University of Groningen, University Medical Center Groningen, Department of Sports and Exercise Medicine, Groningen, The Netherlands.
University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands; and.
Clin J Sport Med. 2020 Jul;30(4):390-403. doi: 10.1097/JSM.0000000000000624.
To determine the association between clinical and imaging outcomes after therapeutic loading exercise in Achilles tendinopathy (AT) and patellar tendinopathy (PT) populations at both short- and long-term follow-up.
The PUBMED and EMBASE databases were searched (up to June 2017) to identify articles that meet the inclusion criteria: (1) patients diagnosed with AT (insertional or midportion) or PT; (2) rehabilitation based on therapeutic loading exercise; and (3) assessment of clinical outcomes and tendon structure using an imaging modality.
Two independent reviewers screened 2894 search results, identifying 21 suitable studies. According to the studies included in this review, clinical results showed significant improvements for patients with AT and PT after eccentric exercise (ECC) and heavy slow resistance (HSR) at short- and long-term follow-up. Imaging outcomes were not consistent. Moderate-to-strong evidence for patients with AT suggested an association between clinical outcomes and imaging outcomes (tendon thickness and tendon neovascularization) after ECC at long-term follow-up. For patients with PT, there was moderate evidence supporting an association between clinical outcomes (questionnaire score and pain) and imaging (tendon thickness and tendon neovascularization) after ECC at short-term follow-up. For both the AT and PT groups, there was moderate evidence for an association between clinical outcomes and tendon thickness and neovascularization after HSR exercise. Results related to the HSR exercise should be interpreted with caution because of the small number of studies.
Based on the findings of the present review, the use of imaging outcomes as a complementary examination to the clinical assessment was confirmed. Overall, an improvement in clinical outcomes seems to be associated with a reduction in tendon thickness and tendon neovascularization. Clinicians should be aware that during the interpretation of the imaging outcomes, factors such as tendinopathy location, exercise modality performed, and a follow-up period should be considered.
在短期和长期随访中，确定治疗性加载运动后跟腱病（AT）和髌腱病（PT）患者的临床和影像学结果之间的关联。
检索 PUBMED 和 EMBASE 数据库（截至 2017 年 6 月），以确定符合纳入标准的文章：（1）诊断为 AT（插入或中段）或 PT 的患者；（2）基于治疗性加载运动的康复；（3）使用影像学方式评估临床结果和腱结构。
两位独立的审查员筛选了 2894 条搜索结果，确定了 21 项合适的研究。根据本综述中包含的研究，ECC 和 HSR 治疗后，AT 和 PT 患者的临床结果在短期和长期随访中均显示出显著改善。影像学结果不一致。对于 AT 患者，有中度到强证据表明 ECC 后长期随访时临床结果（肌腱厚度和肌腱新生血管）与影像学结果（肌腱厚度和肌腱新生血管）之间存在关联。对于 PT 患者，有中度证据支持 ECC 后短期随访时临床结果（问卷评分和疼痛）与影像学（肌腱厚度和肌腱新生血管）之间存在关联。对于 AT 和 PT 两组，HSR 运动后临床结果与肌腱厚度和新生血管之间存在中度关联。由于研究数量较少，对于 HSR 运动的结果应谨慎解释。
基于本综述的研究结果，证实了将影像学结果作为临床评估的补充检查。总的来说，临床结果的改善似乎与肌腱厚度和肌腱新生血管的减少有关。临床医生应该注意，在解释影像学结果时，应考虑到腱病位置、所进行的运动方式和随访时间等因素。
