Ultrasound-Guided Electrocoagulation of Neovessels for Chronic Patellar Tendinopathy.
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ABSTRACT:
SUBMITTER: Moura JL
PROVIDER: S-EPMC7301331 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:PURPOSE: The efficacy of platelet-rich plasma (PRP) in the treatment and healing of chronic tendinopathy through stimulation of cell proliferation and total collagen production has been demonstrated by both in vitro and in vivo studies. The aim of this study is to evaluate the effectiveness of ultrasound (US)-guided autologous PRP injections in patellar and Achilles tendinopathy. MATERIALS AND METHODS: Autologous PRP was injected under US-guidance into the Achilles and patellar tendons (30 Achilles tendons, 28 patellar tendons) in 48 prospectively selected patients (30 males, 18 females, mean age 38 ± 16 years, range 20-61 years). All patients were previously evaluated according to the Victoria Institute of Sport Assessment (VISA) scale, which assessed pain and activity level, and they all underwent US of the tendon before treatment and at follow-up after 20 days and 6 months. Statistical analysis was performed with Chi-square and Wilcoxon tests. RESULTS: 20 days after PRP injection the patients presented a non-significant improvement of clinical symptoms. At the 6-month follow-up VISA score increased from a mean value of 57-75.5 (p < .01). US evaluation revealed a reduction of hypoechoic areas in 26 tendons (p < .01) associated with a widespread improvement of fibrillar echotexture of the tendon and reduced hypervascularity at power Doppler. CONCLUSION: PRP injection in patellar and Achilles tendinopathy results in a significant and lasting improvement of clinical symptoms and leads to recovery of the tendon matrix potentially helping to prevent degenerative lesions. US-guidance allows PRP injection into the tendon with great accuracy.
| S-EPMC3558233 | biostudies-other
Project description:BackgroundThe mechanism that causes pain in chronic Achilles tendinosis is not known. However, high resolution colour Doppler ultrasound has shown that neovascularisation may be involved.ObjectiveTo investigate if sclerosing the neovessels would affect the level of tendon pain.MethodsThe effect of colour Doppler ultrasound guided injection of a sclerosing agent, polidocanol, against neovessels was studied in 10 patients (seven men and three women, mean age 55 years) with painful chronic mid-portion Achilles tendinosis.ResultsEight patients were satisfied with the results of treatment. There was significantly reduced pain during activity (reported on a visual analogue scale (VAS)) and no remaining neovascularisation after an average of two injections. Two patients were not satisfied, and neovascularisation remained. At the six month follow up, the same eight patients remained satisfied and could perform Achilles tendon loading activities as desired. Their VAS score had decreased from 74 before treatment to 8 (p<0.01).ConclusionsSclerosing neovessels appears to be an effective treatment for painful chronic Achilles tendinosis, suggesting that neovessels play a key part in causing chronic tendon pain.
| S-EPMC1724500 | biostudies-literature
Project description:ContextPatellar tendinopathy is a common condition. There are a wide variety of treatment options available, the majority of which are nonoperative. No consensus exists on the optimal method of treatment.Evidence acquisitionPubMed spanning 1962-2014.Study designClinical review.Level of evidenceLevel 4.ResultsThe majority of cases resolve with nonoperative therapy: rest, physical therapy with eccentric exercises, cryotherapy, anti-inflammatories, corticosteroid injections, extracorporeal shockwave therapy, glyceryl trinitrate, platelet-rich plasma injections, and ultrasound-guided sclerosis. Refractory cases may require either open or arthroscopic debridement of the patellar tendon. Corticosteroid injections provide short-term pain relief but increase risk of tendon rupture. Anti-inflammatories and injectable agents have shown mixed results. Surgical treatment is effective in many refractory cases unresponsive to nonoperative modalities.ConclusionPhysical therapy with an eccentric exercise program is the mainstay of treatment for patellar tendinopathy. Platelet-rich plasma has demonstrated mixed results; evidence-based recommendations on its efficacy cannot be made. In the event that nonoperative treatment fails, surgical intervention has produced good to excellent outcomes in the majority of patients.
| S-EPMC4547110 | biostudies-literature
Project description:Chronic proximal patellar tendinopathy is a challenging condition for its troublesome management in the active patient and difficulty in defining the failure of conservative treatment to indicate surgery. Usually, patients with chronic proximal patellar tendinopathy have already tried several physiotherapeutic modalities and are away from their preferred physical activities for variable periods. The current literature presents some open and even arthroscopic options for treating recalcitrant patellar tendinopathy using a variable magnitude of resources and costs. The purpose of this article was to depict a very simple and inexpensive surgical option for treating this condition, which can be applied worldwide.
