Current pharmacological approaches to the treatment of tendinopathy

Aicale, Rocco; Bisaccia, Rocco Domenico; Oliviero, Antonio; Oliva, Francesco; Maffulli, Nicola

doi:10.1080/14656566.2020.1763306

Cited by 51 publications

(44 citation statements)

References 143 publications

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“…Tendinopathy is an umbrella term used to identify a complex clinical condition characterized by molecular, cellular, and histological changes occurring in affected tendons that leads to persistent pain, swelling, and impaired physical performance [1,2]. Several pathogenic mechanisms are involved in the occurrence of this condition.…”

Section: Introductionmentioning

confidence: 99%

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The Role of Hyaluronic Acid in Sport-Related Tendinopathies: A Narrative Review

et al. 2021

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Tendinopathy is a complex clinical condition with a rising incidence and prevalence, particularly during sports practice. For the return to play in affected patients, adequate functional and structural recovery of the tendon is the ultimate goal, avoiding the high risk of recurrence. In this perspective, local therapies alongside exercise are showing promising results. Despite evidence suggesting hyaluronic acid (HA) injections as effective in the treatment of tendinopathy, current recommendations about the management of this condition do not include this intervention. HA seems to be an effective therapeutic option for the management of sport-related tendinopathies, but further studies with a larger sample size are needed to confirm available findings. In this narrative review, we analyzed available literature about the rationale of the use of HA in the management of tendon injury and, particularly, in sport-related tendinopathies.

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Section: Introductionmentioning

confidence: 99%

“…Currently, recommended treatment strategies are extremely variable [1]. Exercise remains the most effective approach [7,8] and may be associated with the use of the local therapies as adjunctive treatment [2]. For several years, glucocorticoids (GC) have been used as the main injection treatment in patients with tendinopathy.…”

Section: Introductionmentioning

confidence: 99%

The Role of Hyaluronic Acid in Sport-Related Tendinopathies: A Narrative Review

et al. 2021

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“…Therapies for tendinopathies keep changing as research in this field progresses. To date, different injective substances have been investigated: platelet-rich plasma, high volume image-guided injections, hyaluronic acid, and prolotherapy, as a suitable option beside the commonly used eccentric loading rehabilitation regimen (56). Preclinical and clinical findings appear to be promising for hyaluronic acid, especially for Achilles and patellar tendon pathology.…”

Section: Perspectivesmentioning

confidence: 99%

The Role of Hyaluronic Acid Injection for the Treatment of Tendinopathy

Frizziero

Vittadini²,

Bigliardi

et al. 2020

Muscle Ligaments and Tendons J

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Hyaluronic acid has carved out an essential, though sometimes discussed, role in the treatment of joint degenerative pathology. Recent studies, first in vitro, then preclinical, have paved the way for use in tendon pathology. Clinical experience to date has shown extremely encouraging results in different tendinopathy frameworks such as tenosynovitis, insertional tendinopathies and tendon mid-portion.

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“…Other regenerative injection therapies such as platelet rich plasma (PRP) and hyaluronic acid (HA) are also showing promise [ 11 , 12 ]. However, there is currently no clear advantage between one treatment over another and comparisons are normally made in pairwise manner [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of prolotherapy in comparison to other therapies for chronic soft tissue injuries: A systematic review and network meta-analysis

et al. 2021

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Introduction Prolotherapy and other injections, primarily acting on pathways associated with maladaptive tissue repair, are recommended for recalcitrant chronic soft tissue injuries (CSTI). However, selection of injection is challenging due to mixed results. This network meta-analysis (NMA) aimed to compare prolotherapy with other therapies, particularly injections, for CSTI and establish robustness of the results. Methodology Pubmed, Medline, SPORTDiscus and Google scholar were searched from inception to 4th January 2021 for randomised controlled trials (RCTs) involving injection therapies (e.g. blood derivatives, corticosteroid, hyaluronic acid, botulinum toxin) for CSTI. The primary and secondary outcomes were pain and function, respectively, at (or nearest to) 6 months. Effect size (ES) was presented as standardised mean difference with 95% confidence interval (CI). Frequentist random effect NMA was used to generate the overall estimates, subgroup estimates (by region and measurement time point) and sensitivity analyses. Results A total of 91 articles (87 RCTs; 5859 participants) involving upper limb (74%), lower limb (23%) and truncal/hip (3%) injuries were included. At all time points, prolotherapy had no statistically significant pain benefits over other therapies. This observation remained unchanged when tested under various assumptions and with exclusion of studies with high risk of bias. Although prolotherapy did not offer statistically significant functional improvement compared to most therapies, its ES was consistently better than non-injections and corticosteroid injection for both outcomes. At selected time points and for selected injuries, prolotherapy demonstrated potentially better pain improvement over placebo (<4 months: shoulder [ES 0.65; 95% CI 0.00 to 1.30]; 4–8 months: elbow [ES 0.91; 95% CI 0.12 to 1.70]; >8 months: shoulder [ES 2.08; 95% CI 1.49, to 2.68]). Injections generally produced greater ES when combined with non-injection therapy. Conclusion While clinical outcomes were generally comparable across types of injection therapy, prolotherapy may be used preferentially for selected conditions at selected times.

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Current pharmacological approaches to the treatment of tendinopathy

Cited by 51 publications

References 143 publications

The Role of Hyaluronic Acid in Sport-Related Tendinopathies: A Narrative Review

The Role of Hyaluronic Acid in Sport-Related Tendinopathies: A Narrative Review

The Role of Hyaluronic Acid Injection for the Treatment of Tendinopathy

Efficacy of prolotherapy in comparison to other therapies for chronic soft tissue injuries: A systematic review and network meta-analysis

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