The Best Current Research on Patellar Tendinopathy: A Review of Published Meta-Analyses
Abstract
:1. Introduction
2. Materials and Methods
2.1. Eligibility Criteria
2.2. Information Sources and Search Methods for Identifying Studies
2.3. Data Extraction and Data Items
2.4. Assessment of the Risk of Bias in the Included Studies
2.5. Assessment of Results
3. Results
3.1. Study Characteristics
3.2. AMSTAR-2
- Did the research questions and inclusion criteria for the review include the components of PICO?
- Did the report of the review contain an explicit statement that the review methods were established prior to the conduction of the review, and did the report justify any significant deviations from the protocol?
- Did the review authors explain their selection of the studies included in the review?
- Did the review authors use a comprehensive literature search strategy?
- Did the review authors perform study selection in duplicate?
- Did the review authors perform data extraction in duplicate?
- Did the review authors provide a list of excluded studies and justify their exclusions?
- Did the review authors describe the included studies in adequate detail?
- Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in the individual studies that were included in the review?
- Did the review authors report on the sources of funding for the studies included in the review?
- If a meta-analysis was performed, did the review authors use appropriate methods for statistically combining results?
- If a meta-analysis was performed, did the review authors assess the potential impact of the RoB in individual studies on the results of the meta-analysis or other evidence synthesis?
- Did the review authors account for the RoB in individual studies when interpreting/discussing the results of the review?
- Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review?
- If they performed quantitative synthesis, did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss its likely impact on the results of the review?
- Did the review authors report any potential sources of conflicts of interest, including any funding they received for conducting the review?
3.3. Summary of Main Outcomes (Table 3 and Table 4)
Risk Factors Associated with Patellar Tendinopathy
Study | Main Outcomes | Limitations | Conclusions |
---|---|---|---|
Andriolo et al., 2018 [25] | VISA-P. | Different exercise protocols. | Positive overall outcome for treatments of patellar tendinopathy. Multiple PRP injections show potential as a treatment that is superior to eccentric exercises and lasting results compared to eccentric exercises, particularly in cases where conservative approaches have proven ineffective. |
Woodley et al., 2007 [44] | IASP, VAS, McGill Pain Questionnaire, Function. | NS. | The effectiveness of eccentric exercise therapy for common tendinopathies remains unclear due to a lack of high-quality research, along with inconclusive results. Further rigorous trials are necessary to determine its optimal dose–response and long-term efficacy compared to other treatments. |
Mani-Babu et al., 2014 [32] | VAS, Harris Hip Score, Roles and Maudsley Score, Mid-Portion. | NS. | For PT, ESWT seems to be superior to other non-operative treatments and equal to surgery in the long term. |
Wang et al., 2023 [14] | Frequency or incidence of PT. | NS. | The risk of PT cannot be reduced with the current prophylactic program. However, for athletes, the negative results may be due to an insufficient sample size. |
Masiello et al., 2023 [33] | VAS, VISA-P. | NS. | The limited available evidence shows no significant difference between PRP and control groups for pain or function in patellar tendinopathy. |
Khan et al., 2023 [30] | Pain, functional. | Variability in both the number and dosage of the HA. | The single study on PRP versus HA for proximal patellar tendinopathy found that PRP was superior for improving pain and quadricep strength. |
Chen et al., 2019 [26] | Pain. | No functional outcomes. | PRP may provide both short-term and long-term pain relief for tendon and ligament injuries and pathologies compared to alternative treatments. |
