Agergaard Anne-Sofie, Svensson Rene B, Malmgaard-Clausen Nikolaj M, Magnusson S Peter
Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark.
Center for Healthy Aging, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Orthop J Sports Med. 2024 Oct 18;12(10):23259671241280192. doi: 10.1177/23259671241280192. eCollection 2024 Oct.
The long-term recovery (in years) of patellar tendinopathy treated with loading-based rehabilitation remains largely unknown.
To examine the clinical outcome and tendon structure years after exercise-based treatment of chronic patellar tendinopathy.
Case series; Level of evidence, 4.
This was a 3- to 4-year follow-up evaluation of participants (N = 28) from a previous randomized clinical trial by the author group. All participants received loading-based rehabilitation for 12 weeks with either moderate-slow resistance (55% of 1 repetition maximum) or heavy-slow resistance (up to 90% of 1 repetition maximum). Both groups showed similar improvements after 3 and 12 months and were therefore collapsed in the present analysis. Function and symptoms (the Victorian Institute of Sport Assessment-Patella [VISA-P] questionnaire), tendon pain (numeric rating scale [NRS] during activity and during a single-leg decline squat test), and tendon structure (tendon vascularization and thickness on ultrasound) were assessed.
The mean follow-up was 3.6 ± 0.4 years after the baseline assessment in the original clinical trial. The VISA-P score was 83.9 ± 11.9 (95% CI, 79.3-88.5) at the latest follow-up and did not differ from the 1-year follow-up score ( = .54). Similarly, NRS score during preferred sport (1.6 ± 1.7; 95% CI, 0.9-2.2) and single-leg decline squat (1.0 ± 1.8; 95% CI, 0.3-1.7) did not differ from the 1-year values and remained elevated. Power Doppler area and tendon thickness decreased significantly from 1 year to latest follow-up ( < .0001 and = .02, respectively), but power Doppler area >1 mm was still present in 43% of the participants after 3 to 4 years, and the tendon thickness was still mildly elevated (6.4 ± 1.8 mm; 95% CI, 5.7-7.1 mm). Sports participation after 3 to 4 years (3.9 ± 2.7 h/wk; 95% CI, 2.9-7.1 h/wk) was significantly lower compared with preinjury levels ( < .0001).
Clinical symptoms remained even years after loading-based treatment for patellar tendinopathy, whereas some but not all tendon structures normalized in this longer term follow-up.
基于负荷的康复治疗髌腱病的长期恢复情况（以年计）在很大程度上尚不清楚。
研究慢性髌腱病运动疗法治疗数年后的临床疗效和肌腱结构。
病例系列；证据等级，4级。
这是作者团队对先前一项随机临床试验中的参与者（N = 28）进行的3至4年随访评估。所有参与者接受为期12周的基于负荷的康复治疗，采用中速-慢速阻力（1次重复最大值的55%）或高速-慢速阻力（最高可达1次重复最大值的90%）。两组在3个月和12个月后均有相似改善，因此在本分析中合并。评估了功能和症状（维多利亚运动评估-髌骨[VISA-P]问卷）、肌腱疼痛（活动期间和单腿下蹲试验期间的数字评定量表[NRS]）以及肌腱结构（超声检查的肌腱血管化和厚度）。
在原临床试验的基线评估后，平均随访时间为3.6±0.4年。最新随访时VISA-P评分为83.9±11.9（95%CI，79.3 - 88.5），与1年随访评分无差异（P = 0.54）。同样，在偏好运动期间的NRS评分（1.6±1.7；95%CI，0.9 - 2.2）和单腿下蹲时的评分（1.0±1.8；95%CI，0.3 - 1.7）与1年时的值无差异且仍较高。从1年到最新随访，能量多普勒面积和肌腱厚度显著降低（分别为P < 0.0001和P = 0.02），但3至4年后仍有43%的参与者能量多普勒面积>1mm，且肌腱厚度仍轻度增加（6.4±1.8mm；95%CI，5.7 - 7.1mm）。3至4年后的运动参与时间（3.9±2.7小时/周；95%CI，2.9 - 7.1小时/周）与受伤前水平相比显著降低（P < 0.0001）。
髌腱病基于负荷的治疗数年后临床症状依然存在，而在这一长期随访中部分但并非所有肌腱结构恢复正常。
