A systematic review: impact of dry needling, isometric, and eccentric exercises on pain and function in individuals with patellar tendinopathy.

Nine trials, most of them small (from 6 to 76 participants), and no meta-analysis. The authors could not pool the results because the trials were too different and because of time constraints, so no single treatment can be called the best one. The authors state they could not evaluate the three interventions in isolation, so it remains unclear which treatment is more effective for patellar tendinopathy. Participants were not withdrawn from sport in any trial, so training continued alongside every intervention and the effect of the treatment alone cannot be separated from continued loading. Everyone in the trials was a regular volleyball or basketball player aged 16 to 48, with at least three months of symptoms. Nothing here speaks to older, sedentary or more severely affected patients. Many of the trials did not justify their sample size, and several did not report whether control groups avoided contamination from other treatment. Follow-up ranged from immediately after a single session to 26 weeks, so "long-term" in this review means months, not years. Participants are counted per intervention group rather than as one total, and the two Breda eccentric trials both report 76 participants, so the group figures overlap. The review relied on free online publications rather than all available literature, and the search stopped in September 2022.

The authors declare that no financial support was received for the research or publication of this article. No sponsor role in the design, conduct or writing of the review is reported.

Do not read the dry needling results as evidence that the needles did the work. In the only trial that added a comparison, dry needling plus eccentric exercise was no better than eccentric exercise alone at 10 or 22 weeks, and in both dry needling trials every participant was also doing an eccentric programme. The review's own discussion goes further than its data when it suggests platelet-rich plasma plus dry needling beats dry needling alone.