Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands
Department of Orthopaedics and Sports Medicine, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands.
Br J Sports Med. 2021 May;55(9):501-509. doi: 10.1136/bjsports-2020-103403. Epub 2020 Nov 20.
To compare the effectiveness of progressive tendon-loading exercises (PTLE) with eccentric exercise therapy (EET) in patients with patellar tendinopathy (PT).
In a stratified, investigator-blinded, block-randomised trial, 76 patients with clinically diagnosed and ultrasound-confirmed PT were randomly assigned in a 1:1 ratio to receive either PTLE or EET. The primary end point was clinical outcome after 24 weeks following an intention-to-treat analysis, as assessed with the validated Victorian Institute of Sports Assessment for patellar tendons (VISA-P) questionnaire measuring pain, function and ability to play sports. Secondary outcomes included the return to sports rate, subjective patient satisfaction and exercise adherence.
Patients were randomised between January 2017 and July 2019. The intention-to-treat population (mean age, 24 years, SD 4); 58 (76%) male) consisted of patients with mostly chronic PT (median symptom duration 2 years). Most patients (82%) underwent prior treatment for PT but failed to recover fully. 38 patients were randomised to the PTLE group and 38 patients to the EET group. The improvement in VISA-P score was significantly better for PTLE than for EET after 24 weeks (28 vs 18 points, adjusted mean between-group difference, 9 (95% CI 1 to 16); p=0.023). There was a trend towards a higher return to sports rate in the PTLE group (43% vs 27%, p=0.13). No significant between-group difference was found for subjective patient satisfaction (81% vs 83%, p=0.54) and exercise adherence between the PTLE group and EET group after 24 weeks (40% vs 49%, p=0.33).
In patients with PT, PTLE resulted in a significantly better clinical outcome after 24 weeks than EET. PTLE are superior to EET and are therefore recommended as initial conservative treatment for PT.
比较渐进性肌腱负荷训练（PTLE）与离心运动疗法（EET）治疗髌腱炎（PT）的疗效。
在一项分层、研究者盲、块随机试验中，76 例临床诊断和超声证实的 PT 患者按 1:1 比例随机分配接受 PTLE 或 EET。主要终点是在 24 周的意向治疗分析后评估的临床结果，使用经过验证的维多利亚运动评估髌腱（VISA-P）问卷评估疼痛、功能和运动能力。次要结果包括重返运动率、患者满意度和运动依从性。
患者于 2017 年 1 月至 2019 年 7 月随机分组。意向治疗人群（平均年龄 24 岁，标准差 4 岁；58 名男性）由大多数慢性 PT 患者（中位症状持续时间 2 年）组成。大多数患者（82%）曾接受过 PT 治疗，但未能完全康复。38 例患者被随机分配到 PTLE 组，38 例患者被随机分配到 EET 组。24 周后，PTLE 组的 VISA-P 评分改善明显优于 EET 组（28 分比 18 分，调整后的组间差异为 9 分[95%CI 1 至 16]；p=0.023）。PTLE 组的重返运动率有升高趋势（43%比 27%，p=0.13）。24 周后，PTLE 组和 EET 组的患者满意度（81%比 83%，p=0.54）和运动依从性（40%比 49%，p=0.33）均无显著差异。
在 PT 患者中，24 周后，PTLE 的临床疗效明显优于 EET。PTLE 优于 EET，因此被推荐为 PT 的初始保守治疗方法。
