scholarly journals The Effectiveness of Isometric Contractions Compared With Isotonic Contractions in Reducing Pain For In-Season Athletes With Patellar Tendinopathy

2020 ◽  
pp. 1-4
Author(s):  
Chee Vang ◽  
Alexander Niznik
Keyword(s):  
Pain Relief ◽  
Patellar Tendon ◽  
Patellar Tendinopathy ◽  
Current Evidence ◽  
Isometric Contractions ◽  
Bottom Line ◽  
Difficult Condition ◽  
Level 3 ◽  
Isotonic Contractions

Clinical Scenario: Patellar tendinopathy is a common musculoskeletal disorder affecting the lower-extremities and a difficult condition to manage for athletes that are in season. To facilitate improvement in function and to decrease pain, initial treatment for patellar tendinopathy is typically conservative. Traditional interventions may include eccentric training, cryotherapy, patellar counterforce straps, oral anti-inflammatories, injectable agents, phonophoresis, iontophoresis, orthotics, therapeutic ultrasound, and extracorporeal shockwave. In addition, recent literature suggests that implementing isometric and isotonic contractions may be effective in reducing patellar tendon pain. Focused Clinical Question: How effective are isometric contractions compared with isotonic contractions in reducing pain for in-season athletes with patellar tendinopathy? Summary of Key Findings: Implementation of isometric and isotonic exercises statistically reduced pain levels in the short term of 4 weeks for in-season athletes; however, isometric contractions provided statistically greater pain relief immediately for up to 45 minutes postintervention compared with isotonic contractions. Clinical Bottom Line: Current evidence supports the use of isometric and isotonic contractions to reduce pain for in-season athletes with patellar tendinopathy. Based on the reviewed literature, clinicians should consider utilizing heavy loaded isometrics or progressive heavy loaded isotonic exercises, which showed reduction in pain levels immediately after intervention and at 4-week follow-up for both intervention groups. Isometric contractions appear to provide greater pain relief immediately after intervention. Strength of Recommendation: There is Grade B evidence from 2 level 2 randomized controlled trials and 1 level 3 randomized crossover study supporting the use of isometric and isotonic contractions to reduce patellar tendon pain for in-season athletes.

scholarly journals Augmentation of Meniscal Repair With Platelet-Rich Plasma: A Systematic Review of Comparative Studies

2020 ◽  
Vol 8 (6) ◽  
pp. 232596712092614
Author(s):  
John W. Belk ◽  
Matthew J. Kraeutler ◽  
Stephen G. Thon ◽  
Connor P. Littlefield ◽  
John H. Smith ◽  
...  
Keyword(s):  
Systematic Review ◽  
Platelet Rich Plasma ◽  
Meniscal Repair ◽  
International Knee Documentation Committee ◽  
Current Evidence ◽  
Cochrane Library ◽  
Level Of Evidence ◽  
Level 3 ◽  
The Cochrane Library

Background: The effect of platelet-rich plasma (PRP) augmentation for meniscal repair (MR) is unclear, as current evidence is limited to small, mostly nonrandomized studies. Purpose: To systematically review the literature to evaluate the efficacy and safety of MR with PRP augmentation. Study Design: Systematic review; Level of evidence, 3. Methods: A systematic review was performed by searching PubMed, the Cochrane Library, and Embase to identify studies (level of evidence 1-3) that compared the clinical efficacy of MR performed with versus without PRP. The search phrase used was platelet-rich plasma meniscus. Patients were assessed based on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the visual analog scale (VAS) for pain, the Lysholm score, the Knee injury and Osteoarthritis Outcome Score (KOOS), the subjective International Knee Documentation Committee (IKDC) score, and treatment failure. Results: We identified 6 studies (2 studies with level 1 evidence; 4 studies with level 3 evidence) that met inclusion criteria, for a total of 309 patients undergoing MR with PRP (mean age, 31.9 years) and 445 patients without PRP augmentation (mean age, 29.6 years). The mean follow-up was 32.8 months (range, 12-72 months). Overall, 17.0% of PRP patients experienced MR failure compared with 22.1% of non-PRP patients. No differences in VAS, Lysholm, or subjective IKDC scores were found between groups except in 1 study, in which postoperative subjective IKDC scores were significantly better in the PRP group ( P < .01). Another study found significantly better postoperative WOMAC scores among PRP patients, and 2 studies found significantly better KOOS subscores among PRP patients. Conclusion: There are a limited number of high-quality studies comparing outcomes and healing rates between patients undergoing MR with versus without PRP augmentation. Based on the available evidence, patients undergoing MR with PRP augmentation experience similar clinical outcomes at midterm follow-up when compared with conventional MR, and additional studies are needed to determine the efficacy of MR augmented with PRP.

