Victorian Institute Of Sport Assessment-Patella Research Articles

Translation and Cross-cultural Adaptation and Version of the Victorian Institute of Sport Assessment-Patella (VISA-P) Scale to Turkish

Purpose:It is important to objectively measure symptoms and functional limitations related to patellar tendinopathy using outcome measures that have been validated in the language of the target population. Cross-cultural adaptations are also useful to enhance the understanding of the measurement properties of an assessment tool, regardless of the target language. The aim of the study to translate and adapt the Victorian Institute of Sport Assessment-Patella (VISA-P) questionnaire to Turkish.Methods:The translation and cultural adaptation were performed according to international recommendations. In the first stage, 2 Turkish individuals with a good command of English were responsible for the literal and conceptual translation of the VISA-P. The informed translator was a physical therapist, and the uninformed translator was a teacher. Both translators were fluent in English and spoke Turkish as their mother tongue. The translations were completed independently. In the second stage, both translations were compared and reviewed by a bilingual individual who highlighted any conceptual errors or inconsistencies in the translations to establish the first Turkish translation. In the third stage, after the first Turkish translation was agreed upon, 2 native English speakers with a good command of Turkish separately translated the finalized Turkish translation back into English. In the fourth stage, the back-translated version of the VISA-P was compared to the initial English version of the VISA-P. The committee evaluated the 4 translations and compared the discrepancies. After discussing the discrepancies, the committee finalized and approved the Turkish version of the VISA-P. In the final stage, prelimi-nary testing was performed. with 22 patients and 40 healthy participants to determine comprehension of the Turkish version.Results:Preliminary testing was conducted on 22 patients (12 male, mean ± SD age, 27.5 ± 6.6 years) who fulfilled the eligibility criteria and 40 healthy participants (30 male, mean ± SD age, 25.7 ± 4.9 years) of the study to determine comprehension of the Turkish version. The patients and healthy participants did not report any difficulties of the understanding of the questions.Conclusion:The VISA-P was translated and adapted to the Turkish language and can be used in clinical evaluation on the patellar tendinopathy. Additional studies are underway with the objective of evaluating the reproducibility and validity of the Turkish translation.

Refractory patella tendinopathy with failed conservative treatment—shock wave or arthroscopy?

To identify whether the location of refractory patella tendinopathy (PT) has an effect on treatment modality (radial extracorporeal shock wave therapy (rESWT) or arthroscopic debridement). Between 2012 and 2014, 40 patients with PT underwent a magnetic resonance imaging (MRI) scan. This confirmed the diagnosis as either involving the tendon itself (group A, 20) or with retropatella fat pad extension (group B, 20). All patients underwent rESWT. If there was no improvement patients proceeded with surgery in the form of arthroscopic debridement (by senior authors CW and AG). Outcomes were assessed before and after treatment using the Victorian Institute of Sports Assessment-Patella (VISA-P) score. There were 18 males and 2 females in group A and 15 males and 5 females in group B. The mean age was 41.4 years in group A (23-59) and 34.7 in group B (19-52). Seventeen of 20 in group A reported good or excellent outcomes and did not require surgical intervention (remaining three improved after second course of ESWT). All patients in group B failed to improve with rESWT, resulting in arthroscopic debridement and reported good or excellent outcomes. After 6 months, group A mean VISA-P score increased from 50.2 to 65.0 ( p = 0.01) and group B from 39.6 to 78.4 ( p = <0.001). An MRI should be performed to determine the precise location of tendinosis in patients with refractory PT who fail standard conservative management. If the MRI scan shows intratendon changes only, ESWT should be performed and those with extension into the fat pad should proceed to arthroscopic debridement without rESWT.

Randomized controlled trial comparing the effectiveness of the ultrasound-guided galvanic electrolysis technique (USGET) versus conventional electro-physiotherapeutic treatment on patellar tendinopathy.

