Tell us more about yourself and the author team.
The first and senior authors are orthopaedic surgeons both clinically and academically active in West of Scotland hospitals and the University of Glasgow. Their main academic interest is tendinopathy research. Over the last few years, we have published a series of systematic reviews aiming to inform clinical practice and guidelines on the management of tendinopathy. The rest of the team comprises musculoskeletal physiotherapists, orthopaedic surgeons/aspiring orthopaedic surgeons, and a sports medicine physician interested in tendinopathy and its management. This multi-disciplinary is hugely important to us as a group to include all specialists that treat tendon disease.
What is the story behind your study?
This study is part of a series of publications from our group to provide insights into the effectiveness of the several available treatment modalities for tendinopathy. Before our study, the literature on the management of patellar tendinopathy was somewhat conflicting. Additionally, the availability of dozens of interventions and especially the absence of clinical guidelines can be overwhelming and create confusion. Through a network meta-analysis, we wanted to help implicated healthcare professionals choose the right treatment for this very challenging condition.
In your own words, what did you find?
We could only make recommendations for clinical practice for extracorporeal shockwave therapy, which does not appear to add any benefits to eccentric loading, and isometric exercise, which may be as effective as isotonic exercise for immediate pain relief. Treatment modalities that appear promising but need further evidence include topical glyceryl trinitrate, hyaluronic acid injections and moderate, slow resistance exercise.
What was the main challenge you faced in your study?
By far, the biggest challenge was the pooling of results. Even though we included 37 studies, there were 33 different interventions assessed. Therefore only two head-to-head comparisons of interventions could be made with adequate strength of evidence.
If there is one take-home message from your study, what would that be?
Regardless of patient demographics, severity and chronicity of patellar tendinopathy, we advise a trial of eccentric loading on its own as first-line therapy for at least 3 months. If that fails, the nature of further treatment should be decided jointly with the patient after consideration of their circumstances, their preferences, the clinician’s previous experience and availability of interventions. We believe wholly in the notion of ‘precision tendinopathy’. Listen to the patient, understand their lifestyle/issues and design your exercise and subsequent treatment programme to their needs.