Causative factors and rehabilitation of patellar tendinopathy: A systematic review.
Sanell Morgan, Elizabeth C Janse van Vuuren, Frederik F Coetzee
PMID 30135894WHAT IT FOUND
For patellar tendinopathy, the review reported eccentric exercise in 10 included studies and linked risk factors to tendon overload from training load, jump technique and flexibility or strength problems, but it did not pool outcomes.
Key findings
01Thirteen of the 20 included studies described rehabilitation components, and 10 studies described eccentric exercise as a rehabilitation modality for patellar tendinopathy.
02The included studies reported lower-limb flexibility problems, quadriceps or vastus medialis strength changes, and higher skill level or participation as possible intrinsic or extrinsic risk factors for patellar tendinopathy.
03Return-to-sport advice varied: some advice allowed sport if pain did not exceed 3/10 on the Visual Analogue Scale, while other advice recommended waiting until tendon healing was complete.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Only 20 articles were included after quality screening, so the review may not capture all relevant evidence. The studies differed too much in outcomes to be pooled into a meta-analysis. Several included studies were case reports, case series or pilot studies, so they cannot show that a treatment caused improvement. The average methodological quality score was 72%, and some initially identified articles were excluded for poor quality. Many risk-factor findings were described as indecisive, so they should not be treated as proven causes. All participants were older than 18 years, so the review says nothing about children or adolescents. The review included a high incidence of similar authors, which may point to publication bias.
The easy way to misread this
Do not read eccentric exercise as proven superior to other treatments. The review did not pool outcomes for meta-analysis, and many rehabilitation reports were descriptive, case-report or small-study accounts, so it cannot show that one component caused improvement.