BackgroundPatellar tendinopathy has a high prevalence rate among athletes. Different therapeutic options can be found in the current literature, but none of them has been clearly established as the gold standard. The purpose of this study is to compare, in a randomized controlled trial, the clinical efficacy of eccentric exercise combined with either an ultrasound-guided galvanic electrolysis technique (USGET) or conventional electrophysiotherapy to treat patellar tendinopathy.MethodsSixty patients diagnosed with patellar tendinopathy were randomized into two groups. Group 1 (n = 30) received electrophysiotherapy treatment consisting of ultrasound, laser and interferential current techniques. Group 2 (n = 30) received USGET. Both groups did the same standardized eccentric exercise program. Periodic assessments of the subjects were carried out with the Victorian Institute of Sport Assessment-Patella (VISA-P) score. An analysis of means and a survival study were performed.ResultsThere were statistically significant differences in the VISA-P between the baseline and final follow-up in each treatment group. Group 1 (conventional electrophysiotherapy) went from 52.5 ± 18.8 to 61.9 ± 13.7 (in VISA-P < 90 subgroup) and from 69.1 ± 9.1 to 95.2 ± 2.5 (in VISA-P > 90 subgroup). Group 2 (USGET) went from 51.4 ± 17.9 to 63.3 ± 14.3 (in VISA-P < 90 subgroup) and from 66.3 ± 13.1 to 97.1 ± 1.7 (in VISA-P > 90 subgroup). There were statistically significant correlations between the baseline and final score in the VISA-P > 90 subjects upon completing the study but no statistically significant correlations between subjects with VISA-P < 90. The mean number of sessions applied was 22.6 ± 2.5 in Group 1 and 3.2 ± 0.9 in Group 2. The success probability in Group 1 was 36.1% versus 72.4% in Group 2. The difference was statistically significant.ConclusionThe results obtained with the combination of USGET and eccentric exercise reported better outcomes than with the conventional electrophysiotherapy techniques in the treatment of patellar tendinopathy.

Cross-cultural Adaptation and Validation of the Victorian Institute of Sport Assessment-Patella Questionnaire for French-Speaking Patients With Patellar Tendinopathy.

Study Design Clinical measurement study. Background The Victorian Institute of Sport Assessment-Patella (VISA-P), originally developed in English, assesses the severity of patellar tendinopathy symptoms. To date, no French version of the questionnaire exists. Objectives The aim of our study was to translate the VISA-P into French and verify its psychometric properties. Methods The translation and cultural adaptation were performed according to international recommendations in 6 steps: initial translation, translation merging, back translation to the original language, use of an expert committee to reach a prefinal version, test of the prefinal version, and expert committee appraisal of a final version. Afterward, the psychometric properties of the final French version (VISA-PF) were assessed in 92 subjects, divided into 3 groups: pathological subjects (n = 28), asymptomatic subjects (n = 22), and sports-risk subjects (n = 42). Results All members of the expert committee agreed with the final version. On a scale ranging from 0 to 100, with 100 representing an asymptomatic subject, the average ± SD scores on the VISA-PF were 53 ± 17 for the pathological group, 99 ± 2 for the healthy group, and 86 ± 14 for the sports-risk group. The test-retest reliability of the VISA-PF was excellent, with good internal consistency. Correlations between the VISA-PF and divergent validity of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) were low, and the correlation coefficient values measured between the VISA-PF scores and converged items of the SF-36 were higher. Conclusion The VISA-PF is understandable, valid, and suitable for French-speaking patients with patellar tendinopathy. J Orthop Sports Phys Ther 2016;46(5):384-390. Epub 21 Mar 2016. doi:10.2519/jospt.2016.5937.

Confirmatory factor analysis of VISA-P scale and measurement invariance across sexes in athletes with patellar tendinopathy

BackgroundThe Victorian Institute of Sport Assessment–Patella (VISA-P) scale is the most condition-specific patient-reported outcome measure used to assess symptom severity in athletes with patellar tendinopathy. Previous exploratory factor analyses have been conducted to evaluate the scale's dimensionality, with inconsistent results, and the factor structure of the scale remains unclear. The aims of the present study were to determine the factorial structure of the VISA-P scale using confirmatory factor analysis (CFA) and test measurement invariance across sexes. MethodsThe study included a convenience sample of 249 Spanish athletes with patellar tendinopathy. CFA was performed to assess factorial validity. Hypothesized 1- and 2-factor models were tested. Measurement invariance across sexes was evaluated via multi-group CFA with several fit indices using EQS 6.1 software. ResultsThe internal consistency coefficient was 0.74. Several CFA models were examined and the 1-factor model in which errors for Items 7 and 8 were correlated showed acceptable fit in terms of comparative fit index (CFI) and goodness-of-fit index (GFI) statistics (CFI = 0.93; GFI = 0.94; standardized root mean square residual = 0.06; root mean square error of approximation = 0.10; 90% confidence interval: 0.08–0.13). This model was invariant across sexes. ConclusionThe 1-factor model of the Spanish version of the VISA-P scale (VISA-P-Sp) in which errors for Items 7 and 8 were correlated demonstrated relative fit in CFA. Scores obtained via VISA-P-Sp can be compared between men and women without sexes bias. Further studies should examine the VISA-P scale and other single-score patient-reported outcome measures concurrently.

