Victorian Institute Of Sport Assessment Research Articles

High volume ultrasound guided injections at the interface between the patellar tendon and Hoffa's body are effective in chronic patellar tendinopathy: A pilot study

Purpose. To evaluate a novel conservative management modality for patellar tendinopathy.Methods. We recruited nine patients with patellar tendinopathy who had failed conservative management and showed evidence of neovascularisation on power Doppler scanning. A high volume ultrasound guided injection at the interface between the patellar tendon and Hoffa's body. The injection contained 10 ml 0.5% Bupivacaine, 25 mg Hydrocortisone, and between 12 and 40 ml normosaline. 100 mm visual analogue scales (VAS) for pain and for function, and Victorian Institute of Sport Assessment – Patellar tendon (VISA-P) questionnaires at an average of 9 months from the injection.Results. All but one patient (whose pain was unchanged) improved (p = 0.028). The mean improvement in function 2 weeks after injection was 58 mm on VAS (interquartile range 27 – 88, p = 0.018). The mean improvement in pain 2 weeks after injection was 56 mm on a VAS scale (interquartile range 32 – 80, p = 0.018). At a mean follow up of 9 months, an improvement of 22 points from a baseline score of 46 on the VISA-P questionnaire (100 being normal) was established.Conclusion. High volume injections to mechanically disrupt the neovascularisation in patellar tendinopathy are helpful in the management of this condition. Controlled trials would be warranted to investigate in a more conclusive fashion this management modality.

Eccentric treatment for patellar tendinopathy: a prospective randomised short-term pilot study of two rehabilitation protocols

Objective: To compare the efficacy and safety of two eccentric rehabilitation protocols for patients with symptomatic patellar tendinopathy. A new eccentric overload training device was compared with the present standard...

Eccentric Loading, Shock-Wave Treatment, or a Wait- and-See Policy for Tendinopathy of the Main Body of Tendo Achillis

Background Few randomized controlled trials compare different methods of management in chronic tendinopathy of the main body of tendo Achillis. Purpose To compare the effectiveness of 3 management strategies—group 1, eccentric loading; group 2, repetitive low-energy shock-wave therapy (SWT); and group 3, wait and see—in patients with chronic tendinopathy of the main body of tendo Achillis. Study Design Randomized controlled trial; Level of evidence, 1. Methods Seventy-five patients with a chronic recalcitrant (>6 months) noninsertional Achilles tendinopathy were enrolled in a randomized controlled study. All patients had received unsuccessful management for >3 months, including at least (1) peritendinous local injections, (2) nonsteroidal anti-inflammatory drugs, and (3) physiotherapy. A computerized random-number generator was used to draw up an allocation schedule. Analysis was on intention-to-treat basis. Results At 4 months from baseline, the Victorian Institute of Sport Assessment (VISA)-A score increased in all groups, from 51 to 76 points in group 1 (eccentric loading), from 50 to 70 points in group 2 (repetitive low-energy SWT), and from 48 to 55 points in group 3 (wait and see). Pain rating decreased in all groups, from 7 to 4 points in group 1, from 7 to 4 points in group 2, and from 8 to 6 points in group 3. Fifteen of 25 patients in group 1 (60%), 13 of 25 patients in group 2 (52%), and 6 of 25 patients in Group 3 (24%) reported a Likert scale of 1 or 2 points (“completely recovered” or “much improved”). For all outcome measures, groups 1 and 2 did not differ significantly. For all outcome measures, groups 1 and 2 showed significantly better results than group 3. Conclusion At 4-month follow-up, eccentric loading and low-energy SWT showed comparable results. The wait- and-see strategy was ineffective for the management of chronic recalcitrant tendinopathy of the main body of the Achilles tendon.

Eccentric exercise and shock-wave therapy benefit patients with chronic Achilles tendinopathy

Is eccentric exercise or shock-wave therapy more effective than wait-and-see in the management of chronic Achilles tendinopathy? Pragmatic randomised controlled trial. Primary health care clinics in Germany. Seventy-five patients with a diagnosis of chronic midportion Achilles tendinopathy (duration > 6 months), aged 18 to 70 years. All patients had received previous treatment for at least 3 months, without success. Subjects were randomly allocated to one of 3 groups: eccentric loading, shock-wave therapy, or wait-and-see. The eccentric loading group performed twicedaily, eccentric, calf muscle exercises, gradually progressed over 12 weeks. The shock-wave wave therapy intervention consisted of 3 sessions at weekly intervals of repetitive, low-energy shock-wave therapy. Patients in the wait-and-see group visited their physician once and were encouraged to await spontaneous improvement. Outcomes were assessed at 4 months from baseline. The Victorian Institute of Sport Assessment (VISA-A) questionnaire was used to measure pain, function and activity (0–100 scale, 100 = asymptomatic). Recovery was measured on a 6-point Likert scale (1 = completely recovered, 6 = much worse). Pain was assessed on an 11-point Numeric Rating Scale. Compared with the wait-and-see group, both eccentric exercise and shock-wave therapy resulted in improved VISA-A scores (21, 95% CI 12 to 29; and 15, 95% CI 8 to 23 respectively). Sixty percent of patients in the eccentric loading group reported complete recovery or much improved (scores of 1 or 2 on the Likert scale), compared with 53% in the shock-wave therapy group and 24% in the wait-and-see group. Between-group differences in pain were 2.4 (95% CI 1.3 to 3.5) for eccentric loading and 2.0 (95% CI 1.0 to 3.0) for shock-wave therapy, compared with wait-and-see. No serious complications were reported. This study provides evidence that both eccentric exercise and shock-wave therapy produce worthwhile improvements for patients with chronic Achilles tendinopathy.

