Conservative treatment in patellar tendinopathy
This review found only low to very low quality evidence to support the short- and medium- term effect of exercise, dry needling, and iontophoresis for patellar tendinopathy (PT).
The authors warn that the available randomized controlled trials (RCTs) have major methodological shortcomings and that well-designed trials with pain and function as primary outcomes are urgently needed.
PT is a common complaint which frequently requires prolonged rehabilitation including load management and modification of musculoskeletal factors. Previous reviews about conservative treatment (CT) for PT have failed to properly inform which CT modalities are recommended for PT management.
This review aimed to investigate the effect of individual types of CT on pain and function in patients with PT compared with minimal or other intervention.
Nine RCTs were included in this review with a PEDro study quality score of 1 to 9 and two-thirds of the studies with a score >5. The GRADE classification system was used to determine the strength of the evidence for the effect of treatment.
Low certainty evidence was found that exercise improves function at 6 months and low to very low certainty evidence was found that iontophoresis and dry needling may improve pain at 3 and 6 months, respectively.
The authors state that this was the first review about this topic performing a meta-analysis and - considering the effect of small sample sizes - therefore showing a truer isolated effect of each CT modality.
Expert opinion by José Pedro Correia
The results of this review should come as a serious warning regarding the current state of evidence-based practice on patellar tendinopathy.
Despite the number of studies being published, evidence for any effect of conservative treatment on pain and function remains of low certainty at best after pooling results.
While the findings should not be interpreted as meaning that conservative treatment modalities have no effect, it should warn practitioners to interpret the findings of the available RCTs more carefully.
> From: Mendonça et al., Br J Sports Med (2019) (Epub ahead of print). All rights reserved to The Author(s). Click here for the online summary.