Management of patellar tendinopathy: a systematic review and network meta-analysis of randomised studies

Challoumas, D., Pedret, C., Biddle, M., Ng, N. Y. B., Kirwan, P., Cooper, B., Nicholas, P., Wilson, S., Clifford, C. and Millar, N. L. (2021) Management of patellar tendinopathy: a systematic review and network meta-analysis of randomised studies. BMJ Open Sport and Exercise Medicine, 7(4), e001110. (doi: 10.1136/bmjsem-2021-001110)

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Abstract

Objectives: We performed a systematic review and network meta-analysis (NMA) of randomised controlled trials (RCTs) to provide insights into the effectiveness of available treatment modalities in patellar tendinopathy(PT). Methods: Several databases were searched in May 2021 for RCTs assessing the effectiveness of any intervention compared with any other intervention, placebo or no treatment for pain and/or function in PT. The risk of bias and strength of evidence were assessed with the Cochrane Collaboration and GRADE (Grading of Recommendations, Assessment, Development and Evaluations)/GRADE-NMA tools. Results: A total of 37 RCTs were eligible that assessed 33 different interventions and their combinations, most represented by single studies. Based on pairwise meta-analyses of two RCTs, extracorporeal shockwave therapy (ESWT) does not appear to be superior to sham ESWT (eccentric exercise in both groups) for short-term pain (mean differences (MD) +0.1, 95% CI (−0.8 to 1), p=0.84) or function (MD −1.8, 95% CI (–8 to 4.4), p=0.57). Based on a pairwise meta-analysis of three RCTs, isometric exercise appears as effective as isotonic exercise for immediate postintervention pain relief (MD −1.03, 95% CI (−2.6 to 0.5), p=0.19). Our NMA showed that topical glyceryl trinitrate (GTN) and hyaluronic acid injection, both combined with eccentric exercise and moderate, slow resistance exercise had the highest probability of being the most effective interventions (low/very low strength of evidence). Conclusions: Promising interventions with inadequate evidence, such as topical GTN, hyaluronic acid injections and isometric and slow resistance exercise, should be further investigated through high-quality RCTs. Meanwhile, eccentric loading with or without adjuncts should remain the first-line treatment for all individuals with patellar tendinopathy.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Nicholas, Dr Patrick and Clifford, Christopher and Challoumas, Mr Dimitris and Millar, Professor Neal and Wilson, Dr Scott and Ng, Dr Nigel
Authors: Challoumas, D., Pedret, C., Biddle, M., Ng, N. Y. B., Kirwan, P., Cooper, B., Nicholas, P., Wilson, S., Clifford, C., and Millar, N. L.
College/School:College of Medical Veterinary and Life Sciences > School of Infection & Immunity
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Research Centre:College of Medical Veterinary and Life Sciences > School of Infection & Immunity > Centre for Immunobiology
Journal Name:BMJ Open Sport and Exercise Medicine
Publisher:BMJ Publishing Group
ISSN:2055-7647
ISSN (Online):2055-7647
Published Online:29 November 2021
Copyright Holders:Copyright © 2021 The Authors
First Published:First published in BMJ Open Sport and Exercise Medicine 7(4): e001110
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
301515Damage mechanisms in tendon diseaseNeal MillarMedical Research Council (MRC)MR/R020515/1III - Immunology