title: Nutraceutical supplement in the management of tendinopathies: a systematic review.
abstract: BACKGROUND
  nutraceuticals are common support therapy for management of tendinopathies. Even if they are widely diffused, our knowledge is still poor. The aim of this systematic review is to analyze the most commonly used nutraceuticals and their effects on tendons.
  
  
  METHODS
  glucosamine and chondroitin sulphate, vitamin C, hydrolazed type 1 collagen, arginine alpha-keto-glutarate, bromelain, curcumin, boswellic acid, and methil-sulfonil-methane were considered. During the last week of Dicember 2015 a comprehensive research of main databases for each substance was made in relation with tendinopathy. Repeated articles, articles not in English nor in Italian, not common nutraceuticals, and articles not related with tendons or tenocytes were excluded. Clinical article quality was assessed independently by two reviewers using the modified Coleman methodology score.
  
  
  RESULTS
  preclinical and clinical data from 46 articles from all databases were analyzed. All these nutraceuticals demonstrated several effects on normal and pathological tendons. Preclinical and clinical studies showed a possible role on collagen synthesis, inflammation, mechanical properties, and maturation of collagen bundles, antioxidant effect, edema, and analgesia. The majority clinical studies had some methodological limitations with an average Modified Coleman Methodology Score of 51.3 points and SD of 20.5 points. In particular, there were very low values in power, error, outcome assessment, and clinical effect.
  
  
  CONCLUSIONS
  preclinical results are very encouraging, however they are not fully confirmed by clinical studies. There are few clinical papers on the use of nutraceuticals in tendon disorders, and their methodological quality is poor. Furthermore, in most of the studies more than one supplement was administered at the same time. This may bias the results, and the effect of each single component cannot be determined. Furthermore, the interactions between nutraceuticals and drugs, or other dietary supplements (especially at high doses) has not been evaluated, neither their effects on chronic diseases. For these reasons, it is not possible to draw any definitive raccomendations on the use of nutraceutical supplementation in tendinopathies.
authors.affiliation: Clinical Orthopaedics, Department of Orthopaedics, Traumatology, Plastic Surgery and Rehabilitation, Second University of Naples, Naples, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Fusini
authors.affiliation: Department of Orthopaedic Surgery, San Pietro Fatebenefratelli Hospital, Rome, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Bisicchia
authors.affiliation: Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Bottegoni
authors.affiliation: Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Gigante
authors.affiliation: Clinical Orthopaedics, Department of Orthopaedics, Traumatology, Plastic Surgery and Rehabilitation, Second University of Naples, Naples, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Zanchini
authors.affiliation: Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Busilacchi
keywords: arginine alpha-keto-glutarate; ascorbate; boswellic acid; curcumin; oral supplement; tendon disorder