Moraes et al., 2014 [36] | Disabilities of the Arm, Shoulder, and Hand questionnaire (Hudak 1996), Victorian Institute of Sports Assessment—Achilles questionnaire (VISA-A), and American Orthopaedic Foot and Ankle Society (AOFAS) foot questionnaire. Visual analogue scales (VASs) and local and systemic adverse effects. | Some studies may have been missed since PRP is an emerging field; extensive contacts were made with experts to find unpublished data. | The current evidence is insufficient to support the use of PRP therapy for treating musculoskeletal soft tissue injuries, both overall and for specific clinical conditions. When considering future RCTs, researchers should evaluate ongoing trials to determine the need for additional studies on particular injuries. The standardization of PRP preparation protocols is warranted. |
Saltychev et al., 2022 [40] | Pain: VAS or NRS. | Great heterogeneity. | There was no evidence that NTG is more effective in reducing pain in Achilles tendinopathies, as well as patellar tendinopathies. |
Shim et al., 2023 [40] | Global Rating of Change (GROC), VAS. | NS. | Patients report general satisfaction and positive perceptions of exercise therapy for tendinopathy, but more focus on these outcomes is recommended. |
Study | Main Outcomes | Limitations | Conclusions |
---|---|---|---|
Sprague et al., 2018 [42] | CMJ height, standing jump height, knee extension torque, knee flexion torque, occupational classification, knee loading during work. | Few women and non-athletes; different definitions of tendinitis. | Conflicting evidence that decreased ankle dorsiflexion range of motion, decreased posterior thigh and quadricep flexibility, greater volume of jump training, more volleyball sets played per week, greater CMJ height, and greater activity volume are potential modifiable risk factors. |
Tayfur et al., 2022 [43] | Kinematic variables: initial contact angles of joints (hip, knee, ankle) or segments (i.e., trunk); range of motion (RoM) and peak angles in the same joints or segments; and joint angular velocities. Kinetic variables such as joint moments, peak ground reaction forces (GRF) in both horizontal and vertical planes, peak patellar tendon force (PTF), and lower-limb muscle activation patterns. | Few women; heterogeneity in tasks implemented, populations, and variables. | Three recommendations: improve ankle dorsiflexion–plantarflexion range, optimize trunk flexion strategies, and use soft landing patterns. |
Obst et al., 2018 [38] | VISA-P, duration of symptoms, strain and stiffness, modulus, knee extension contractions using 2D ultrasound combined with dynamometry. | No quantitative 3D ultrasound. | Insufficient evidence exists to establish a consistent impact of tendinopathy on the mechanical properties of the patellar tendon, suggesting that the location and nature of the pathology may not significantly affect its overall tensile behavior in vivo. |
McAuliffe et al., 2016 [35] | US and symptoms. | Reliability, variability in terms of terminology used in defining what is accepted as a structurally ‘abnormal’ tendon; lack of gold-standard tests for diagnosing tendinopathy. | Tendon abnormalities are predictive of the development of future Achilles or patellar tendinopathies. |
Mousavi et al., 2019 [37] | Kinematics: running mileage, speed, gait phase, diagnosis, gait analysis tools and testing conditions. | Great variety of diagnostic methods. | Kinematic analysis showed that patellar tendinopathy patients had increased peak ankle eversion, hip adduction, and decreased tibial rotation compared to the controls. No other differences were significant. |
Kim et al., 2021 [31] | Gene. | NS. | Genetic markers in COA1 seem to be associated with patellar tendinopathy and are potential risk factors for patellar tendinopathy that deserve further validation regarding molecular mechanisms. |
Palazón-Bru et al., 2021 [39] | Reliability VISA-P. | NS. | The reliability of VISA-P for assessing the severity of patellar tendinopathies requires greater evaluation with more scientific evidence before it can be implemented in clinical practice. |
Heales et al., 2013 [29] | Pain, sensory and motor function. | Lack of confirmatory diagnosis with image (just two studies). | Tendinopathy patients frequently have sensory and motor deficits in their non-injured limb, indicating CNS involvement beyond just local pathology. The contralateral side should not be used as a reference in assessment. |
Matthews et al., 2018 [34] | Endonmatrix changes (e.g., tendon thickness, echogenicity, collagen organization, fibrillar pattern, vascularization. | NS. | US-based tendinopathy diagnosis criteria are variable. Ultrasound predicts future symptoms. Assessing tendon structure with three parameters has a higher predictive value than using two parameters. |