| S-EPMC6926302 | biostudies-literature
Project description:Purpose: Whole body vibration (WBV) triggers anabolic responses in various tissues, including tendons, without requiring high force production. In this waitlist-controlled equivalence trial, we tested its clinical effectiveness as an alternative treatment for patellar tendinopathy against conventional heavy slow resistance training (HSR). Methods: Thirty-nine patients were randomized to either 3 months of WBV training (n = 13), HSR training (n = 11), or a waitlist control (WLC) group (n = 15). In a partly cross-over design, 14 patients of the WLC group were redistributed to one of the two intervention groups (5 in WBV, 9 in HSR). Pre- and post-intervention testing included pain assessments (VAS), functional limitations (VISA-P), knee extension strength and tendon morphological, mechanical and material properties. Follow-up measurements (VAS, VISA-P) were performed in the WBV and HSR groups 6 months after the intervention. Results: Comparisons with the WLC group revealed significant improvements in VISA-P and VAS scores after HSR (41%, p = 003; 54%, p = 0.005) and WBV (22%, p = 0.022; 56%, p = 0.031) training. These improvements continued until follow-up (HSR: 43%, 56%; WBV: 24%, 37%). Pre-post improvements in VAS scores were equivalent between WBV and HSR groups but inconclusive for the VISA-P score and all pre-test to follow up comparisons. The mid-tendon cross-sectional area was significantly reduced after WBV (-5.7%, p = 0.004) and HSR (-3.0%, p = 0.004) training compared to WLC although the equivalence test between interventions was inconclusive. Conclusion: Whole body vibration improved symptoms typically associated with patellar tendinopathy. This type of intervention is as effective as HSR against maximum pain, although equivalence could not be confirmed for other variables. The beneficial responses to WBV and HSR treatments persisted for 6 months after the end of the intervention. Clinical Trial Registration: https://www.drks.de/drks_web/setLocale_EN.do, identifier DRKS00011338.
| S-EPMC9633993 | biostudies-literature
Project description:Imaging findings in patellar tendinopathy are questioned. The aim of this pilot study was to characterize ultrasound measures, by calculating ultrasound ratio and neovascularization of the patellar tendon in non-elite sport players with unilateral painful patellar tendinopathy. Cross-sectional area (CSA), width, and thickness of the patellar tendon were assessed bilaterally in 20 non-elite sport-players with unilateral painful patellar tendinopathy and 20 asymptomatic controls by a blinded assessor. Ultrasound ratios were calculated to discriminate between symptomatic and asymptomatic knees. The Ohberg score was used for characterizing neovascularization. We found that non-elite sport players with patellar tendinopathy exhibited bilateral increases in CSA, width, and thickness of the patellar tendon compared to asymptomatic controls (Cohen d > 2). The ability of ultrasound ratios to discriminate between painful and non-painful patellar tendons was excellent (receiver operating characteristic, ROC > 0.9). The best diagnostic value (sensitivity: 100% and specificity: 95%) was observed when a width ratio ≥ 1.29 between the symptomatic and asymptomatic patellar tendon was used as a cut-off. Further, neovascularization was also observed in 70% of non-elite sport players with unilateral patellar tendinopathy. A greater CSA ratio was associated with more related-disability and higher tendon neovascularization. This study reported that non-elite sport players with painful unilateral patellar tendinopathy showed structural ultrasound changes in the patellar tendon when compared with asymptomatic controls. Ultrasound ratios were able to discriminate between symptomatic and asymptomatic knees. Current results suggest that ultrasound ratios could be a useful imaging outcome for identifying changes in the patellar tendon in sport players with unilateral patellar tendinopathy.
| S-EPMC7694007 | biostudies-literature
Project description:Minimal literature is available on the diagnosis and treatment of proximal plantaris tendinopathy. Calf pain is a common complaint in runners, ranging from myofascial pain to acute strains. Rarely, the plantaris tendon can be involved in mid-calf pain. This case highlights a 23-year-old female elite runner with a case of symptomatic proximal plantaris tendinopathy. Insidious mid-calf pain and/or tightness with tenderness to palpation was noted, and ultrasonographic examination provided an accurate diagnosis. An ultrasound-guided corticosteroid injection was performed, providing complete pain relief without recurrence, even 1 year after the initial injection. The patient was able to return to full activity. Successful treatment of this rare condition with ultrasound-guided corticosteroid injection should be considered once a proper diagnosis is made.