A soft patellar tendon on ultrasound elastography is associated with pain and functional deficit in volleyball players

To investigate the diagnostic performance of grey scale Ultrasound (US), power Doppler (PD) and US elastography for diagnosing painful patellar tendinopathy, and to establish their relationship with Victorian Institute of Sport Assessment-Patella (VISA-P) scores in a group of volleyball players with and without symptoms of patellar tendinopathy. Cross-sectional study. Thirty-five volleyball players (70 patellar tendons) were recruited during a national university volleyball competition. Players were imaged with conventional US followed by elastography. The clinical findings of painful patellar tendons were used as the reference standard for diagnosing patellar tendinopathy. In addition, all participants completed the VISA-P questionnaires. Of the 70 patellar tendons, 40 (57.1%) were clinically painful. The diagnostic accuracy of grey scale US, PD and elastography were 60%, 50%, 62.9%, respectively, with sensitivity/specificity of 72.5%/43.3%, 12.5%/100%, and 70%/53.3%, respectively. Combined US elastography and grey scale imaging achieved 82.5% sensitivity, 33.3% specificity and 61.4% accuracy while routine combination technique of PD and grey scale imaging revealed 72.5% sensitivity, 43.3% specificity and 60.0% accuracy. Tendons in players categorized as soft on elastography had statistically significantly greater AP thickness (p<0.001) and lower VISA-P scores (p=0.004) than those categorized as hard. There was no significant association between grey scale US abnormalities (hypoechogenicities and/or fusiform swelling) and VISA-P scores (p=0.098). Soft tendon properties depicted by US elastography may be more related to patellar tendon symptoms compared to grey scale US abnormalities. The supplementation of US elastography to conventional US may enhance the sensitivity for diagnosing patellar tendinopathy in routine clinical practice.

Platelet-rich plasma as a treatment for chronic patellar tendinopathy: comparison of a single versus two consecutive injections

platelet-rich-plasma is increasingly used in chronic patellar tendinopathy. Ideal number of PRP injections needed is not yet established. This study compares the clinical outcomes of a single versus two consecutive PRP injections. between December 2009 and January 2012, 40 athletes with proximal patellar tendinopathy were treated by PRP injection. Patients received single (20 patients) or two PRP injections 2 weeks apart (20 patients). All patients underwent prospective clinical evaluation, including Victorian Institute of Sport Assessment-Patella (VISA-P) score, visual analog scale (VAS) for pain, and Tegner scale before PRP and after a minimum of 2 year follow-up. 9 patients failed PRP treatment and needed surgery. 1 patient was lost to follow-up. For the remaining patients, the VISA-P, VAS, and Tegner scores all significantly improved from 35.2 to 78.5 (p = 0.0001), 6.6 to 2.4 (p = 0.0001), and 4.8 to 6.9 (p = 0.0003). Patients who received two injections had better scores than those who received single injection with VAS of 1.07 versus 3.7 (p = 0.0005), Tegner score of 8.1 versus 5.9 (p = 0.0003) and VISA-P of 93.2 versus 65.7 (p = 0.0001). two consecutive PRP injections in chronic patellar tendinopathy showed better improvement in outcomes when compared to single injection. randomized prospective consecutive series, Level 2.

Changes in morphological and elastic properties of patellar tendon in athletes with unilateral patellar tendinopathy and their relationships with pain and functional disability.