De oliveira Silva et al., 2019 [28] | Remote pressure pain thresholds, remote thermal pain thresholds, pain assessments of manifestations of pain sensitization. | Need for multivariate analysis. | The findings in people with patellar tendinopathy were conflicting. |
De Bleecker et al., 2020 [27] | Kinematics: type of jump, phase of landing, plane of movement, and main results. | NS. | Preliminary evidence links impaired local and non-local landing kinematics with lower-extremity overuse injuries. Excess frontal and transverse plane motions during jumping/landing may increase forces on lower-limb structures. |
3.4. Platelet-Rich Plasma
3.5. Physical Therapies or Rehabilitation
3.6. Extracorporeal Shockwave Therapy
3.7. Ultrasound
3.8. Miscellaneous
3.8.1. Genetics
3.8.2. Reliability
3.8.3. Central Sensitization
3.8.4. Nitroglycerin
4. Discussion
Limitations
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Study | Region | Journal | Pathology | PROTOCOL | Population | n Studies | Diagnosis Method | Compared Treatment * |
---|---|---|---|---|---|---|---|---|
Andriolo et al., 2018 [25] | Italy | Am J Sports Med | Patellar tendinopathy | NS | NSP | 22 | NS | Non-surgical treatments |
Chen et al., 2019 [26] | USA | Am J Sports Med. | Tendons and ligaments | NS | NSP | 21 (2 patellar) | Clinically | PRP vs. others |
De Bleecker et al., 2020 [27] | Belgium | Sports Med | Lower-extremity overuse injuries | CRD42019135602 | Physically active populations | 12 (9 patellar) | NS | NA |
De oliveira Silva et al., 2019 [28] | Brazil | Pain Med | Painful knee disorders | CRD42015024211 | Knee joint in people with painful knee disorders | 52 (3 patellar) | Manifestations of pain sensitization measured locally | NA |
Heales et al., 2013 [29] | Australia | Br J Sports Med | Bilateral measurement in patients with unilateral tendinopathy | NS | Bilateral measurements in patients with unilateral tendinopathy | 20 (1 patellar) | Clinical | NA |
Khan et al., 2023 [30] | Canada | Sports Health | Soft tissue | NS | NSP | 19 (1 patellar) | NS | HA vs. PRP |
Kim et al., 2021 [31] | USA | Med Sci Sports Exerc | Patellar tendonitis | NS | NSP | NA | Gene | NA |
Mani-Babu et al., 2014 [32] | UK | Am J Sports Med | Lower-limb tendinopathy | NS | NSP | 20 (7 patellar) | NS | Extracorporeal shockwave therapy vs. others |
Masiello et al., 2023 [33] | Italy | Blood Transfus. | Tendon and ligament injuries | CRD42021289419 | NSP | 33 (3 patellar) | NS | PRP vs. control |
Matthews et al., 2018 [34] | Australia | Ultrasound Med Biol | Tendinopathy in any location | NS | Males or females of any age, from anyathletic or community back ground | 19 (12 patellar) | US | NA |
McAuliffe et al., 2016 [35] | Ireland | Br J Sports Med | Achilles and patellar tendinopathy | CRD42015020664 | NSP | 17 (13 patellar) | Ultrasound | NA |
Moraes et al., 2014 [36] | Brazil | Cochrane Database Syst Rev. | Musculoskeletal soft tissue injuries | NS | NSP | 19 (1 patellar) | Clinically | PRP vs. placebo, autologous whole blood, dry needling or no platelet-rich therapy |
Mousavi et al., 2019 [37] | The Netherlands | Gait Posture | Lower-limb tendinopathy | NS | Distance runners | 28 (1 patellar) | NS | NA |
Obst et al., 2018 [38] | Australia | Sports Med | Achilles and patellar tendinopathy | NS | NSP | 20 (7 patellar) | Clinically | NA |
Palazón-Bru et al., 2021 [39] | Spain | Clin J Sport Med | Patellar tendinopathy | NS | NSP | 12 | Reliability scale | NA |
Saltychev et al., 2022 [40] | Finland | Disabil Rehabil | Tendinopathy | NS | Adults (>16 years) with acute or chronic tendinopathy | 11 (1 patellar) | NS | Glyceryl trinitrate applied topically vs. placebo, sham, or other treatment |
Shim et al., 2023 [41] | UK | Physiotherapy | Tendinopathy | CRD42020168187 | Any age or gender | 34 (5 patellar) | Clinical | Exercise therapy |
Sprague et al., 2018 [42] | USA | Br J Sports Med | Patellar tendinopathy | CRD42016052904 | NSP | 28 | Symptoms isolated to the inferior pole of the patella | NA |
Tayfur et al., 2022 [43] | UK | Sports Med | Patellar tendinitis/tenosynovitis/tendinosis | NS | Jumping athletes (any sport) | 16 | Clinically or ultrasound | NA |
Wang et al., 2023 [14] | China | Sports Health | Patellar tendinopathy | NS | Athletes and recruits | 11 | NS | Prophylactic program vs. control strategy |
