Nonsteroidal Antiinflammatory Drugs in Tendinopathy

Magra, Merzesh; Maffulli, Nicola

doi:10.1097/01.jsm.0000194764.27819.5d

Cited by 71 publications

(38 citation statements)

References 29 publications

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“…Platelet-rich plasma (PRP) with a high concentration of platelets has been used in cardiac, maxillofacial, plastic, neuro, and orthopedic surgery [17e19]. More recently, PRP injections have been used to treat muscle, tendon, and cartilage injuries [20,21].…”

Section: Introductionmentioning

confidence: 99%

Ultrasound-guided injection of platelet-rich plasma in chronic Achilles and patellar tendinopathy

Ferrero

Fabbro

Orlandi

et al. 2012

Journal of Ultrasound

117

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KEYWORDSPlatelet-rich plasma; Achilles tendon; Patellar tendon; Jumper's knee; Achilles tendinopathy.Abstract 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 AE 16 years, range 20e61 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 e75.5 (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. Sommario Scopo: Il plasma ricco di piastrine (PRP), provocando un iperafflusso di citochine nel sito di iniezione si è dimostrato efficace, sia in vitro che in studi clinici in vivo, come promotore della rigenerazione tissutale. Lo scopo di questo studio è quello di valutare l'efficacia dell'iniezione ecoguidata di PRP autologo nel trattamento delle tendinopatie croniche del rotuleo e dell'achilleo. Materiali e metodi: Il PRP autologo è stato iniettato sotto guida ecografica in tendini rotulei e achillei (30 tendini di Achille, 28 tendini rotulei) di 48 pazienti selezionati in modo prospettico (30 maschi, 18 femmine, età media 38 AE 16 anni, range 20e61 anni). Tutti i pazienti erano stati precedentemente valutati mediante questionario Victoria Institute of Sport di valutazione (VISA) in cui si analizza il punteggio del dolore e il livello di attività. È stata poi eseguita una valutazione ecografica dei tendini mirata a valutarne l'ecostruttura e vascolarizzazione. La valutazione statistica dei dati ottenuti è stata eseguita mediante i test del Chi-quadrato e di Wilcoxon. Risultati: Venti giorni dopo l'iniezione di PRP è stato rilevato un miglioramento dei sintomi clinici non significativo. Il punteggio VISA è migliorato da una base di 57 a 75,5 a 6 mesi (p < .01). La v...

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Section: Introductionmentioning

confidence: 99%

Ultrasound-guided injection of platelet-rich plasma in chronic Achilles and patellar tendinopathy

Ferrero

Fabbro

Orlandi

et al. 2012

Journal of Ultrasound

117

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“…It is important to highlight that the rest and anti-inflammatory are mainly used for the symptomatic relief with no direct effect in the tendinopathy as chronic tendon disorders are predominantly degenerative. Further, both non steroidal antiinflammatory drugs [91] and corticosteroid drugs [92,93] could have deleterious effects on long-term tendon healing.…”

Section: Conservative Treatment Of Shoulder Tendinopathymentioning

confidence: 99%

Eccentric training as a new approach for rotator cuff tendinopathy: Review and perspectives

