Results of Arthroscopic Treatment of Chronic Patellar Tendinopathy

Andonovski, Alan; Andonovska, Biljana; Trpeski, Simon

doi:10.2478/prilozi-2020-0035

Cited by 5 publications

(13 citation statements)

References 24 publications

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“…Moreover, decortication at the distal pole of the patella has been previously described to maximize healing potential 9 . Both surgeries give satisfactory results with success rate of more than 77% and arthroscopic surgery is associated with fewer complications, faster return to preinjury level of sport activities, and a non-significant higher success rate 4 . A review of 21 studies showed no significant differences regarding return to sports and surgical success rates between arthroscopic and open procedures 9 .…”

Section: Discussionmentioning

confidence: 97%

“…The application of PRP has been associated with tendon healing and remodeling as a result of growth factors that lead to matrix production and heightened tenocyte activity. Several studies have shown symptomatic improvement and evidence of improvement on imaging in patients with patellar insertional tendinopathy after application of PRP 4 . The last issue that is under question is the necessity of resection of the lower patellar pole during the arthroscopic surgery.…”

Section: Discussionmentioning

confidence: 99%

“…In the paratenon, mucoid degeneration, fibrosis, and vascular proliferation, with a slight inflammatory infiltrate, have been reported 3 . The mechanical impingement and compression of the inferior patellar pole onto the posterior aspect of the patellar tendon in flexion is another important factor in the pathogenesis 4 . Determining increased tendon thickness of the posterior part of the proximal patellar tendon in the place of impingement with the elongated lower patellar pole, Andonovski concluded that this was a more compatible mechanism in pathogenesis than in tendon stress overload alone.…”

Section: Introductionmentioning

confidence: 99%

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Treatment of recalcitrant patellar tendinosis: can the peignage technique be a viable alternative?

et al. 2022

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Objective. Patellar tendinopathy typically affects young athletes engaged in running and jumping activities. If conservative therapy fails at one year, surgery generally leads to therapeutic success. This study evaluated the clinical effectiveness of the "peignage" technique combined with PRP infiltration. Methods. Since 2018 we have treated 7 active patients with open patellar "peignage" technique, excision of degenerations, micro-perforation,s and PRP infiltration, subsequently subjected to a standardized 3-month rehabilitation protocol. Results. There was a reduction in the mean VAS pain from 7.2 to 2.5 points and functional improvement on the VISA-P-I scale from 49 to 85% between pre-and post-operative periods (1 year follow-up), with statistically significant differences. Conclusions. In resistant cases of patellar tendinopathy, the combined use of surgery and orthobiologics allows the athlete to return to pre-injury activities, with good results regarding pain and function. The lack of high-quality evidence studies does not allow systematic conclusions on patellar "peignage" to be drawn; however, the case series present in the literature underline good clinical efficacy. Level of evidence. IV, Case series, prospective.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Treatment of recalcitrant patellar tendinosis: can the peignage technique be a viable alternative?

et al. 2022

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“…Fifteen studies detailed results regarding pain, most commonly reporting scores along a VAS or as a number/percentage of patients who were pain free. 14,15,18,19,22,23,25,29,31,36,37,[42][43][44][45] Three studies 23,41,43 reporting pre-and postoperative VAS pain scores (0-10) with standard deviations had an average reduction in VAS postoperatively of 5.10 (95% CI: 4.52-5.68, I 2 ¼ 0%) which is above the MCID of 2.0 to 3.5 (►Fig. 9).…”

Section: Pain Scoresmentioning

confidence: 99%

Surgical Management of Patellar Tendinopathy Results in Improved Outcomes and High Rates of Return to Sport: A Systematic Review

et al. 2022

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Although the majority of patients with patellar tendinopathy (PT) can be treated nonoperatively, operative management may be indicated for recalcitrant cases. While several surgical techniques have been described, there is limited understanding of postoperative outcomes and expectations regarding return to activity and sport. The purpose of this study was to characterize the clinical outcomes associated with the surgical management of PT with an emphasis on return to sport (RTS) rates. We hypothesized that surgical management would lead to clinically important improvements in patient-reported outcomes (PROs) with high rates of RTS and RTS at the same level. A comprehensive search of the PubMed, Medline, and Embase databases was performed in December 2020. Level of evidence studies I through IV, investigating results of surgical management for PT (PRO, functional outcomes, pain, and/or RTS), were included. The search was performed in accordance with the Preferred Reported Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Forty clinical studies reporting on surgery for PT satisfied inclusion criteria, with 1,238 total knees undergoing surgery for PT. A comparison of pre- and postoperative Victorian Institute of Sport Assessment, patellar tendon (VISA-P) scores (mean difference: 41.89, p < 0.00001), Lysholm scores (mean difference: 41.52, p < 0.00001), and visual analogue scale (VAS) pain scores (mean difference: 5, p < 0.00001) demonstrated clinically and statistically significant improvements after surgery. The overall RTS rate following operative management was 89.8% (95% confidence interval [CI]: 86.4–92.8, I 2 = 56.5%) with 76.1% (95% CI: 69.7.5–81.9, I 2 = 76.4%) of athletes returning to the same level of activity. Surgery for PT provides meaningful improvement in patient reported outcomes and pain while allowing athletes to RTS at high rates with levels of participation similar to that of preinjury. Comparative studies of open and/or arthroscopic surgery are still limited but current evidence suggests better rates of RTS for arthroscopic surgery compared with open surgery. This is a systematic review of level-I to -IV studies.

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“…Macroscopically, surgical specimens demonstrate that pathologic tendons lose the parallel, closely packed collagen fibers with increased waviness, disordered arrangement, and separated fibers as a result of mucoid degeneration, lipid deposition, and increased matrix metalloproteinases (8). In addition, multiple studies have demonstrated increased vascularity with increased neovascularization between the associated fat pads and tendons, which may result in tissue adherence and reduced glide between these structures (9). Lastly, fusiform thickening also can develop as a result of increased water content within tendon cells undergoing apoptosis (10).…”

Section: Anatomy and Pathophysiologymentioning

confidence: 99%

Knee Extensor Mechanism Tendinopathy: Evaluation, Treatment, and Prevention

Catapano¹,

Babu²,

Tenforde

et al. 2022

Curr Sports Med Rep

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Knee extensor mechanism tendinopathy, including patellar and quadriceps tendinopathy, is common among athletes and those involved in jumping sports. It is largely a clinical diagnosis that presents as anterior knee pain and stiffness with associated tenderness over the affected tendon. Imaging modalities, including ultrasound and/or magnetic resonance imaging, may be helpful with the diagnosis of difficult cases or in the planning of interventional procedures. Focused and structured rehabilitation using eccentric or heavy slow resistance exercise in conjunction with load management is important for recovery. Adjuvant therapies (e.g., injections or surgery) may be necessary in recalcitrant cases or those with insufficient response to rehabilitation efforts. Prevention strategies focus on improving biomechanics, landing mechanism and lower-extremity balance, flexibility, and strength.

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Results of Arthroscopic Treatment of Chronic Patellar Tendinopathy

Cited by 5 publications

References 24 publications

Treatment of recalcitrant patellar tendinosis: can the peignage technique be a viable alternative?

Treatment of recalcitrant patellar tendinosis: can the peignage technique be a viable alternative?

Surgical Management of Patellar Tendinopathy Results in Improved Outcomes and High Rates of Return to Sport: A Systematic Review

Knee Extensor Mechanism Tendinopathy: Evaluation, Treatment, and Prevention

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