduced MMP1/13 expression, and improved collagen alignment within 1 week. By 4 weeks, treated tendons exhibited functional recovery with normalized gait patterns. Transcriptomics revealed dual modulation of IL-1 signaling and extracellular matrix (ECM) remodeling pathways, alongside macrophage polarization and oxidative stress regulation. Systemic safety was confirmed by unaltered serum biomarkers and organ histology. This SM102-Il1rn mRNA therapy enables spatiotemporally controlled anti-inflammatory therapy, providing a promising non-surgical solution for refractory tendinopathies. Its adaptable design allows expansion to other regenerative targets, advancing precision treatment for musculoskeletal degeneration.

Which nonoperative treatments for patellar tendinopathy provide the greatest improvement and pain reduction?

Are self-reported exercise adherence measures associated with pain and function outcomes among participants receiving treatment for Achilles tendinopathy? A secondary analysis of a randomised controlled trial.

Ultrasound imaging of the knee is a highly valuable modality that enhances diagnostic accuracy and optimizes the precision of injection therapy. This article reviews the application of ultrasound in various knee interventions, including intra-articular injections, treatments for prepatellar bursitis and patellar ligament tendinopathy, pes anserinus, iliotibial band procedures, and guidance for popliteal fossa pathologies. Detailed guidance is provided on probe selection, patient positioning, and procedural techniques for specific anatomical targets. Key considerations include optimizing needle placement using in-plane and out-of-plane techniques, ensuring accurate interventions, minimizing risks such as cartilage injury or vascular complications, and achieving effective therapeutic delivery. Text is supplemented with anatomical notes.

Tendon overuse models have different effects on tissue mechanical properties in ex vivo bovine tendons.

Exploring the potential mechanism of the active components of Rhizoma Coptidis in tendinopathy treatment applying network pharmacology and molecular docking analysis

Changes in patellar tendon stiffness and mechanical strength test using collagenase injection: Verification ex vivo experiment using porcine model.

Objectives: This study aimed to investigate the efficacy of Percutaneous Electrolysis (PE), Percutaneous peripheral Nerve Stimulation (PNS), and Eccentric Exercise (EE) in patients with supraspinatus tendinopathy. Methods: Forty-six participants with supraspinatus tendinopathy were randomly allocated to either an invasive therapy group (four sessions in four weeks of PE+PNS and EE program) or a conventional physical therapy group (ten sessions for 2 weeks). The multimodal physical program included Ultrasound therapy (US), Transcutaneous Electric Nerve Stimulation (TENS) and the same EE program. The Numerical Pain Rating Scale (NPRS), shoulder Range of Motion (ROM), Pressure Pain Threshold (PPT), and disability (DASH and SPADI) were measured at baseline, at the end of treatment, and at 12- and 24-weeks follow-up. Results: The PE+PNS+EE group demonstrated consistently greater and statistically significant improvements across nearly all pain, mobility, and functional outcomes at all follow-up points (post-treatment, 12-weeks, and 24-weeks) compared to the TENS+US+EE group, with generally medium to large effect sizes. Conclusions: This study concludes that the combined PE+PNS+EE intervention offers safe and effective treatment for supraspinatus tendinopathy, demonstrating statistically significant improvements in pain, mobility, and function compared to conventional electrotherapy.

Introduction: Hyaluronic acid (HA) is a long, unbranched polysaccharide classified as a glycosaminoglycan. Since its isolation from the vitreous body of an ox in 1934 by Karl Meyer and John Palmer, HA has attracted considerable interest across medical disciplines. Naturally occurring HA possesses several favorable properties, including high water-binding capacity, biocompatibility, viscoelasticity, free radical scavenging, and unique rheological characteristics. It also exhibits anti-inflammatory, antiangiogenic, and immunosuppressive effects, contributing to its increasing popularity—especially in orthopedics. HA is present in high concentrations within synovial fluid, joint capsules, and cartilage, making it highly relevant in conditions involving joint degeneration or injury. Accordingly, HA-based therapies have found widespread application in treating osteoarthritis, rheumatoid arthritis, tendinopathies, and other soft tissue disorders. Aim: The aim of this work is to evaluate the clinical relevance, efficacy, and safety of hyaluronic acid (HA) in the treatment of orthopedic conditions, particularly osteoarthritis, tendinopathies, and other soft tissue injuries. The objective is to clarify HA's therapeutic value, especially via intra-articular injection, amid ongoing debate regarding its clinical effectiveness compared to placebo and standard non-surgical treatments. Materials and Methods: This review is based on an analysis of numerous studies, particularly randomized controlled trials (RCTs), that assessed the efficacy of HA in orthopedic applications. Emphasis was placed on comparing HA treatment outcomes—most notably intra-articular injections—with those of placebo and conventional non-operative therapies. Literature was reviewed from relevant medical databases and peer-reviewed sources. Results: Evidence from multiple studies suggests that intra-articular HA injections can lead to improvements in pain and joint function compared to baseline or non-surgical treatments. However, many randomized controlled trials have shown no statistically significant advantage of HA over placebo. Despite this, patient-reported outcomes often indicate symptom relief and improved function following HA administration. Conclusion: Due to conflicting data regarding its clinical utility, the use of HA in orthopedics remains a topic of ongoing debate. Nonetheless, HA's favorable safety profile and biological properties support its consideration in selected orthopedic cases. When used appropriately, HA injections may offer a viable non-surgical option for managing joint and soft tissue disorders.

Tendinopathies are among the leading causes of Nova Scotia's high rate of disability and the incidence of tendinopathy is increasing in developed nations with aging populations. The considerable impact of tendinopathies may stem from a shortfall of effective treatments. Presently, even the most successful medical interventions cannot fully restore the properties of damaged tendons. This gap signals a need for novel treatments with the potential to improve tissue regeneration. Increased research into treatments involving (i) transcutaneous nitric oxide, (ii) sclerotherapy, (iii) extracorporeal shock wave therapy, (iv) the administration of growth factors, (v) stem cell therapy, and (vi) biomaterials could help reduce individual suffering, strengthen Nova Scotia's workforce, and decrease the portion of the population relying on limited provincial disability payouts and stipends for disabled persons.