Sclerotherapy and prolotherapy for chronic patellar tendinopathies - a promising therapy with limited available evidence, a systematic review

Abstract

Chronic Patellar tendinopathy (CPT) is a frequent overuse disorder in athletes and active people. Sclerotherapy (ST) and prolotherapy (PT) are, among a wide range of conservative treatment options, two promising therapies and have shown positive results in other tendinopathies. Since the treatments’ efficacy and safety are still not defined, this review sought to answer questions on recommendations for use in clinical utility, safety, and how to perform the injection in the most effective way. An electronic database search was conducted following the PRISMA guidelines. Inclusion criteria were set up according to the PICOS-scheme. Included were athletes and non-athletes of all ages with diagnosed painful CPT. Studies including patients suffering from patellar tendinopathy which can be originated to any systemic condition affecting the musculoskeletal system (e.g. disorders associated with rheumatism) and animal studies were excluded. Methodological quality (modified Coleman Methodology Score) and risk of bias (Cochrane Risk of Bias Assessment Tool 2.0) were assessed by two independent reviewers, with disagreements resolved with a third reviewer. The search yielded a total of 416 entries. After screening titles, abstracts, and full texts, ten articles were found for qualitative analysis. The mean Coleman Score was 64.57. Three randomized-controlled trials showed positive results with an increase in VISA-P score or a decrease in VAS or NPPS, respectively. The non-randomized studies confirmed the positive results as well. Among all ten studies no serious adverse events were reported. Based on this limited set of studies, there seems to be some evidence that ST and PT may be effective treatment options to treat pain and to improve function in patients with CPT. To strengthen this recommendation, more research is needed with larger volume studies and randomized controlled studies with long term follow up. Level of evidence IV

Novel Implications of Tissue Engineering in the Treatment and Management of Rotator Cuff Tendinopathy

“…The underlying theory of this treatment is that by sclerosing the vessels, the surrounding hypersensitized nerves will also die, leading to decreased pain sensation [23,24,42]. Few studies have been performed, and have promising results for the resolution of pain symptoms [43]. These studies do not show, however, an improvement in the prognosis of the pathology.…”

Low Molecular Weight Hyaluronic Acid (500–730 Kda) Injections in Tendinopathies—A Narrative Review

“…Recently, thanks also to the ultrasound high-definition evaluation and guide [ 29 ], injection therapy has also carved out an important role in the treatment of tendinopathies through different proposals with different levels of success, as hyaluronic acid [ 30 ], PRP [ 31 ], high volume injections [ 32 ], prolotherapy [ 33 , 34 ], autologous conditioned serum [ 35 ], sclerotherapy [ 34 ], percutaneous electrolysis [ 36 ], etc.…”

Safety and Efficacy of Bone Marrow–Derived Mesenchymal Stem Cells for Chronic Patellar Tendinopathy (With Gap >3 mm) in Patients: 12-Month Follow-up Results of a Phase 1/2 Clinical Trial

“…17 In addition, the results of nonoperative management are unpredictable, and returning to sport is not certain despite rigorous adherence to rehabilitation programs. 5,14,19,22 Shockwave therapy, 12 prolotherapy, 20 high-volume injection, 21 and corticosteroid injection 1,21 have been tried as treatments for patellar tendinopathy, and recently, platelet-rich plasma (PRP) injections have become popular, although the ideal composition of PRP is still unclear. 10,25,26 Increased apoptotic cell death is a feature of patellar tendinopathy, and it contributes to the pathophysiology of patellar tendinopathy.…”