Studies of surgical outcome after patellar tendinopathy: clinical significance of methodological deficiencies and guidelines for future studies

Coleman, Bd; Khan, Khalid; Maffulli, Nicola; Cook, J.; Wark, John D.

doi:10.1034/j.1600-0838.2000.010001002.x

Cited by 828 publications

(685 citation statements)

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“…In order to minimize the response bias, which can affect the patients' reports of pain and symptoms, it is important to use outcome assessments in which the investigator has a minimal influence on the scoring (Coleman et al, 2000, Tallon et al, 2001. In many of the above studies, it is difficult to judge how much the investigator could have influenced the results.…”

Section: Outcome Scores -Questionnairementioning

confidence: 99%

Iontophoresis with or without dexamethazone in the treatment of acute Achilles tendon pain

Neeter

Thomeé

Silbernagel

et al. 2003

Scandinavian Med Sci Sports

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The purpose of this double‐blind study was to evaluate the effects of iontophoresis with dexamethazone to iontophoresis with saline solution on patients who had acute (less than 3 months) pain from the Achilles tendon, in terms of range of motion, muscular endurance, pain and symptoms. Twenty‐five patients (15 men and 10 women), aged between 18 and 76 years (mean = 38), were evaluated before and after 2 weeks of treatment with iontophoresis, as well as after 6 weeks, 3 and 6 months and 1 year. Two groups were treated for 2 weeks with iontophoresis for each treatment. Three ml of dexamethazone were used for the experiment group (n = 14) and 3 ml of saline solution for the control group (n = 11). Both groups then followed the same rehabilitation programme for 10 weeks. Good reliability was found for the toe‐raise and range of motion tests. Poor reliability was, however, found for the pain on palpation test, which was therefore excluded. No difference was found between or within groups for the toe‐raise test. Several significant improvements were seen in the experiment group but not in the control group, in the range of motion test, pain during and after physical activity, pain during walking and walking up and down stairs, morning stiffness and tendon swelling. Even though the small sample size limits the possibilities to draw definite conclusions, we conclude from the present study, using a double‐blind, randomised approach and a 1‐year follow‐up period, that positive effects from using iontophoresis with dexamethazone were found in the treatment of patients with acute Achilles tendon pain.

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Section: Outcome Scores -Questionnairementioning

confidence: 99%

Iontophoresis with or without dexamethazone in the treatment of acute Achilles tendon pain

Neeter

Thomeé

Silbernagel

et al. 2003

Scandinavian Med Sci Sports

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“…Over the last decade, several studies have provided the opportunity to develop novel therapeutic strategies [4-9, 17, 19, 23, 26]. While many of the epidemiological and imaging difficulties have been addressed [2,11], relatively few studies have tried to quantify the histopathological findings of tendinopathy [18,20,21], and the histopathological changes are currently described in a subjective or at best semiquantitative fashion [1,12,20,25,27]. This may result in uncertainty about the histopathological findings of tendinopathy, and has produced a lack of diagnostic uniformity among surgical pathologists.…”

Section: Introductionmentioning

confidence: 99%

Movin and Bonar Scores Assess the Same Characteristics of Tendon Histology

Maffulli

Longo

Franceschi

et al. 2008

Clinical Orthopaedics &Amp; Related Research

215

190

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The Movin scoring system and its validated modifications and the Bonar scoring system are used to classify the histopathological findings of tendinopathy. We compared the reliability of these two different histopathological evaluation scores of tendon tissue. Tendon samples were harvested from 88 individuals (49 men, 39 women; mean age, 58.2 years) who underwent arthroscopic repair of a rotator cuff tear, and from five male patients who died of cardiovascular events (mean age, 69.6 years). A piece of supraspinatus tendon that was not directly involved in the tear was harvested en bloc within the intact middle portion of the tendon. Using hematoxylin and eosin staining and Alcian blue, slides were assessed using Bonar and Movin scores. The intraclass correlation was 0.921 (confidence interval 95% 0.790-0.963). Movin's and Bonar's scores have a high correlation and assess similar characteristics and variables of tendon abnormalities.

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“…Tendinosis can be disabling and frequently results in lost productivity, reduced physical activity, and early retirement from sports or labor (4)(5)(6).…”

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confidence: 99%

Tenocyte responses to mechanical loading in vivo: A role for local insulin‐like growth factor 1 signaling in early tendinosis in rats

Scott

Cook

Hart

et al. 2007

Arthritis & Rheumatism

148

138

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Objective. To investigate tenocyte regulatory events during the development of overuse supraspinatus tendinosis in rats.Methods. Supraspinatus tendinosis was induced by running rats downhill at 1 km/hour for 1 hour a day. Tendons were harvested at 4, 8, 12, and 16 weeks and processed for brightfield, polarized light, or transmission electron microscopy. The development of tendinosis was assessed semiquantitatively using a modified Bonar histopathologic scale. Apoptosis and proliferation were examined using antibodies against fragmented DNA or proliferating cell nuclear antigen, respectively. Insulin-like growth factor 1 (IGF-1) expression was determined by computer-assisted quantification of immunohistochemical reaction. Local IGF-1 signaling was probed using antibodies to phosphorylated insulin receptor substrate 1 (IRS-1) and ERK-1/2.Results. Tendinosis was present after 12 weeks of downhill running and was characterized by tenocyte rounding and proliferation as well as by glycosaminoglycan accumulation and collagen fragmentation. The proliferation index was elevated in CD90؉ tenocytes in association with tendinosis and correlated with increased local IGF-1 expression by tenocytes and phosphorylation of IRS-1 and ERK-1/2. Both apoptosis and cellular inflammation were absent at all time points. Conclusion. In this animal model, early tendinosis was associated with local stimulation of tenocytes rather than with extrinsic inflammation or apoptosis. Our data suggest a role for IGF-1 in the load-induced tenocyte responses during the pathogenesis of overuse tendon disorders.

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Studies of surgical outcome after patellar tendinopathy: clinical significance of methodological deficiencies and guidelines for future studies

Cited by 828 publications

References 1 publication

Iontophoresis with or without dexamethazone in the treatment of acute Achilles tendon pain

Iontophoresis with or without dexamethazone in the treatment of acute Achilles tendon pain

Movin and Bonar Scores Assess the Same Characteristics of Tendon Histology

Tenocyte responses to mechanical loading in vivo: A role for local insulin‐like growth factor 1 signaling in early tendinosis in rats

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