scholarly journals The Effects of Early Physical Activity Compared to Early Physical Rest on Concussion Symptoms

2019 ◽  
Vol 28 (1) ◽  
pp. 99-105 ◽  
Author(s):  
Landon Lempke ◽  
Abbis Jaffri ◽  
Nicholas Erdman
Keyword(s):  
Physical Activity ◽  
Acute Phase ◽  
Current Evidence ◽  
Symptom Duration ◽  
Multiple Time ◽  
Initial Examination ◽  
Bottom Line ◽  
Time Points ◽  
Multiple Time Points

Clinical Scenario: Currently, rest following concussion serves as the keystone of concussion treatment, but substantial evidence to support it is lacking. Recent literature suggests that early physical activity may be beneficial in reducing concussion symptoms which may influence clinical recovery time. Clinical Question: Does early physical activity decrease postconcussion symptoms compared to physical rest following concussion? Summary of Key Findings: A total of 5 articles were included that examined symptom duration changes at multiple time points. All 5 studies utilized follow-up time points compared to initial examination, but there was variance in the specific time points reported. Two studies employed control groups and compared strict or recommended rest to early activity or limited rest. Three studies were observational studies that directly compared baseline measurements to follow-up assessments. Clinical Bottom Line: Current evidence suggests that early physical activity in the acute phase following a concussion may decrease the time needed for symptom resolution compared to immediate rest. Strength of Recommendation: Using Centre for Evidence-Based Medicine 2011 level 3 evidence and higher, the results suggest that early physical activity during the acute phase of a concussion may decrease symptom duration; however, a lack of high-quality studies and inconsistent interventions are limitations to this recommendation.

scholarly journals Advanced Patellar Tendinopathy Is Associated With Increased Rates of Bone–Patellar Tendon–Bone Autograft Failure at Early Follow-up After Anterior Cruciate Ligament Reconstruction

2018 ◽  
Vol 6 (11) ◽  
pp. 232596711880771 ◽  
Author(s):  
Alexander L. Lazarides ◽  
Eduard Alentorn-Geli ◽  
Emily N. Vinson ◽  
Thomas W. Hash ◽  
Kristian Samuelsson ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Patellar Tendon ◽  
Graft Failure ◽  
Cruciate Ligament ◽  
Patellar Tendinopathy ◽  
Anterior Cruciate ◽  
Primary Acl Reconstruction ◽  
Bone Patellar Tendon

Background: Revision anterior cruciate ligament (ACL) reconstruction can be potentially devastating for a patient. As such, it is important to identify prognostic factors that place patients at an increased risk for graft failure. There are no data on the effects of patellar tendinopathy on failure of ACL reconstruction when using a bone–patellar tendon–bone (BPTB) autograft. Purpose/Hypothesis: The purpose of this study was to investigate the association of patellar tendinopathy with the risk of graft failure in primary ACL reconstruction when using a BPTB autograft. The hypothesis was that patellar tendinopathy would result in higher rates of graft failure when using a BPTB autograft for primary ACL reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: All patients undergoing ACL reconstruction at a single institution from 2005 to 2015 were examined. A total of 168 patients undergoing primary ACL reconstruction with a BPTB autograft were identified. Patients’ magnetic resonance imaging scans were reviewed for the presence and grade of patellar tendinopathy by 2 musculoskeletal fellowship–trained radiologists; both were blinded to the aim of the study, patient demographics, surgical details, and outcomes. Patients were divided into 2 groups: failure (defined as presence of symptomatic laxity or graft insufficiency) and success of the ACL graft. Statistical analyses were run to examine the association of patellar tendinopathy with failure of ACL reconstruction using a BPTB autograft. Results: At a mean follow-up of 18 months, there were 7 (4.2%) patients with graft failure. Moderate or severe patellar tendinopathy was associated with ACL graft failure ( P = .011). Age, sex, and side of reconstruction were not associated with the risk of graft failure, although the majority of patients who failed were younger than 20 years. The use of patellar tendons with moderate to severe tendinopathy was associated with a relative risk of ruptures of 6.1 (95% CI, 1.37-27.34) as compared with autograft tendons without tendinopathy. Conclusion: Moderate or severe patellar tendinopathy significantly increases the risk of graft failure when using a BPTB autograft for primary ACL reconstruction. Patellar tendinopathy should be considered when determining the optimal graft choice for patients undergoing primary ACL reconstruction with autograft tendons.