BackgroundPatellar tendinopathy (PT) is one of the most common knee disorders among athletes. Changes in morphology and elasticity of the painful tendon and how these relate to the self-perceived pain and dysfunction remain unclear.ObjectivesTo compare the morphology and elastic properties of patellar tendons between athlete with and without unilateral PT and to examine its association with self-perceived pain and dysfunction.MethodsIn this cross-sectional study, 33 male athletes (20 healthy and 13 with unilateral PT) were enrolled. The morphology and elastic properties of the patellar tendon were assessed by the grey and elastography mode of supersonic shear imaging (SSI) technique while the intensity of pressure pain, self-perceived pain and dysfunction were quantified with a 10-lb force to the most painful site and the Victorian Institute of Sport Assessment-patella (VISA-P) questionnaire, respectively.ResultsIn athletes with unilateral PT, the painful tendons had higher shear elastic modulus (SEM) and larger tendon than the non-painful side (p<0.05) or the dominant side of the healthy athletes (p<0.05). Significant correlations were found between tendon SEM ratio (SEM of painful over non-painful tendon) and the intensity of pressure pain (rho = 0.62; p = 0.024), VISA-P scores (rho = −0.61; p = 0.026), and the sub-scores of the VISA-P scores on going down stairs, lunge, single leg hopping and squatting (rho ranged from −0.63 to −0.67; p<0.05).ConclusionsAthletes with unilateral PT had stiffer and larger tendon on the painful side than the non-painful side and the dominant side of healthy athletes. No significant differences on the patellar tendon morphology and elastic properties were detected between the dominant and non-dominant knees of the healthy control. The ratio of the SEM of painful to non-painful sides was associated with pain and dysfunction among athletes with unilateral PT.

Autologous Growth Factor Injections in Chronic Tendinopathy

Reference: de Vos RJ, van Veldhoven PLJ, Moen MH, Weir A, Tol JL. Autologous growth factor injections in chronic tendinopathy: a systematic review. Br Med Bull. 2010;95:63–77. Clinical Question: The authors of this systematic review evaluated the literature to critically consider the effects of growth factors delivered through autologous whole-blood and platelet-rich–plasma (PRP) injections in managing wrist-flexor and -extensor tendinopathies, plantar fasciopathy, and patellar tendinopathy. The primary question was, according to the published literature, is there sufficient evidence to support the use of growth factors delivered through autologous whole-blood and PRP injections for chronic tendinopathy? Data Sources: The authors performed a comprehensive, systematic literature search in October 2009 using PubMed, MEDLINE, EMBASE, CINAHL, and the Cochrane library without time limits. The following key words were used in different combinations: tendinopathy, tendinosis, tendinitis, tendons, tennis elbow, p...

Are Multiple Platelet-Rich Plasma Injections Useful for Treatment of Chronic Patellar Tendinopathy in Athletes?

Background: Chronic patellar tendinopathy (PT) is one of the most common overuse knee disorders. Platelet-rich plasma (PRP) appears to be a reliable nonoperative therapy for chronic PT. Purpose: To evaluate clinical and radiological outcomes of 3 consecutive ultrasound (US)–guided PRP injections for the treatment of chronic PT in athletes. Study Design: Case series; Level of evidence, 4. Methods: A total of 28 athletes (17 professional, 11 semiprofessional) with chronic PT refractory to nonoperative management were prospectively included for US-guided pure PRP injections into the site of the tendinopathy. The same treating physician at a single institution performed 3 consecutive injections 1 week apart, with the same PRP preparation used. All patients underwent clinical evaluation, including the Victorian Institute of Sport Assessment–Patella (VISA-P) score, visual analog scales (VAS) for pain, and Lysholm knee scale before surgery and after return to practice sports. Tendon healing was assessed with MRI at 1 and 3 months after the procedure. Results: The VISA-P, VAS, and Lysholm scores all significantly improved at the 2-year follow-up. The average preprocedure VISA-P, VAS, and Lysholm scores improved from 39 to 94 (P < .001), 7 to 0.8 (P < .0001), and 60 to 96 (P < .001), respectively, at the 2-year follow-up. Twenty-one of the 28 athletes returned to their presymptom sporting level at 3 months (range, 2-6 months) after the procedure. Follow-up MRI assessment showed improved structural integrity of the tendon at 3 months after the procedure and complete return to normal structural integrity of the tendon in 16 patients (57%). Seven patients did not recover their presymptom sporting level (among them, 6 were considered treatment failures): 3 patients returned to sport at a lesser level, 1 patient changed his sport activity (for other reasons), and 3 needed surgical intervention. Conclusion: In this study, application of 3 consecutive US-guided PRP injections significantly improved symptoms and function in athletes with chronic PT and allowed fast recovery to their presymptom sporting level. The PRP treatment permitted a return to a normal architecture of the tendon as assessed by MRI.