Surgical Treatment Compared with Eccentric Training for Patellar Tendinopathy (Jumperʼs Knee)

Although the surgical treatment of patellar tendinopathy (jumper's knee) is a common procedure, there have been no randomized, controlled trials comparing this treatment with forms of nonoperative treatment. The purpose of the present study was to compare the outcome of open patellar tenotomy with that of eccentric strength training in patients with patellar tendinopathy. Thirty-five patients (forty knees) who had been referred for the treatment of grade-IIIB patellar tendinopathy were randomized to surgical treatment (twenty knees) or eccentric strength training (twenty knees). The eccentric training group performed squats on a 25 degrees decline board as a home exercise program (with three sets of fifteen repetitions being performed twice daily) for a twelve-week intervention period. In the surgical treatment group, the abnormal tissue was removed by means of a wedge-shaped full-thickness excision, followed by a structured rehabilitation program with gradual progression to eccentric training. The primary outcome measure was the VISA (Victorian Institute of Sport Assessment) score (possible range, 0 to 100), which was calculated on the basis of answers to a symptom-based questionnaire that was developed specifically for patellar tendinopathy. The patients were evaluated after three, six, and twelve months of follow-up. There was no difference between the groups with regard to the VISA score during the twelve-month follow-up period, but both groups had improvement (p < 0.001). The mean combined VISA score for the two groups increased from 30 (95% confidence interval, 25 to 35) before the start of treatment to 49 (95% confidence interval, 42 to 55) at three months, 58 (95% confidence interval, 51 to 65) at six months, and 70 (95% confidence interval, 62 to 78) at twelve months. In the surgical treatment group, five knees had no symptoms, twelve had improvement but were still symptomatic, two were unchanged, and one was worse after twelve months (p = 0.49 compared with the eccentric training group). In the eccentric training group, five knees did not respond to treatment and underwent secondary surgery after three to six months. Of the remaining fifteen knees in the eccentric training group, seven had no symptoms and eight had improvement but were still symptomatic after twelve months. No advantage was demonstrated for surgical treatment compared with eccentric strength training. Eccentric training should be tried for twelve weeks before open tenotomy is considered for the treatment of patellar tendinopathy.

Superior results with eccentric compared to concentric quadriceps training in patients with jumper’s knee: a prospective randomised study

Background: A recent study reported promising clinical results using eccentric quadriceps training on a decline board to treat jumper’s knee (patellar tendinosis).Methods: In this prospective study, athletes (mean age 25...

Eccentric decline squat protocol offers superior results at 12 months compared with traditional eccentric protocol for patellar tendinopathy in volleyball players

Background: Conservative treatment of patellar tendinopathy has been minimally investigated. Effective validated treatment protocols are required. Objectives: To investigate the immediate (12 weeks) and long term (12 months) efficacy of...

Psychometric properties of a Swedish translation of the VISA-P outcome score for patellar tendinopathy

BackgroundSelf-administrated patient outcome scores are increasingly recommended for evaluation of primary outcome in clinical studies. The VISA-P score, developed at the Victorian Institute of Sport Assessment in Melbourne, Australia, is a questionnaire developed for patients with patellar tendinopathy and the patients assess severity of symptoms, function and ability to participate in sport. The aim of this study was to translate the questionnaire into Swedish and to study the reliability and validity of the translated questionnaire and resultant scores.MethodsThe questionnaire was translated into Swedish according to internationally recommended guidelines for cross-cultural adaptation of self-report measures. The reliability and validity were tested in three different populations. The populations used were healthy students (n = 17), members of the Swedish male national basketball team (n = 17), considered as a population at risk, and a group of non-surgically treated patients (n = 17) with clinically diagnosed patellar tendinopathy. The questionnaire was completed by 51 subjects altogether.ResultsThe translated VISA-P questionnaire showed very good test-retest reliability (ICC = 0.97).The mean (± SD) of the VISA-P score, at both the first and second test occasions was highest in the healthy student group 83 (± 13) and 81 (± 15), respectively. The score of the basketball players was 79 (± 24) and 80 (± 23), while the patient group scored significantly (p < 0.05) lower, 48 (± 20) and 52 (± 19).ConclusionsThe translated version of the VISA-P questionnaire was linguistically and culturally equivalent to the original version. The translated score showed good reliability.

The VISA score: An index of severity of symptoms in patients with jumper's knee (patellar tendinosis)

Symptoms of jumper's knee (patellar tendinosis) are not easily quantified and this may explain why there are no evidence-based guidelines for managing the condition. A simple, practical questionnaire-based index of severity would facilitate jumper's knee research and subsequently, clinical management. Thus we devised and tested the Victorian Institute of Sport Assessment (VISA) questionnaire. The brief questionnaire assesses (i) symptoms, (ii) simple tests of function and (iii) ability to play sport. Six of the eight questions are scored on a visual analogue scale from 0-10 with 10 representing optimal health. The maximal VISA score for an asymptomatic, fully performing individual is 100 points and the theoretical minimum is 0 points. We found the VISA scale to have excellent short-term test-retest, and inter-tester reliability (both, r>0.95) as well as good short-term (one week) stability (r=0.87). Mean (SD) of the VISA scores ranged from 95 (8) points in asymptomatic control subjects to 55 (12) points in patients who presented to a sports medicine clinic with jumper's knee and 22 (17) points in patients before surgery for chronic jumper's knee. Six- and twelve-months after surgery VISA scores returned to 49 (15) and 75 (17) points respectively, mirroring clinical recovery. We conclude that the VISA score is a reliable index of the severity of jumper's knee that has potential to aid clinicians and researchers.