No Treatment Benefits of Local Administration of Insulin-like Growth Factor-1 in Addition to Heavy Slow Resistance Training in Tendinopathic Human Patellar Tendons: A Randomized, Double-Blind, Placebo-Controlled Trial With 1-Year Follow-up

2021 ◽  
pp. 036354652110210
Author(s):  
Jens L. Olesen ◽  
Mette Hansen ◽  
Ida F. Turtumoygard ◽  
Rikke Hoffner ◽  
Peter Schjerling ◽  
...  
Keyword(s):  
Growth Factor ◽  
Patellar Tendon ◽  
Collagen Synthesis ◽  
Controlled Trial ◽  
Isotonic Saline ◽  
Patellar Tendinopathy ◽  
Local Administration ◽  
Insulin Like Growth Factor ◽  
Patient Reported

Background: Heavy slow resistance (HSR) training is currently recommended as part of the treatment of patellar tendon tendinopathy. However, treatment success is not reached in all patients, and combinations of different treatments could be beneficial. Local administration of insulin-like growth factor-1 (IGF-1) in humans has been shown to quickly stimulate tendon collagen synthesis. Purpose: To study whether IGF-1 injections combined with HSR training enhance tendon synthesis, tissue structure, and patient satisfaction versus saline injection combined with HSR training in patients with patellar tendinopathy. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Forty patients (age 18-50 years) with unilateral patellar tendinopathy undertook HSR training (3 times a week for 12 weeks) and received intratendinous IGF-1 injections (1 mg IGF-1 per dose) or isotonic saline injections (sham injections) at baseline and after 1 and 2 weeks of training. The primary outcome was collagen synthesis parameters after 12 weeks (primary endpoint). The secondary outcomes were patient-reported outcomes (scores on the Victorian Institute of Sport Assessment–Patella [VISA-P] and visual analog scale [VAS] for pain) and structural changes before the initiation of treatment and at week 3, week 12, and 1 year after the initiation of treatment. Results: Analysis of the patellar tendon biopsy specimens at 12 weeks showed that collagen mRNA and total RNA were increased in the tendinopathic tendons compared with the contralateral healthy tendons regardless of treatment with IGF-1 or saline. Similarly, no difference between the groups was seen in tendon thickness and Doppler activity at week 12 or at 1-year follow-up. The combination of HSR training and IGF-1 injections significantly improved VISA-P and VAS pain scores after 3 weeks, whereas the overall responses after 12 weeks and at 1-year follow-up were identical in the 2 groups. Conclusion: Although a small, immediate clinical response to IGF-1 injections was seen when combined with training, no additional long-term effect of intratendinous IGF-1 was observed on structural and clinical outcomes in patients with patellar tendinopathy. Registration: NCT01834989 ( ClinicalTrials.gov identifier)

Current evidence around patellar tendon graft in ACLR for high-risk patients: current concepts

2020 ◽  
Vol 5 (1) ◽  
pp. 32-35
Author(s):  
Jérôme Murgier ◽  
Donald Hansom ◽  
Mark Clatworthy
Keyword(s):  
High Risk ◽  
Patellar Tendon ◽  
Failure Rate ◽  
Cruciate Ligament ◽  
High Risk Patient ◽  
Activity Level ◽  
Current Evidence ◽  
Patellar Tendon Graft ◽  
Scientific Publications

Hamstrings and patellar tendon (PT) are the most common autografts used to perform anterior cruciate ligament (ACL) reconstructions. The debate to know which graft should be better has been going on for decades. However, in relation to underpowered studies, no strong conclusions have been drawn until recently. Indeed, there was a need for a greater magnitude of data and assessment of specific population to properly compare these grafts. Our objective was to provide a current review based on recent scientific publications with high level of evidence. Registries have provided conclusive information. The Scandinavian registry showed lower failure rate for bone–patellar tendon–bone (BPTB) versus hamstring tendon (HT) at 5-year follow-up in over 45 000 patients (2.8% vs 4.2%; p<0.001). In the Norwegian registry, with 12 643 patients included, higher revision rates were recorded in HT graft versus BPTB graft at all follow-up times (2.8% vs 0.7% at 2 years and 5.1% vs 2.1% at 5 years). Moreover, as far as high-risk profile patients were concerned, this difference was even more significant. This trend has also been confirmed more recently in a study when assessing young females, showing that the failure rate amounted to 6.4% in the PT group while it reached 17.5% in the HT group at 3.7-year follow-up (p=0.02). ACL graft selection should be a discussion between the physician and the patient, taking into consideration age, activity level and occupation. Within the high-risk patient group however, scientific evidence supports the PT as the gold standard for ACL reconstruction.