Clinical results after ultrasound-guided intratissue percutaneous electrolysis (EPI®) and eccentric exercise in the treatment of patellar tendinopathy

To investigate the outcome of ultrasound (US)-guided intratissue percutaneous electrolysis (EPI(®)) and eccentric exercise in the treatment of patellar tendinopathy during a long-term follow-up. Forty patients with patellar tendinopathy were prospectively evaluated over a 10-year follow-up period. Pain and function were evaluated before treatment, at 3months and at 2, 5 and 10years using the Victorian Institute of Sport Assessment-Patella (VISA-P) score, the Tegner score and Blazina's classification. According to VISA-P score at baseline, patients were also dichotomized into Group 1 (<50 points) and Group 2 (≥50 points). There were 21 patients in Group 1 and 19 in Group 2. Patient satisfaction was measured according to the Roles and Maudsley score. The VISA-P score improved globally by 41.2 points (p<0.01) after a mean 4.1 procedures. In Group 1, VISA-P score improved from 33.1±13 to 78.9±14.4 at 3-month and to 88.8±10.1 at 10-year follow-up (p<0.001). In Group 2, VISA-P score improved from 69.3±10.5 to 84.9±9 at 3-month and to 96.0±4.3 at 10-year follow-up (p<0.001). After 10years, 91.2% of the patients had a VISA-P score >80 points. The same level (80% of patients) or the Tegner score at no more than one level lower (20% of patients) was restored, and 97.5% of the patients were satisfied with the procedure. Treatment with the US-guided EPI(®) technique and eccentric exercises in patellar tendinopathy resulted in a great improvement in knee function and a rapid return to the previous level of activity after few sessions. The procedure has proved to be safe with no recurrences on a long-term basis. Therapeutic study, Level IV.

Comparing PRP Injections With ESWT for Athletes With Chronic Patellar Tendinopathy

To compare the effectiveness of injections of platelet-rich plasma (PRP) compared with focused extracorporeal shock-wave therapy (ESWT) among athletes with chronic patellar tendinopathy (jumper's knee). Randomized controlled single-center trial, with 12 months of follow-up. Tertiary-level care in Rome, Italy. Patients were recruited from January 2009 to May 2011. Patients who received a diagnosis of jumper's knee from a participating physician were recruited into the study (n = 46). Inclusion criteria were chronic (≥6 months), unilateral, proximal patellar tendinopathy in a recreational or elite athlete confirmed by ultrasound (US); prior failed nonoperative management that concluded ≥12 weeks prior to study entry; and ages 18 to 50 years. Exclusion criteria were coexisting knee lesions, systemic disorders, knee surgery or corticosteroid injection in the previous 3 months, and contraindications to PRP treatment. Patients in the PRP group (n = 23) received 2 US-guided injections separated by 1 week and directed at the affected tendon portion. Each injection consisted of 2 mL of nonactivated, autologous PRP extracted from a single centrifugation of 10-mL blood and administered by a trained physician via a 22-guage needle. Patients in the focused ESWT group (n = 23) received 3 treatments (2400 impulses at 0.17-0.25 mJ/mm per session) separated by 48 to 72 hours. Treatments were guided by inline US and administered by 1 experienced operator. No local anesthesia was used in either group. One week later, both groups began a conventional stretching and strengthening program for 2 weeks. At 4 weeks, patients gradually resumed normal activities and sports, as tolerated. At 2, 6, and 12 months after treatment, patients were assessed by a single investigator, blinded to group assignment. The main measure was the Italian version of the Victorian Institute of Sports Assessment-Patella (VISA-P) questionnaire, which evaluates severity of symptoms, function, and ability to participate in sport. A 10-cm visual analog scale (VAS) was used to assess pain while doing 5 single-leg squats. Patients also assessed their response to treatment on the Blazina scale (excellent to poor). No patients were lost to follow-up During the 12-month follow-up period, VISA-P scores for both groups improved significantly from baseline (55.3 for PRP, 56.1 for ESWT), although the PRP group had greater improvement at 6 months (86.7 vs 73.7; P = 0.014) and 12 months (91.3 vs 77.6; P = 0.026). Pain scores during 5 single-leg squats demonstrated similar findings. At 12 months a greater proportion of patients in the PRP group rated their response to treatment as good or excellent (PRP, 91.3% vs ESWT, 60.8%; P = 0.035), although at earlier follow-ups the groups did not differ. Both the injections and ESWT caused transient discomfort. No patient had surgery during follow-up. Athletes with chronic patellar tendinopathy responded positively to both PRP injection and ESWT. However, the PRP-treated patients demonstrated significantly greater improvements in VISA-P and pain scores by 6 months and significantly better functional outcomes and satisfaction based on a modified Blazina scale, at 12 months.

