Are Current Prophylactic Programs Effective in Preventing Patellar Tendinopathy in Athletes and Recruits? A Meta-Analysis and Trial Sequential Analysis

Abstract

Context: Patellar tendinopathy (PT), or jumper’s knee, is a chronic painful overuse patellar tendon injury. For PT, prevention is more important than treatment. However, there is still a lack of strong evidence to confirm the effectiveness of prevention. Objective: This study will analyze by meta-analysis the effect of a prophylactic program on high PT risk people (but without PT) in reducing PT occurrence. Data Sources: PubMed, Embase, the Cochrane Library, Scopus, and Ebscohost, from inception to January 11, 2022. Study Selection: A study comparing the effects of prophylactic programs and controls on the risk of PT was included in the analysis. After a database search with search terms ((patellar tendinopathy) OR (jumper’s knee) OR (patellar tendinitis) OR (patellar tendinosis) OR (patellar tendonitis)) AND ((Prevent*) OR (prophyla*)), a total of 1444 items were obtained. Of these, 11 studies with 6091 participants were eligible for inclusion in this meta-analysis. Study Design: Systematic review and meta-analysis. Level of Evidence: Level 2. Data Extraction: The first author’s name, publication year, study design, country, population, mean age, sex, prophylactic program, control, study duration, and the frequency or incidence of PT in each group were extracted. Results: A total of 11 articles were included in the analysis. Overall, no significant difference was considered in the risk of PT between the prophylactic program and control groups based on the random-effect model (odds ratio [OR], 0.85; 95% CI, 0.67, 1.08; P = 0.18). In the recruit subgroup, there was even a tendency to elevate the risk of PT occurrence after prophylaxis was executed (OR, 1.89; 95% CI, 0.68, 5.28; P = 0.22). In athletes, the prophylactic program tended to decrease the risk of PT compared with the control (OR, 0.81; 95% CI, 0.63, 1.04; P = 0.10); however, the difference was not statistically significant. Trial sequential analysis results suggested that prophylaxis may still be effective for athletes, but this needs to be confirmed with a larger sample size. Conclusion: The risk of PT cannot be reduced with the current prophylactic program. However, for athletes, the negative results may be due to insufficient sample size.

The Best Current Research on Patellar Tendinopathy: A Review of Published Meta-Analyses

“…A systematic search of PubMed for meta-analyses on patellar tendinopathy was performed, leading to the identification of a total of 21 studies that met the inclusion criteria [ 14 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ] ( Table 1 ). Regarding the origin of the meta-analyses, three were from the United States, two were from Italy, one was from New Zealand, three were from the United Kingdom, three were from Australia, one was from China, one was from Ireland, one was from Canada, one was from the Netherlands, one was from Brazil, one was from Spain, one was from Finland, and one was from Belgium.…”

“…In particular, the results of the patellar tendinopathy prophylactic program, in terms of reducing injury risk, have been disappointing. It is important to acknowledge that these outcomes may be skewed by the insufficient sample sizes in athlete studies, which may impede the discernment of significant differences and the drawing of definitive conclusions about the prophylactic program’s effectiveness [ 14 , 40 ].…”

“…This may be especially relevant in elite athletes participating in jumping sports due to the high demand placed on their patellar tendon and incidence of patellar tendinopathy in this population [ 3 , 4 ]. However, prevention program results have been controversial [ 14 ].…”

“…Some biomechanical risk factors that have been investigated include hip range of motion and knee angle during landing, as well as quadricep flexibility [ 13 ]. However, despite this knowledge, prevention programs have not proven to be effective in reducing the risk and may even increase the likelihood of injury in individuals with preexisting tendon changes [ 14 , 15 ]. As a result, 10% of patients ultimately require surgery due to the failure of conservative treatments [ 16 ].…”

Moderate evidence exists for four microRNAs as potential biomarkers for tendinopathies and degenerative tendon ruptures at the upper extremity in elderly patients: conclusion of a systematic review with best‐evidence synthesis

“…Since associated degenerative changes are present in 97% of all ruptured tendons [9], it is assumed that tendinopathies can cause such acute severe tendon injuries [10]. However, high‐quality evidence for effective preventive measures for tendinopathies is lacking [11, 12] and early clinical management is challenging due to asymptomatic early stages [13] as well as often ignored minor symptoms [14]. In this context, established clinical routine diagnostics such as anamnesis, clinical examination, and tendon imaging [15] are suitable for the diagnosis of manifested tendinopathies, but inappropriate for asymptomatic early stages.…”