Camargo

Alburquerque‐Sendín

Salvini

2014

WJO

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Excessive mechanical loading is considered the major cause of rotator cuff tendinopathy. Although tendon problems are very common, they are not always easy to treat. Eccentric training has been proposed as an effective conservative treatment for the Achilles and patellar tendinopathies, but less evidence exists about its effectiveness for the rotator cuff tendinopathy. The mechanotransduction process associated with an adequate dose of mechanical load might explain the beneficial results of applying the eccentric training to the tendons. An adequate load increases healing and an inadequate (over or underuse) load can deteriorate the tendon structure. Different eccentric training protocols have been used in the few studies conducted for people with rotator cuff tendinopathy. Further, the effects of the eccentric training for rotator cuff tendinopathy were only evaluated on pain, function and strength. Future studies should assess the effects of the eccentric training also on shoulder kinematics and muscle activity. Individualization of the exercise prescription, comprehension and motivation of the patients, and the establishment of specific goals, practice and efforts should all be considered when prescribing the eccentric training.In conclusion, eccentric training should be used aiming improvement of the tendon degeneration, but more evidence is necessary to establish the adequate doseresponse and to determine long-term follow-up effects. Key words: Cellular; Mechanotransduction; Rehabilitation; Shoulder Impingement; Supraspinatus; Tendon injuries Core tip: Eccentric training can be considered a new and ambitious treatment approach for several tendinopathies. The paper establishes the basic principles for explaining the effects on the tendon of an intense mechanical load, as the eccentric training. Further, the authors bring other possible explanations of the success of this training for tendinopathies, as the individualization of the exercise programs and the motivation of the patients who reach specific goals. Negative and side effects are also identified. Finally, the main evidence afforded by original articles is commented and future research purposes are defined.Camargo PR, Alburquerque-Sendín F, Salvini TF. Eccentric training as a new approach for rotator cuff tendinopathy: Review and perspectives. World J Orthop 2014; 5(5): 634-644 Available from:

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“…Non-operative Eccentric exercises Promotion of tissue reorganization with improved changes in tendon structure and mechanical properties 31,34 Positive outcomes including reduced pain, improved strength, and decreased time to return to sport 32,33 NSAIDs Reduced pain and inflammation during tendon healing 37 Positive short-term outcomes for analgesia 35,36 ; no significant long-term benefits 29,37 ; some evidence to support that NSAIDs have potential to inhibit normal tendon healing 39,40 Corticosteroids…”

Section: Treatment Proposed Mechanism Outcomementioning

confidence: 99%

“…35,36 While useful for reducing pain and inflammation, NSAIDs do not appear to alter the course of the disease process, which is consistent with the lack of an inflammatory phenotype in tendinopathic tendons. 29,37 Furthermore, the drugs likely do not accumulate in sufficient quantities within the tendon tissue to change gene transcription. 38 There is also some evidence to suggest that NSAIDs may negatively impact tendon healing by impairing the proliferation and differentiation of tenocytes, as well as promoting the formation of adipocytes from mesenchymal stem cells.…”

Section: Non-steroidal Anti-inflammatory Drugs (Nsaids)mentioning

confidence: 99%

Pathogenesis and management of tendinopathies in sports medicine

et al. 2018

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Tendinopathy is a major clinical problem in sports medicine and is often difficult to treat. Traditional therapeutic approaches have focused on reducing inflammation, yet research suggests that little to no inflammation is present in the tendons that fail to heal. The purpose of this review was to evaluate the effectiveness of the available treatment options for tendinopathy and to inform best clinical practices. A comprehensive search of electronic databases (PubMed, Google Scholar, and Web of Science) was conducted to identify relevant studies through June 2016. Studies were deemed relevant if they were published in English and contained original research on the management of tendinopathy in humans. Studies varied in methodological quality and were often limited by small sample size and lack of sufficient control groups. Critical evaluation of the literature suggests that physical therapy with or without eccentric exercise should be considered a first-line treatment. Corticosteroids and non-steroidal anti-inflammatory drugs provide short-term symptomatic relief, but long-term efficacy has not been demonstrated. Inconsistent results do not support the routine use of prolotherapy, platelet-rich plasma injections, and topical nitric oxide patches. Operative intervention should be reserved until conservative measures fail or an obvious operative lesion is present. While numerous therapeutic modalities exist for tendinopathy in the athlete, the ideal treatment protocol has not been clearly defined. The development of new targeted therapies for tendinopathy is likely to follow a greater understanding of the cellular and molecular mechanisms that underlie its pathogenesis.

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Nonsteroidal Antiinflammatory Drugs in Tendinopathy

Cited by 71 publications

References 29 publications

Ultrasound-guided injection of platelet-rich plasma in chronic Achilles and patellar tendinopathy

Ultrasound-guided injection of platelet-rich plasma in chronic Achilles and patellar tendinopathy

Eccentric training as a new approach for rotator cuff tendinopathy: Review and perspectives

Pathogenesis and management of tendinopathies in sports medicine

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