THU0560 Hyaluronan Alone, Combined with Botulinus Toxin or Placebo Injection Therapy for Athletic Patients with Patellar Tendinopathy (Jumpers Knee)

BackgroundPatellar tendinopathy produces activity-related pain and focal tenderness at the attachment of the patellar tendon at the lower pole of the patella. Despite its frequency and negative impact on athletics,...

No difference in effectiveness between focused and radial shockwave therapy for treating patellar tendinopathy: a randomized controlled trial

The aim of the study was to compare the effectiveness of focused shockwave therapy (FSWT) and radial shockwave therapy (RSWT) for treating patellar tendinopathy. Patients were randomized into two groups. One group received three sessions of FSWT, and the other group received three sessions of RSWT. Both groups also received an eccentric training programme. Follow-up measurements took place 1, 4, 7 and 14weeks after the final shockwave treatment. The primary outcome measure was the Victorian Institute of Sport Assessment-Patella (VISA-P) questionnaire. Secondary outcome measures were pain during ADL, sports activities and the decline squat. Forty-three subjects (57 tendons) were included in the study. Twenty-one subjects (31 tendons) received FSWT, and 22 subjects (26 tendons) received RSWT. Both groups improved significantly on the VISA-P score, but there were no differences in improvement between the FSWT group (15 points on the VISA-P) and the RSWT group (9.6 points, n.s.). This was also the case for the secondary outcome measures. There were no statistically significant differences in effectiveness between FSWT and RSWT. It is therefore not possible to recommend one treatment over the other on grounds of outcome. Both groups improved significantly, although it is questionable whether this difference is clinically relevant. II.

Platelet-Rich Plasma Versus Focused Shock Waves in the Treatment of Jumper’s Knee in Athletes

Background: Tendinopathies represent a serious challenge for orthopaedic surgeons involved in treatment of athletes. Purpose: To compare the effectiveness and safety of platelet-rich plasma (PRP) injections and focused extracorporeal shock wave therapy (ESWT) in athletes with jumper’s knee. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Forty-six consecutive athletes with jumper’s knee were selected for this study and randomized into 2 treatment groups: 2 autologous PRP injections over 2 weeks under ultrasound guidance (PRP group; n = 23), and 3 sessions of focused extracorporeal shock wave therapy (2.400 impulses at 0.17-0.25 mJ/mm2 per session) (ESWT group; n = 23). The outcome measures were Victorian Institute of Sports Assessment–Patella (VISA-P) questionnaire, pain visual analog scale (VAS), and modified Blazina scale. A reviewer who was blinded as to the group allocation of participants performed outcome assessments before treatment and at 2, 6, and 12 months after treatment. Nonparametric tests were used for within-group (Friedman/Wilcoxon test) and between-group (Kruskal-Wallis/Fisher test) testing, and the significance level was set at .05. Results: The 2 groups were homogeneous in terms of age, sex, level of sports participation, and pretreatment clinical status. Patients in both groups showed statistically significant improvement of symptoms at all follow-up assessments. The VISA-P, VAS, and modified Blazina scale scores showed no significant differences between groups at 2-month follow-up (P = .635, .360, and .339, respectively). The PRP group showed significantly better improvement than the ESWT group in VISA-P, VAS scores at 6- and 12-month follow-up, and modified Blazina scale score at 12-month follow-up (P < .05 for all). Conclusion: Therapeutic injections of PRP lead to better midterm clinical results compared with focused ESWT in the treatment of jumper’s knee in athletes.

