Sports Health. 2009 Jul;1(4):284-92. doi: 10.1177/1941738109337778.
Tendinosis is a troublesome clinical entity affecting many active people. Its treatment remains a challenge to sports medicine clinicians. The etiopathophysiology of tendinosis has not been well delineated. The known pathophysiology and the recent advances in the understanding of the etiologic process of tendinosis are discussed here, including new concepts in mechanotransduction and the biochemical alterations that occur during tendon overload. The optimal, nonoperative treatment of tendinosis is not clear. This article reviews recent evidence of the clinical efficacy of the following interventions: eccentric exercise, extracorporal shock wave treatment, corticosteroid and nonsteroidal anti-inflammatory medications, sclerosing injections, nitric oxide, platelet-rich plasma injections, and matrix metalloproteinase inhibitors. Eccentric exercise has strongest evidence of efficacy. Extracorporal shock wave treatment has mixed evidence and needs further study of energy and application protocols. Sclerosing agents show promising early results but require long-term studies. Corticosteroid and nonsteroidal anti-inflammatory medications have not been shown to be effective, and many basic science studies raise possible concerns with their use. Nitric oxide has been shown in several basic science studies to be promising, but clinical efficacy has not been well established. More clinical trials are needed to assess dosing, indications, and clinical efficacy of nitric oxide. Platelet-rich plasma injections have offered encouraging short-term results. Larger and longer-term clinical trials are needed to assess this promising modality. Matrix metalloproteinase inhibitors have had few clinical studies, and their role in the treatment of tendinosis is still in the early phase of investigation.
肌腱病是一种常见的临床疾病，影响着许多活跃人群。它的治疗仍然是运动医学临床医生的挑战。肌腱病的病因病理生理学尚未得到很好的描述。本文讨论了肌腱病的已知病理生理学和最近对其病因过程的理解的进展，包括机械转导的新概念和在肌腱过载期间发生的生化改变。肌腱病的最佳非手术治疗方法尚不清楚。本文综述了以下干预措施的临床疗效的最新证据：离心运动、体外冲击波治疗、皮质类固醇和非甾体抗炎药、硬化剂注射、一氧化氮、富含血小板的血浆注射和基质金属蛋白酶抑制剂。离心运动具有最强的疗效证据。体外冲击波治疗的证据混杂，需要进一步研究能量和应用方案。硬化剂显示出有希望的早期结果，但需要长期研究。皮质类固醇和非甾体抗炎药已被证明无效，并且许多基础科学研究对其使用提出了可能的担忧。一氧化氮在几项基础科学研究中显示出有希望的结果，但临床疗效尚未得到很好的证实。需要更多的临床试验来评估一氧化氮的剂量、适应症和临床疗效。富含血小板的血浆注射提供了令人鼓舞的短期结果。需要更大规模和更长时间的临床试验来评估这种有前途的治疗方法。基质金属蛋白酶抑制剂的临床研究较少，其在肌腱病治疗中的作用仍处于研究的早期阶段。