Isometric Contractions Are More Analgesic Than Isotonic Contractions for Patellar Tendon Pain

2017 ◽  
Vol 27 (3) ◽  
pp. 253-259 ◽  
Author(s):  
Ebonie Rio ◽  
Mathijs van Ark ◽  
Sean Docking ◽  
G. Lorimer Moseley ◽  
Dawson Kidgell ◽  
...  
Keyword(s):  
Patellar Tendon ◽  
Isometric Contractions ◽  
Isotonic Contractions

scholarly journals Failed Surgery for Patellar Tendinopathy in Athletes: Midterm Results of Further Surgical Management

2021 ◽  
Vol 9 (3) ◽  
pp. 232596712199455
Author(s):  
Nicola Maffulli ◽  
Francesco Oliva ◽  
Gayle D. Maffulli ◽  
Filippo Migliorini
Keyword(s):  
Surgical Management ◽  
Revision Surgery ◽  
Case Series ◽  
Sports Participation ◽  
Patellar Tendinopathy ◽  
Symptom Duration ◽  
Level Of Evidence ◽  
Training Time ◽  
The Mean

Background: Tendon injuries are commonly seen in sports medicine practice. Many elite players involved in high-impact activities develop patellar tendinopathy (PT) symptoms. Of them, a small percentage will develop refractory PT and need to undergo surgery. In some of these patients, surgery does not resolve these symptoms. Purpose: To report the clinical results in a cohort of athletes who underwent further surgery after failure of primary surgery for PT. Study Design: Case series; Level of evidence, 4. Methods: A total of 22 athletes who had undergone revision surgery for failed surgical management of PT were enrolled in the present study. Symptom severity was assessed through the Victorian Institute of Sport Assessment Scale for Patellar Tendinopathy (VISA-P) upon admission and at the final follow-up. Time to return to training, time to return to competition, and complications were also recorded. Results: The mean age of the athletes was 25.4 years, and the mean symptom duration from the index intervention was 15.3 months. At a mean follow-up of 30.0 ± 4.9 months, the VISA-P score improved 27.8 points ( P < .0001). The patients returned to training within a mean of 9.2 months. Fifteen patients (68.2%) returned to competition within a mean of 11.6 months. Of these 15 patients, a further 2 had decreased their performance, and 2 more had abandoned sports participation by the final follow-up. The overall rate of complications was 18.2%. One patient (4.5%) had a further revision procedure. Conclusion: Revision surgery was feasible and effective in patients in whom PT symptoms persisted after previous surgery for PT, achieving a statistically significant and clinically relevant improvement of the VISA-P score as well as an acceptable rate of return to sport at a follow-up of 30 months.

Ultrasonic Percutaneous Tenotomy for Recalcitrant Lateral Elbow Tendinopathy: Clinical and Sonographic Results at 90 Months

2021 ◽  
pp. 036354652110101
Author(s):  
Benjamin F.H. Ang ◽  
P. Chandra Mohan ◽  
Meng Ai Png ◽  
John Carson Allen ◽  
Tet Sen Howe ◽  
...  
Keyword(s):  
Pain Relief ◽  
Extensor Tendon ◽  
Tissue Healing ◽  
Lateral Elbow ◽  
Percutaneous Tenotomy ◽  
Vas Scores ◽  
The Common ◽  
Lateral Elbow Tendinopathy