Cross-cultural Adaptation and Measurement Properties of the Brazilian Portuguese Version of the Victorian Institute of Sport Assessment-Patella (VISA-P) Scale

Clinical measurement. To translate, adapt, and test the measurement properties of the Brazilian Portuguese version of the Victorian Institute of Sport Assessment-Patella (VISA-P) questionnaire. It is important to objectively measure symptoms and functional limitations related to patellar tendinopathy using outcome measures that have been validated in the language of the target population. Cross-cultural adaptations are also useful to enhance the understanding of the measurement properties of an assessment tool, regardless of the target language. The VISA-P questionnaire was translated into Brazilian Portuguese, culturally adapted, and titled VISA-P Brazil. It was then administered on 2 occasions with a 24- to 48-hour interval between them, and a third time after a month of physical therapy treatment. The following measurement properties were analyzed: internal consistency, test-retest reliability, agreement, construct validity, floor and ceiling effects, and responsiveness. The VISA-P Brazil had high internal consistency (Cronbach α = .76; if item deleted, Cronbach α = .69-.78), excellent reliability and agreement (intraclass correlation coefficient = 0.91; 95% confidence interval: 0.85, 0.95; standard error of measurement, 5.2 points; minimal detectable change at the 90% confidence level, 12.2 points), and good construct validity (Pearson r = 0.60 compared to Lysholm). No ceiling and floor effects were detected for the VISA-P Brazil, and the responsiveness, based on 32 patients receiving physical therapy intervention for 1 month, demonstrated a large effect size of 0.97 (95% confidence interval: 0.68, 1.25). The VISA-P Brazil is a reproducible and responsive tool and can be used in clinical practice and research to assess the severity of pain and disability of patients with patellar tendinopathy.

Topical glyceryl trinitrate treatment of chronic patellar tendinopathy: a randomised, double-blind, placebo-controlled clinical trial

ObjectivesTo assess if continuous topical glyceryl trinitrate (GTN) treatment improves outcome in patients with chronic patellar tendinopathy when compared with eccentric training alone.MethodsRandomised double-blind, placebo-controlled clinical trial comparing a 12-week...

Ultrasound-Guided Sclerosis of Neovessels in Patellar Tendinopathy

Background: A randomized controlled study has shown promising clinical results after treatment with sclerosing injections in a group of patients with patellar tendinopathy, but no study has investigated medium- or long-term outcome in a large and unselected group of patients. Purpose: To investigate if sclerosing treatment would affect the level of patellar tendon pain and knee function after 24 months in a large group of patients with patellar tendinopathy. Study Design: Case series; Level of evidence, 4. Methods: This prospective study recruited patients with a clinical diagnosis of jumper’s knee and visible neovascularization corresponding to the painful area on power Doppler ultrasound. They received up to a maximum of 5 ultrasound-guided sclerosing injections using polidocanol at 4- to 6-week intervals. Knee pain and function were recorded using the Victorian Institute of Sport Assessment–Patella (VISA-P) score before treatment and 6, 12, and 24 months after the first injection. Results: In total, 101 patients (15 women and 86 men) with 120 tendons were included and given from 1 to 5 sclerosing injections (mean [SD], 2.5 [0.9]). The patients reported a significantly improved VISA-P score from baseline (mean, 39; 95% confidence interval [CI], 36-42) to the 24-month follow-up (mean, 65; 95% CI, 60-70) (range, 21-100; P < .001, paired t test). However, a VISA-P score of >95 points was reported in only 22 cases (20%), whereas 37 cases (36%) reported a VISA-P score of <50 at 24 months. Conclusion: Sclerosing treatment with polidocanol resulted in a moderate improvement in knee function and reduced pain in a heterogeneous group of patients with patellar tendinopathy. Nevertheless, few of the patients were cured, and the majority still had reduced function and substantial pain after 24 months of follow-up.

