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

@article{Mendona2019HowSI,
  title={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},
  author={Luciana De Michelis Mendonça and H{\'e}rcules Ribeiro Leite and Johannes Zwerver and Nicholas Henschke and Guilherme Branco and Vin{\'i}cius Cunha Oliveira},
  journal={British Journal of Sports Medicine},
  year={2019},
  volume={54},
  pages={87 - 93}
}
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… 
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References

SHOWING 1-10 OF 53 REFERENCES
Does eccentric exercise reduce pain and improve strength in physically active adults with symptomatic lower extremity tendinosis? A systematic review.
TLDR
It appears that eccentric exercise may reduce pain and improve strength in lower extremity tendinoses, but whether eccentric exercise is more effective than other forms of therapeutic exercise for the resolution of tendinosis symptoms remains questionable.
Outcome Predictors for Conservative Patellofemoral Pain Management: A Systematic Review and Meta-Analysis
TLDR
This systematic review provides a comprehensive summary of current derivation level studies identifying indicators of prediction for conservative PFP management, and concludes that RCTs with evaluation of outcome prediction as a primary aim are clearly warranted to provide clinicians with robust evidence and facilitate evidence-informed, tailored intervention to this heterogeneous patient population.
Comparison of the Effect of 5 Different Treatment Options for Managing Patellar Tendinopathy: A Secondary Analysis.
TLDR
There is evidence that a high training volume, a longer duration of symptoms, and older age negatively influence a treatment's clinical outcome (trend toward significance).
Treatment of patellar tendinopathy—a systematic review of randomized controlled trials
TLDR
Physical training, and particularly eccentric training, appears to be the treatment of choice for patients suffering from patellar tendinopathy; other treatment methods, such as surgical treatment, sclerosing injections, and shockwave therapy, must be investigated further before recommendations can be made regarding their use.
Nonsurgical Treatments of Patellar Tendinopathy: Multiple Injections of Platelet-Rich Plasma Are a Suitable Option: A Systematic Review and Meta-analysis
TLDR
Eccentric exercises may seem the strategy of choice in the short-term, but multiple PRP injections may offer more satisfactory results at long-term follow-up and can be therefore considered a suitable option for the treatment of patellar tendinopathy.
Low-intensity pulsed ultrasound for chronic patellar tendinopathy: a randomized, double-blind, placebo-controlled trial.
TLDR
It is suggested that LIPUS does not provide any additional benefit over and above placebo in the management of symptoms associated with PT.
Do structural changes (eg, collagen/matrix) explain the response to therapeutic exercises in tendinopathy: a systematic review
TLDR
Overall, there is a strong evidence to refute any observable structural change as an explanation for the response to therapeutic exercise when treated by eccentric exercise training and future research should focus on indentifying other explanations.
Topical glyceryl trinitrate treatment of chronic patellar tendinopathy: a randomised, double-blind, placebo-controlled clinical trial
TLDR
It seems that continuous topical GTN treatment in addition to an eccentric exercise programme does not improve clinical outcome compared to placebo patches and an eccentric Exercise programme in patients with chronic patellar tendinopathy.
Platelet-rich plasma: evidence for the treatment of patellar and Achilles tendinopathy—a systematic review
TLDR
Platelet-rich plasma has been introduced in the clinical practice to treat a growing number of different musculoskeletal pathologies and the clinical data currently available, although not univocal, suggest considering PRP as a therapeutic option for recalcitrant patellar and Achilles tendinopathies.
Dry Needling Versus Cortisone Injection in the Treatment of Greater Trochanteric Pain Syndrome: A Noninferiority Randomized Clinical Trial
  • Bryce C. Allen
  • Medicine
    The Journal of orthopaedic and sports physical therapy
  • 2017
TLDR
It is suggested that DN is a noninferior treatment alternative to cortisone injections in this patient population and should be considered as a treatment alternative for greater pain relief and reduction in functional limitations.
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