The Effectiveness of Minimally Invasive Techniques in the Treatment of Patellar Tendinopathy: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials

Abstract

The aim was to determine the effectiveness of minimally invasive techniques (MIT) in patients with patellar tendinopathy. Database searches were performed for randomized controlled trials (RCTs) in electronic databases (WOS, Cochrane Central, SportDiscus, and Medline via PubMed and PEDro). The inclusion criteria used were published in English or Spanish and involving adults with patellar tendinopathy (pain on the inferior pole of the patella for a minimum of 3 months), with at least one group receiving MIT. The quality of the relevant RCTs was evaluated using the PEDro scale. The primary outcome was functionality using the VISA-p questionnaire. Secondary outcome was focused on pain. A total of 1164 studies were screened for possible inclusion in our systematic review. Finally, 10 RCTs were included with a total of 326 individuals. Five RCTs were included in the meta-analysis. The quality assessment revealed that all the studies included were considered to possess high methodological quality. All studies analyzing MIT such as platelet-rich plasma (PRP), dry needling, or skin-derived tenocyte-like cells, when combined with exercise, proved to be effective for patellar tendinopathy. Moreover, the PRP technique with doses greater than 4 mL together and combined with an exercise program lasting over 6 weeks obtained better results in functionality and pain than other treatments in the short term. However, in the long term, dry needling and skin-derived tenocyte-like cells are more effective than PRP. Although the infiltration of drugs was effective at posttreatment, these improvements were not maintained over time and may have secondary effects. Although there are no RCTs analyzing the effectiveness of MIT like percutaneous needle electrolysis, there has been an increasing number of publications achieving excellent results in the last years. However, it is necessary to develop RCTs analyzing not only the effect but also comparing the effectiveness between different MIT such as dry needling and percutaneous needle electrolysis.

Efficacy of different intensities of percutaneous electrolysis for musculoskeletal pain: A systematic review and meta-analysis

“…Looking at a general overview of our results, we found that EP is effective in the management of musculoskeletal disorders, which is consistent with the conclusions of the meta-analysis conducted by Gómez-Chiguano et al (17) and other qualitative systematic reviews (18,19,39,40). These articles reflected that one limitation of the scientific evidence concerning PE is the high variability in the parameters of application of the galvanic current.…”

“…The result of these works is the first meta-analysis concerning the effects of PE on pain intensity and disability related to musculoskeletal pain where it is concluded that there is moderate evidence suggesting a large positive effect of PE to reduce pain and moderate evidence of a large decrease in pain-related disability for musculoskeletal pain conditions in the short, medium, and long term (15). However, like other reviews, they add that it is necessary to study the doses to unify more precise criteria for the application of PE and thus be able to reach a consensus on which clinical entities may be the most benefited by this type of therapy (17)(18)(19)(20).…”

Efficacy of percutaneous electrolysis for the treatment of tendinopathies: A systematic review and meta-analysis

“…Finally, this research also presents different strengths: this is the systematic review on percutaneous electrolysis in the treatment of tendinopathies that has analyzed the most studies to date. [41][42][43][44] In conclusion, the percutaneous electrolysis is effective for the treatment of tendinopathies showing results both immediately after the interventions analyzed and in those with long-term follow-up. The combination of this technique with eccentric training has proven to be one of the most effective treatments to improve tendinopathy pain to date.…”

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

“…The necrotic area of the tendon is debrided, and a rongeur is used to decorticate the distal pole of the patella to arrive at fresh bone. Moreover, multiple microperforations of the distal pole are made with a 2.5 mm k-wire to enhance the healing potential of the tendon attachment after debridement 6 . A PRP coat is placed under the tendon to stimulate further healing and a larger growth factor response (Fig.…”

“…Following the canonical classification of Blazina 5 , early symptomatic PT (Phases I and II) is often treated conservatively, such treatment including oral medications (non-steroidal anti-inflammatory drugs and corticosteroids), rest, immobilization, physical therapy (cryotherapy, extracorporeal shockwave therapy, ESWT) and eccentric exercise therapy 3 . New minimally invasive (MIT) topical techniques, such as platelet-rich-plasma (PRP) infiltrations or ultrasound-guided dry needling, are reserved for recalcitrant cases 6 . However, conservative treatment modalities aimed at modulating inflammation have had limited success in treating severe PT and also do not prevent painful conditions arising from overuse of tendons.…”