How strong is the evidence that conservative treatment reduces pain and improves function in individuals with patellar tendinopathy? A systematic review of randomised controlled trials including GRADE recommendations

Luciana De Michelis Mendonca*, Hercules R. Leite, Johannes Zwerver, Nicholas Henschke, Guilherme Branco, Vinicius Cunha Oliveira

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

16 Citations (Scopus)
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Abstract

Objective To determine the effectiveness of conservative treatment (CT) on pain and function in patients with patellar tendinopathy (PT) compared with minimal intervention (MI) or other invasive intervention, or in addition to decline eccentric squat.

Methods Searches were performed in MEDLINE, Embase, Cochrane, PEDro, SPORTDiscus, CINAHL and AMED databases. All randomised trials that evaluated CT (any intervention not involving invasive procedures or medication) in individuals with PT were included. Two reviewers screened studies, extracted data and assessed risk of bias of all included studies. Where suitable, meta-analyses were conducted; we assessed certainty of the evidence using GRADE methodology.

Results When compared with MI, CT did not improve pain (weighted mean difference (WMD) -2.6, 95% CI -6.5 to 1.2) or function (WMD 1.8, 95% CI -2.4 to 6.1) in the short-term (up to 3 months) follow-up. When compared with invasive intervention, CT did not improve pain (WMD 0.7, 95% CI -0.1 to 1.4) or function (WMD -6.6, 95% CI -13.3 to 0.2) in the short-term follow-up. No overall effects were found for combined CT (when a conservative intervention was added to decline eccentric squat) on pain (WMD -0.5, 95% CI -1.4 to 0.4) or function (WMD -2.3, 95 % -9.1 to 4.6) at short-term follow-up. Single studies showed an effect on pain with iontophoresis at short-term follow-up (d = 2.42) or dry needling at medium/long-term follow-up (d = 1.17) and function with exercise intervention at medium/long-term follow-up (over 3 months) (d = 0.83).

Summary/Conclusion Our estimates of treatment effect have only low to very low certainty evidence to support them. This field of sports medicine/sports physiotherapy urgently needs larger, high-quality studies with pain and function among the potential primary outcomes.

Original languageEnglish
Pages (from-to)87-93
Number of pages7
JournalBritish Journal of Sports Medicine
Volume54
Issue number2
Early online date6-Jun-2019
DOIs
Publication statusPublished - Jan-2020

Keywords

  • PLATELET-RICH PLASMA
  • SHOCK-WAVE THERAPY
  • JUMPERS KNEE
  • DOUBLE-BLIND
  • EXTRACORPOREAL SHOCKWAVE
  • HYPOECHOIC REGIONS
  • PULSED ULTRASOUND
  • DIFFERENT SPORTS
  • MANAGEMENT
  • RISK

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