Mead Matthew P, Gumucio Jonathan P, Awan Tariq M, Mendias Christopher L, Sugg Kristoffer B
Departments of Orthopaedic Surgery, University of Michigan Medical School, Ann Arbor, MI.
Departments of Molecular & Integrative Physiology, University of Michigan Medical School, Ann Arbor, MI.
Transl Sports Med. 2018 Jan;1(1):5-13. doi: 10.1002/tsm2.6. Epub 2017 Dec 19.
Tendinopathy is a major clinical problem in sports medicine and is often difficult to treat. Traditional therapeutic approaches have focused on reducing inflammation, yet research suggests that little to no inflammation is present in the tendons that fail to heal. The purpose of this review was to evaluate the effectiveness of the available treatment options for tendinopathy and to inform best clinical practices.
A narrative review.
A comprehensive search of electronic databases (PubMed, Google Scholar and Web of Science) was conducted to identify relevant studies through June 2016. Studies were deemed relevant if they were published in English and contained original research on the management of tendinopathy in humans.
Studies varied in methodological quality and were often limited by small sample size and lack of sufficient control groups. Critical evaluation of the literature suggests that physical therapy with or without eccentric exercise should be considered a first-line treatment. Corticosteroids and nonsteroidal anti-inflammatory drugs provide short-term symptomatic relief, but long-term efficacy has not been demonstrated. Inconsistent results do not support the routine use of prolotherapy, platelet-rich plasma injections and topical nitric oxide patches. Operative intervention should be reserved until conservative measures fail or an obvious operative lesion is present.
While numerous therapeutic modalities exist for tendinopathy in the athlete, the ideal treatment protocol has not been clearly defined. The development of new targeted therapies for tendinopathy is likely to follow a greater understanding of the cellular and molecular mechanisms that underlie its pathogenesis.
肌腱病是运动医学中的一个主要临床问题，通常难以治疗。传统治疗方法一直侧重于减轻炎症，但研究表明，未能愈合的肌腱中几乎不存在炎症。本综述的目的是评估现有肌腱病治疗方案的有效性，并为最佳临床实践提供依据。
叙述性综述。
对电子数据库（PubMed、谷歌学术和科学网）进行全面检索，以确定截至2016年6月的相关研究。如果研究以英文发表且包含关于人类肌腱病管理的原始研究，则被视为相关研究。
研究的方法学质量各不相同，且常常受到样本量小和缺乏足够对照组的限制。对文献的批判性评价表明，无论有无离心运动的物理治疗都应被视为一线治疗方法。皮质类固醇和非甾体抗炎药可提供短期症状缓解，但长期疗效尚未得到证实。结果不一致不支持常规使用增殖疗法、富血小板血浆注射和局部一氧化氮贴片。手术干预应保留到保守措施失败或出现明显的手术病变时。
虽然运动员肌腱病有多种治疗方式，但理想的治疗方案尚未明确界定。肌腱病新靶向治疗方法的开发可能会随着对其发病机制背后的细胞和分子机制有更深入的了解而出现。