| S-EPMC7484514 | biostudies-literature
Project description:BackgroundActivity modification is a key component of patellar tendinopathy treatment but there is a lack of evidence guiding activity modification prescription. Use of activity modification in treatment studies has varied widely and the impact of those recommendations has not been directly investigated or compared. The purpose of this study was to assess (1) the feasibility of using pain-guided activity modification during treatment for patellar tendinopathy and (2) if our outcome measures are responsive to changes in tendon health over the course of treatment.MethodsThis was an unblinded, randomized two-arm pilot and feasibility study randomized clinical trial with parallel assignment, conducted in Newark, DE. Individuals between the ages of 16 and 40 years old with patellar tendinopathy were included. Participants were randomly assigned to a pain-guided activity (PGA) or pain-free activity (PFA) group using a spreadsheet-based randomization scheme. All participants received standardized treatment using a modified version of the heavy-slow resistance protocol 3×/week for 12 weeks. For the first 6 weeks, the PGA group used the Pain-Monitoring Model to guide activity outside of treatment and the PFA group was restricted from running, jumping, or activities that provoked their patellar tendon pain. Feasibility outcomes included recruitment, enrollment, randomization, compliance, and retention percentages. Clinical evaluations were conducted at baseline, 6, and 12 weeks to assess symptom severity, psychological factors, tendon morphology and mechanical properties, lower extremity function, and quadriceps muscle performance.ResultsIn a ~ 13-month period, 108 individuals were screened, 47/108 (43.5%) were eligible for participation, and 15/47 (32.0%) of those were enrolled (9 PGA, 6 PFA). The recruitment rate was 1.15 participants/month. The mean ± SD compliance with treatment was PGA: 86.1 ± 13.0% and PFA: 67.1 ± 30.7%. There was one missed evaluation session and two adverse events, which were not due to study interventions. Changes exceeding the smallest detectable change were observed for at least one outcome in each domain of tendon health.ConclusionsUse of pain-guided activity modification during exercise therapy for patellar tendinopathy was found to be feasible, and the proposed outcome measures appropriate. Computer-based allocation concealment, blinding of evaluators, and greater recruitment of high-level athletes should be implemented in future trials.Trial registrationClinicalTrials.gov identifier: NCT03694730 . Registered 3rd of October, 2018.
| S-EPMC7905015 | biostudies-literature
Project description:Vascular function and angiogenesis are regulated by vascular endothelial growth factor-A (VEGF). The purpose of this preliminary study was to address the following questions: Is VEGF expression in the patellar tendon more prevalent in patients with patellar tendinopathy than in individuals with normal, pain-free patellar tendons? Which cell populations express VEGF in normal and tendinopathic tendon? Is there a difference in symptom duration between VEGF+ and VEGF- tendons? We collected patellar tendon tissue from 22 patients undergoing open débridement of the patellar tendon and from 10 patients undergoing intramedullary nailing of the tibia. VEGF expression was assessed immunohistochemically. Relevant inflammatory and repair cell types were immunolabeled. VEGF expression was absent from control tendons, but was present in a subset of patients with histopathological evidence of angiofibroblastic tendinosis. VEGF was expressed in the intimal layer of tendon vessels, but was absent in other cell types. Patients demonstrating VEGF expression in the patellar tendon had a shorter symptom duration (12 +/- 7.8 months) than patients with no detectable VEGF (32.8 +/- 23.5 months). VEGF may contribute to the vascular hyperplasia that is a cardinal feature of symptomatic tendinosis, particularly in cases with more recent onset.
| S-EPMC2505256 | biostudies-other
Project description:BACKGROUND:Patellar tendinopathy is an extremely debilitating condition and its treatment usually requires a combination of clinical approaches. Therapeutic ultrasound (TUS) is one of the most available electrophysical agent in rehabilitation settings; however, there is also a lack of high-quality studies that test different dosimetric aspects of TUS. Thus, the purpose of this study is to evaluate the short-, medium-, and long-term effects of the combination of high-energy TUS with a rehabilitation program for patellar tendinopathy. METHODS:This will be a randomized, placebo-controlled trial with blinding of patients, assessors, and therapist. The setting is an outpatient physical therapy clinic. We will recruit 66 participants (male and female) aged between 18 and 40?years and presenting with patellar tendinopathy. A treatment combining high-energy dose TUS and a rehabilitation program for patellar tendinopathy will be delivered twice a week for 8?weeks. The control group will receive the same treatment, but with a placebo TUS. The effectiveness of the intervention will be measured at the beginning (baseline), midpoint (4?weeks), and end of treatment (8?weeks), as well as at 3- and 6-months post-treatment. Primary outcomes will be pain intensity (visual analogue scale, VAS), and VISA-P questionnaire and primary time points will be baseline (T0) and the end of the program (T2). Also, IPAQ-short form questionnaire, muscle strength (manual dynamometry), 2D kinematics, pain pressure threshold (PPT) algometry, thermography, and magnetic resonance imaging (MRI) will be collected. DISCUSSION:TUS will be applied in an attempt to enhance the results obtained with the rehabilitation program proposed in this study, as well as stimulate some repair responses in individuals undergoing treatment for patellar tendinopathy, which in turn may optimize and improve treatment programs for patellar tendinopathy as well as to establish new guidelines for the application of TUS. TRIAL REGISTRATION:This study was prospectively registered at April-3rd-2018 and updated at September-1st-2019 in the Brazilian Registry of Clinical Trials (REBEC) under the registration number: RBR-658n6w.
| S-EPMC6933732 | biostudies-literature