Novel approaches for the management of tendinopathy.
Tendinopathy is a failed healing response of the tendon. Despite an abundance of therapeutic options, very few randomized prospective, placebo-controlled trials have been carried out to assist physicians in choosing the best evidence-based management. Eccentric exercises have been proposed to promote collagen fiber cross-link formation within the tendon, thereby facilitating tendon remodeling. Overall results suggest a trend for a positive effect of eccentric exercises, with no reported adverse effects. Combining eccentric training and shock wave therapy produces higher success rates compared with eccentric loading alone or shock wave therapy alone. The use of injectable substances such as platelet-rich plasma, autologous blood, polidocanol, corticosteroids, and aprotinin in and around tendons is popular, but there is minimal clinical evidence to support their use. The aim of operative treatment is to excise fibrotic adhesions, remove areas of failed healing, and make multiple longitudinal incisions in the tendon to detect intratendinous lesions and to restore vascularity and possibly stimulate the remaining viable cells to initiate cell matrix response and healing. New operative procedures include endoscopy, electrocoagulation, and minimally invasive stripping. The aim of these techniques is to disrupt the abnormal neoinnervation to interfere with the pain sensation caused by tendinopathy. Randomized controlled trials are necessary to better clarify the best therapeutic options for the management of tendinopathy.
Centre for Sports and Exercise Medicine, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London E1 4DG, England. n.maffulli@qmul.ac.uk
Nicola
N
Maffulli
Umile Giuseppe
UG
Longo
Vincenzo
V
Denaro
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000627:therapeutic use; D001804:Blood Transfusion, Autologous; D004564:Electrocoagulation; D004724:Endoscopy; D005081:Exercise Therapy / Q000379:methods; D019220:High-Energy Shock Waves / Q000627:therapeutic use; D006801:Humans; D019060:Minimally Invasive Surgical Procedures; D053657:Platelet-Rich Plasma; D000077423:Polidocanol; D011092:Polyethylene Glycols / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012597:Sclerosing Solutions / Q000627:therapeutic use; D052256:Tendinopathy / Q000628:therapy*; D000267:Tissue Adhesions / Q000628:therapy; D014945:Wound Healing / Q000502:physiology
D000305:Adrenal Cortex Hormones; D000779:Anesthetics, Local; D012597:Sclerosing Solutions; D000077423:Polidocanol; D011092:Polyethylene Glycols