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MINERVA ORTOPEDICA E TRAUMATOLOGICA
Rivista di Ortopedia e Traumatologia
Minerva Ortopedica e Traumatologica 2015 December 66(6):255-69
Current treatment options for tendinopathy
Svensson J. 1, 2, Ackermann P. W. 1, 2
1 Section of Orthopedics and Sports Medicine, Karolinska University Hospital, Stockholm, Sweden;
2 Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
AIM: Tendinopathy, both sports and work related, is increasing in prevalence also because of underlying recently discovered relationship to metabolic disorders. Google “tendon treatment” and you will get more than 26,000,000 hits; however, evidence-based treatment options for tendinopathy have been scarce.
METHODS: A MEDLINE search on tendinopathy, or “tendonitis” or “tendinosis” or “epicondylitis” or “jumpers knee” from 1980 to 2015 was conducted. The emphasis was placed on up-dates on treatment options and recent patient-oriented Level 1 literature.
RESULTS: Tendinopathy is often a challenging disorder, which nesseccitates an initial understanding and targeted management of a multitude of underlying etiologies, e.g. training patterns and metabolic disorders. Non-invasive treatment options, including eccentric exercise (EE) programs and for some indications extracorporeal shockwave treatment (SWT), mostly exhibit higher level of evidence for management of tendinopathy as compared to other treatment options and should therefore be seen as th e basis for therapy. Twelve-week twice-daily, home-based EE programs produce good outcome for Achilles-, patellar-, rotator cuff-, lateral elbow tendinopathies. SWT potentiates the effects of EE in midportion Achilles tendinopathy (AT) and gives better outcomes than EE for insertional AT and chronic calcific shoulder tendinopathy. Other treatment options such as injection therapies with eg. cortisone, sclerosing agents, and platelet rich plasma (PRP) are less indicated due to association with complications (cortisone) and at best only short-term pain mitigating effects. Novel mini-invasive surgical procedures are being developed, however, they are in need of high quality clinical studies.
CONCLUSION: This evidence-based review demonstrates that eccentric exercise and extracorporeal shockwave treatment exhibit the best efficacy, cost effectiveness and less side effects and therefore should be the first-line of treatment for tendinopathy.