School of Health and Kinesiology, University of Nebraska at Omaha, Omaha, Nebraska, USA.
Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, Pennsylvania, USA.
Scand J Med Sci Sports. 2020 Oct;30(10):1810-1826. doi: 10.1111/sms.13734. Epub 2020 Jun 18.
While the pathoetiology is disputed, a wide array of treatments is available to treat tendinopathy. The most common treatments found in the literature include therapeutic modalities, exercise protocols, and surgical interventions; however, their effectiveness remains ambiguous. The purpose of this study was to perform a systematic review of systematic reviews to determine the ability of therapeutic interventions to improve pain and dysfunction in patients with tendinopathy regardless of type or location. Five databases were searched for systematic reviews containing only randomized control trials to determine the effectiveness of treatments for tendinopathies based on pain and patient-reported outcomes. Systematic reviews were assessed via the Assessment of Multiple Systematic Reviews (AMSTAR) for methodological quality. From the database search, 3,295 articles were found, 107 passed the initial inclusion criteria. After further review, 25 systematic reviews were included in the final qualitative analysis. The AMSTAR scores were relatively high (8.8 ± 1.0) across the 25 systematic reviews. Eccentric exercises were the most common and consistently effective treatment for tendinopathy across systematic reviews. Low-level laser therapy and extracorporeal shockwave therapy demonstrated moderate effectiveness, while platelet-rich plasma injections demonstrated inconclusive evidence on their ability to decrease tendinopathy-related pain and improve function. Corticosteroids also showed some effectiveness for short-term pain, but for the long-term use deemed ineffective and at times contraindicated. Regarding surgical options, minimally invasive procedures were more effective compared to open surgical interventions. When treating tendinopathy regardless of location, eccentric exercises were the best treatment option to improve tendinopathy-related pain and improve self-reported function.
尽管发病机制存在争议，但有多种治疗方法可用于治疗腱病。文献中最常见的治疗方法包括治疗方法、运动方案和手术干预；然而，它们的效果仍然存在争议。本研究的目的是对系统评价进行系统评价，以确定治疗干预措施是否能改善无论类型或位置如何的腱病患者的疼痛和功能障碍。对 5 个数据库进行了系统评价，其中仅包含随机对照试验，以确定基于疼痛和患者报告的结果的治疗腱病的效果。通过评估多个系统评价（AMSTAR）评估系统评价的方法学质量。从数据库搜索中发现了 3295 篇文章，有 107 篇文章通过了最初的纳入标准。经过进一步审查，有 25 篇系统评价纳入了最终的定性分析。25 篇系统评价的 AMSTAR 评分相对较高（8.8±1.0）。离心运动是系统评价中最常见和最有效的腱病治疗方法。低水平激光治疗和体外冲击波治疗显示出中等疗效，而富血小板血浆注射在减轻腱病相关疼痛和改善功能方面的疗效证据不足。皮质类固醇在短期疼痛方面也有一定疗效，但长期使用被认为无效，有时甚至被禁用。关于手术选择，微创治疗比开放手术干预更有效。在治疗无论位置如何的腱病时，离心运动是改善腱病相关疼痛和改善自我报告功能的最佳治疗选择。