Woodley et al., 2007 [44] | New Zealand | Br J Sports Med | Achilles tendinopathy and patella tendinopathy and tendinopathy of the common wrist extensor tendon of the lateral elbow | NS | NSP | 11 (n patellar NS) | Clinically | Eccentric exercise vs. others |
AMSTAR-2\Study | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 | Evaluation |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Andriolo et al., 2018 [25] | No | No | Yes | Yes | Yes | Yes | Partial Yes | Yes | Yes | No | Yes | No | Yes | Yes | No | No | Critically low-quality |
Chen et al., 2019 [26] | No | No | Yes | Yes | Yes | Yes | Partial Yes | Yes | No | No | Yes | No | No | Yes | Yes | No | Critically low-quality |
De Bleecker et al., 2020 [27] | Yes | Yes | Yes | Yes | Yes | Yes | Partial Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | No | No | Low-quality |
De oliveira Silva et al., 2019 [28] | No | Yes | Yes | Yes | No | No | Partial Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | No | No | Low-quality |
Heales et al., 2013 [29] | No | No | Yes | Yes | No | No | Partial Yes | Yes | Yes | No | Yes | Yes | No | Yes | No | No | Critically low-quality |
Khan et al., 2023 [30] | No | No | Yes | Yes | Yes | Yes | Partial Yes | Yes | Yes | No | Yes | Yes | No | Yes | Yes | No | Critically low-quality |
Kim et al., 2021 [31] | No | Yes | Yes | Yes | Yes | Yes | Partial Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | Yes | No | Moderate-quality |
Mani-Babu et al., 2014 [32] | No | No | Yes | Yes | Yes | Yes | Partial Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | No | No | Critically low-quality |
Masiello et al., 2023 [33] | No | Yes | Yes | Yes | Yes | Yes | Partial Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | Yes | No | Moderate-quality |
Matthews et al., 2018 [34] | Yes | No | Yes | Yes | No | No | Partial Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | Yes | No | Low-quality |
McAuliffe et al., 2016 [35] | Yes | Yes | Yes | Yes | Yes | Yes | Partial Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | Yes | No | Moderate-quality |
Moraes et al., 2014 [36] | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | Yes | No | Moderate-quality |
Mousavi et al., 2019 [37] | No | No | Yes | Yes | Yes | Yes | Partial Yes | Yes | Yes | No | Yes | Yes | No | Yes | No | No | Critically low-quality |
Obst et al., 2018 [38] | No | No | Yes | Yes | Yes | Yes | Partial Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | No | No | Critically low-quality |
Palazón-Bru et al., 2021 [39] | Yes | Yes | Yes | Yes | Yes | Yes | Partial Yes | Yes | Yes | No | Yes | Yes | No | Yes | Yes | No | Low-quality |
Saltychev et al., 2022 [40] | Yes | No | Yes | Yes | Yes | Yes | Partial Yes | Yes | Yes | No | Yes | Yes | No | Yes | Yes | No | Critically low-quality |
Shim et al., 2023 [41] | Yes | Yes | Yes | Yes | Yes | Yes | Partial Yes | Yes | Yes | No | Yes | Yes | No | Yes | Yes | No | Low-quality |
Sprague et al., 2018 [42] | No | No | Yes | Yes | Yes | Yes | Partial Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | Yes | No | Low-quality |
Tayfur et al., 2022 [43] | No | No | Yes | Yes | Yes | Yes | Partial Yes | Yes | Yes | No | Yes | Yes | No | Yes | No | No | Critically low-quality |
Wang et al., 2023 [14] | No | Yes | Yes | Yes | Yes | Yes | Partial Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | Yes | No | Moderate-quality |
Woodley et al., 2007 [44] | No | Yes | Yes | No | No | Partial Yes | Yes | Yes | No | Yes | Yes | No | Yes | Yes | No | Yes | Critically low-quality |
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© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
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Llombart, R.; Mariscal, G.; Barrios, C.; Llombart-Ais, R. The Best Current Research on Patellar Tendinopathy: A Review of Published Meta-Analyses. Sports 2024, 12, 46. https://doi.org/10.3390/sports12020046
Llombart R, Mariscal G, Barrios C, Llombart-Ais R. The Best Current Research on Patellar Tendinopathy: A Review of Published Meta-Analyses. Sports. 2024; 12(2):46. https://doi.org/10.3390/sports12020046
Chicago/Turabian StyleLlombart, Rafael, Gonzalo Mariscal, Carlos Barrios, and Rafael Llombart-Ais. 2024. "The Best Current Research on Patellar Tendinopathy: A Review of Published Meta-Analyses" Sports 12, no. 2: 46. https://doi.org/10.3390/sports12020046
APA StyleLlombart, R., Mariscal, G., Barrios, C., & Llombart-Ais, R. (2024). The Best Current Research on Patellar Tendinopathy: A Review of Published Meta-Analyses. Sports, 12(2), 46. https://doi.org/10.3390/sports12020046