Background: In a study from our institution, ultrasonic percutaneous tenotomy of the brevis and the common extensor tendon for recalcitrant lateral elbow tendinopathy showed excellent safety profiles, high tolerability, efficiency, sustained pain relief, functional improvement, and sonographic evidence of tissue healing in 20 patients at 3 years’ follow-up. Purpose: To explore the long-term clinical and sonographic results of ultrasonic percutaneous tenotomy of the brevis and the common extensor tendon. Study Design: Case series; Level of evidence, 4. Methods: The same cohort of 20 patients was recalled after 7 years, and visual analog scale (VAS) for pain and Disabilities of the Arm, Shoulder and Hand (DASH) scores, need for secondary intervention, and overall satisfaction were assessed. They were also reassessed using ultrasound imaging of the brevis and the common extensor tendon to evaluate tendon hypervascularity, tendon thickness, and the progress or the recurrence of the hypoechoic scar tissue. Results: We successfully scored 19 patients and performed ultrasound on 16 patients with a median follow-up of 90 months (range, 86-102 months). There were no adverse outcomes and satisfaction remained at 100% (6 patients, satisfied; 13 patients, very satisfied). No patient developed a recurrence of symptoms and signs of lateral elbow tendinopathy, and therefore no secondary intervention was required. The improvement from baseline and early term scores was sustained ( P < .001 for all). At 90 months, there was a significant improvement in VAS scores and DASH–Compulsory scores compared with preprocedure scores and all follow-up times until 3 months. There was no difference in VAS scores and DASH–Compulsory scores at 90 months compared with 6 and 36 months. For DASH–Work scores, there was a significant improvement at 90 months compared with preprocedure scores, but there was no difference between DASH–Work scores at 90 months and scores at all other points of follow-up. At 90 months, hypervascularity remained resolved in 79% of patients, while all patients had reduced tendon swelling and sustained resolution or reduction of the hypoechoic lesion. Conclusion: At the long-term follow-up of 90 months, ultrasonic percutaneous tenotomy of the brevis and the common extensor tendon, previously shown to enhance recovery of lateral elbow tendinopathy, demonstrated good durability of pain relief and functional recovery that was previously achieved. This was accompanied by sustained sonographic tissue healing with no significant deterioration.

scholarly journals The Use of Anterior-Segment Optical-Coherence Tomography for the Assessment of the Iridocorneal Angle and Its Alterations: Update and Current Evidence

2021 ◽  
Vol 10 (2) ◽  
pp. 231
Author(s):  
Giacinto Triolo ◽  
Piero Barboni ◽  
Giacomo Savini ◽  
Francesco De Gaetano ◽  
Gaspare Monaco ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Intraocular Pressure ◽  
Clinical Relevance ◽  
Anterior Segment ◽  
Angle Closure ◽  
Current Evidence ◽  
Optical Coherence ◽  
Iridocorneal Angle ◽  
Wide Range

The introduction of anterior-segment optical-coherence tomography (AS-OCT) has led to improved assessments of the anatomy of the iridocorneal-angle and diagnoses of several mechanisms of angle closure which often result in raised intraocular pressure (IOP). Continuous advancements in AS-OCT technology and software, along with an extensive research in the field, have resulted in a wide range of possible parameters that may be used to diagnose and follow up on patients with this spectrum of diseases. However, the clinical relevance of such variables needs to be explored thoroughly. The aim of the present review is to summarize the current evidence supporting the use of AS-OCT for the diagnosis and follow-up of several iridocorneal-angle and anterior-chamber alterations, focusing on the advantages and downsides of this technology.

Characterization and outcome of 11 children with non-diabetic ketoacidosis

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Elsayed Abdelkreem ◽  
Rofaida M. Magdy ◽  
Abdelrahim A. Sadek
Keyword(s):  
Diabetic Ketoacidosis ◽  
Case Series ◽  
Inborn Errors ◽  
Laboratory Features ◽  
Level 3 ◽  
Conscious Level ◽  
Neurodevelopmental Impairment ◽  
Salicylate Intoxication ◽  
Prompt Diagnosis

AbstractObjectivesTo study the clinical and laboratory features, management, and outcome of pediatric non-diabetic ketoacidosis (NDKA).MethodsBetween May 2018 and April 2020, we prospectively collected children under 18 years who presented with ketoacidosis, defined as ketosis (urinary ketones ≥++ and/or serum β-hydroxybutyrate level ≥3 mmol/L) and metabolic acidosis (pH <7.3 and HCO3− <15 mmol/L). Children with HbA1c level ≥6.5% at initial presentation and those meeting the diagnostic criteria for DM during follow-up were excluded. Data were collected on demographics, clinical and laboratory features, management, and outcome.ResultsEleven children with 19 episodes of NDKA were identified. The median age was 12 months (range from 5 months to 5 years). They manifested dehydration and disturbed conscious level (all cases), convulsions (n=6), hypoglycemia (n=6), hyperglycemia (n=2) and significant hyperammonemia (n=4). Most cases required intensive care management. Death or neurodevelopmental impairment occurred in six cases. Seven cases had inborn errors of metabolism (IEMs). Other cases were attributed to starvation, sepsis, and salicylate intoxication.ConclusionsThis is the largest case series of pediatric NDKA. Ketoacidosis, even with hyperglycemia, is not always secondary to diabetes mellitus. IEMs may constitute a significant portion of pediatric NDKA. Increased awareness of this unfamiliar condition is important for prompt diagnosis, timely management, and better outcome.

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