Management of Achilles and patellar tendinopathy: what we know, what we can do

Abstract

Tendinopathies are challenging conditions frequent in athletes and in middle-aged overweight patients with no history of increased physical activity. The term “tendinopathy” refers to a clinical condition characterised by pain, swelling, and functional limitations of tendons and nearby structures, the effect of chronic failure of healing response. Tendinopathies give rise to significant morbidity, and, at present, only limited scientifically proven management modalities exist. Achilles and patellar tendons are among the most vulnerable tendons, and among the most frequent lower extremity overuse injuries. Achilles and patellar tendinopathies can be managed primarily conservatively, obtaining good results and clinical outcomes, but, when this approach fails, surgery should be considered. Several surgical procedures have been described for both conditions, and, if performed well, they lead to a relatively high rate of success with few complications. The purpose of this narrative review is to critically examine the recent available scientific literature to provide evidence-based opinions on these two common and troublesome conditions.

A Population-Level Summary of Health Care Utilization for the Management of Patellar Tendinopathy in the Military Health System

“…Exercise therapy was one of the most frequently used interventions in this cohort when care was received, which is an expected finding considering it is the most often studied and recommended intervention. 1 6 7 9 10 26 27 Despite exercise therapy being a common intervention, only 5.9% ( n = 280) of the cohort received six or more visits of exercise therapy in the initial episode of care with the median number of visits being 9.00 (IQR 7.00). This likely means individuals were seen approximately two to three times per week for 4 to 6 weeks.…”

“…1 Nonsteroidal anti-inflammatories (NSAIDs) and corticosteroid injections may be useful, but only in the short term. 7,8 Passive modalities, manual therapy, and injections are not recommended on their own, and may lead to reliance on passive treatments from the health care provider. 1,9 Other potential promising interventions with short-term pain relief include patellar strapping, taping of the knee, topical glyceryl trinitrate and hyaluronic acid injections, and platelet-rich plasma.…”

Case Study: The Conservative Management and Rehabilitation of Insertional Patella Tendinopathy in an Elite Footballer

“…The patella tendon can be disrupted in both the central portion and para-tendon, where repeated stress and load effect the collagen proteins within the tendon leading to pain and reduced function [5][6][7] . Insertional and mid tendon irritation can occur within the structure and present with similar symptoms that require comparable treatment [8][9][10] . Within elite sport, acute and chronic forms of patella tendinopathy are seen where athletes are subject to spikes and changes in load 11,12 .…”

3D Biomimetic Scaffold for Growth Factor Controlled Delivery: An In-Vitro Study of Tenogenic Events on Wharton’s Jelly Mesenchymal Stem Cells

“…Surgical procedures are elected when traditional modalities fail. Even if these approaches lead to a relatively high rate of success, they sometimes present limitations [ 1 ]. Tendon tissue poorly responds to current treatments, resulting in permanent changes of the native tendon structures (with scar tissue formation and fibrosis) and biomechanics.…”