Dear all
Fantastic research month in tendinopathy – read all about it below.
Enjoy
Peter
Maffulli et al show 17 year follow up of Achilles longitudinal tenotomy surgery – results are good, but I would argue that 99.9% would get better with conservative too – just need to convince them to do conservative rehab for as long as the post-surgery rehab, ie 6+months
http://www.ncbi.nlm.nih.gov/pubmed/23841991
Helland et al. show that tendon pathology reduced patellar tendons stiffness, although jumping performance was maintained, most likely because these volleyball players were still able to compete.
http://bjsm.bmj.com/content/early/2013/07/04/bjsports-2013-092275.abstract
Durcan et al show a 13% prevalence of symptomatic patellar tendinopathy in academy rugby, but fail to confirm potential risk factors such as waist girth that found in volleyball players
http://www.ncbi.nlm.nih.gov/pubmed/23838071
Gammaitoni 2013 show small improvements in patellar tendinopathy symptoms with a heated lidocaine/tetracaine patch in this single group pilot study. Placebo?
World beating stuff from Michael Kjaer et al. as usual. Inflammation and its markers eg PGE2 increase with loading in normal tendon but the same has not been shown in abnormal tendon. Importantly, inflammatory involvement in the initiation of tendon pathology cannot been ruled out
http://www.ncbi.nlm.nih.gov/pubmed/23620492
Great study from Heinemeier et al (with Kjaer) showing limited tissue turnover in tendon – ie may take years. Other data suggest some adaptation and response to load, so must all occur in the outside of the tendon, ie the core does not turnover
http://www.ncbi.nlm.nih.gov/pubmed/2340156
Somewhat contrasts Mobasheri et al. who put forward the argument that for pro-inflammatory cytokine ILb1 is important in the development of tendinopathy
http://www.ncbi.nlm.nih.gov/pubmed/234635833
Kregel et al show that there is reduced pain pressure threshold in patellar tendinopathy ie hyperalgesia, but may not be able to detect it without algometry
http://www.ncbi.nlm.nih.gov/pubmed/23802873
Oliva et al – Thyroid hormones may have a role in tendon homeostasis
http://www.ncbi.nlm.nih.gov/pubmed/23828568
McCeesh and Lewis discuss the continuum model ie reactive, disrepair and degenerative pathology in the context of new studies. No mention of disconnect between pain and pathology, which is the main issue with the continuum model. PAIN IS THE MAIN DIFFERENTIAL, PATHOLOGY CAN BE ANYTHING AND IS OFTEN MISLEADING
http://onlinelibrary.wiley.com/doi/10.1111/iep.12029/abstract
Littlewood et al 2013 systematic review reports highlights prognostic factors, including negative factors (baseline disability, baseline pain, previous shoulder pain episodes, longer symptom duration). Biomedical diagnosis (eg bursa vs tendon) was NOT associated with outcome, which is an important finding to highlight
http://onlinelibrary.wiley.com/doi/10.1111/sae.12028/abstract