Prevalence of Jumper’s Knee Among Nonelite Athletes From Different Sports

Background: The prevalence of jumper’s knee among nonelite athletes from different sports is unknown. Purpose: This study was undertaken to determine the prevalence of jumper’s knee in nonelite athletes from different sports and to determine potential risk factors for jumper’s knee. Design: Cohort study (prevalence); Level of evidence, 2. Methods: The authors interviewed 891 male and female nonelite athletes from 7 popular sports in The Netherlands: basketball, volleyball, handball, korfball, soccer, field hockey, and track and field. Using a specially developed questionnaire, information was obtained about individual characteristics (age, height, and weight), training background, previous and actual knee problems, and the VISA-P (Victorian Institute of Sport Assessment–Patella) score. Results: The overall prevalence of current jumper’s knee was 8.5% (78 of 891 athletes), showing a significant difference between sports with different loading characteristics. Prevalence was highest among volleyball players (14.4%) and lowest among soccer players (2.5%); it was significantly higher among male athletes (51 of 502 [10.2%]) than female athletes (25 of 389 [6.4%]) (χ2 = 3.91, P = .048). The mean duration of symptoms was 18.9 months (standard deviation [SD], 21.6; median value, 12.0; range, 2.0-59.8). The mean VISA-P score of the athletes with jumper’s knee was 71.4 (SD, 13.8). Athletes with jumper’s knee were significantly younger, taller, and heavier than those without jumper’s knee. Conclusion: Prevalence of jumper’s knee is high among nonelite athletes and varies between 14.4% and 2.5% for different sports. Jumper’s knee is almost twice as common among male nonelite athletes compared with female athletes. Different sport-specific loading characteristics of the knee extensor apparatus, a younger age, a taller body stature, and higher body weight seem to be risk factors associated with patellar tendinopathy.

Arthroscopic Management of Chronic Patellar Tendinopathy

Background: In patients with patellar tendinopathy in whom nonoperative management is unsuccessful, surgery is an option to return to high levels of physical activity. Although open surgery is traditionally advocated, an arthroscopic approach may be safe and effective. Purpose: This study was undertaken to analyze medium- and long-term outcome of 64 patients undergoing arthroscopic surgery for the management of patellar tendinopathy after failing nonoperative treatment. Study Design: Case series; Level of evidence, 4. Methods: A total of 64 patients (73 knees), 27 of whom were professional athletes, with patellar tendinopathy refractory to nonoperative management underwent arthroscopic debridement of the adipose tissue of the Hoffa’s body posterior to the patellar tendon, debridement of abnormal patellar tendon, and excision of the lower pole of the patella. Preoperative and postoperative evaluation was undertaken using the International Knee Documentation Committee (IKDC), Lysholm knee scale, and Victorian Institute of Sport Assessment–Patella (VISA-P) scores for all patients at 1 and 3 years. No patients were lost to follow-up. Forty-three and 29 patients were similarly assessed at 5 and 10 years, respectively, after surgery. Return to sports and rehabilitation was also assessed. Results: The IKDC, Lysholm, and VISA-P scores all significantly improved at 1 and 3 years’ follow-up. The average preoperative IKDC score of 51.6 improved to 86.4 at both the 1- and 3-year stage. The average preoperative Lysholm score of 52.3 improved to 94.7 at 1-year follow-up and was 95.5 at 3-year follow-up. The average preoperative VISA-P score of 35.3 improved to 69.8 at the 1-year stage and was 70.7 at the 3-year follow-up. These scores remained significantly better for the patients assessed at 5 and 10 years’ follow-up. There were no postoperative complications. Nineteen of the 27 professional athletes returned to sports at the same level. Seven patients developed pain after sports within 3 years after the operation, a failure rate of 7 of 73 knees (9.6%). All patients were able to return to sports by 3 months. Conclusion: Arthroscopic surgery for patients with patellar tendinopathy, refractory to nonoperative management, appears to provide significant improvements in symptoms and function, with improvements maintained for at least 3 years. These results suggest that some patients may not be able to achieve their presymptom sporting level; or if they do, they may participate in sports with some degree of residual symptoms. Limited data show that these improvements are maintained for up to 10 years. Early return to sports may also be achieved.