Rehabilitation of tendopathies in human athletes

2013 ◽  
Vol 9 (3-4) ◽  
pp. 153-160 ◽  
Author(s):  
K. Legerlotz
Keyword(s):  
Platelet Rich Plasma ◽  
Treatment Options ◽  
Symptom Relief ◽  
Achilles Tendinopathy ◽  
Basketball Players ◽  
Cross Sectional ◽  
Exercise Treatment ◽  
Recreational Athletes ◽  
Sedentary Population ◽  
Sclerosing Agents

Tendinopathies, chronic tendon disorders characterized by pain and functional impairment, are a common problem particularly in elite and recreational athletes. There is a high prevalence of Achilles tendinopathy in runners, while patellar tendinopathies, also referred to as jumpers knee, are very common amongst volleyball and basketball players. However, tendinopathies also occur in the sedentary population. The syndrome is associated with a variety of morphological, histopathological, biochemical and molecular changes, such as an increase in tendon cross sectional area, loss of fibre organization and infiltration of blood vessels. It has been shown that exercise or mechanical loading plays a role, which is why overuse is suspected to initiate tendinopathies. The exact mechanisms are still poorly understood, which makes the treatment problematic. A variety of treatment options are available, ranging from non-invasive procedures such as exercise treatment, topical nitroglycerin patches or shock wave therapy, over injections of various substances, such as corticosteroids, platelet-rich plasma or sclerosing agents, to surgical debridement. However, most of the treatment options focus solely on symptom relief, and the evidence for their effectiveness is often poor. The effectiveness of a treatment is furthermore likely to depend on the stage of the tendinapathy. In contrast to many therapies, exercise treatment has been relatively well investigated, has been shown to work in the majority of cases and is considered the gold standard.

scholarly journals Platelet-Rich Plasma Diffusion in Achilles Tendon: Relationship with Therapeutic Outcomes

2019 ◽  
Vol 28 (4) ◽  
pp. 367-372 ◽  
Author(s):  
Michele Abate ◽  
Luigi Di Carlo ◽  
Vincenzo Salini
Keyword(s):  
Clinical Outcome ◽  
Platelet Rich Plasma ◽  
Metabolic Activation ◽  
Achilles Tendinopathy ◽  
Cross Sectional ◽  
Therapeutic Outcomes ◽  
Plasma Distribution ◽  
Plasma Diffusion ◽  
And Function

Objective: The therapeutic efficacy of platelet-rich plasma in the treatment of Achilles tendinopathy is controversial. Among the variables which can explain the discrepant results, little attention has been paid to the distribution of platelet-rich plasma inside the tendon. The aim of the present study was to evaluate whether this factor is related to the clinical outcome of treatment. Subjects and Methods: Forty patients suffering from mid-portion Achilles tendinopathy were studied. At baseline, pain and function were measured by means of a visual analogue scale and the Victorian Institute of Sport Assessment-Achilles questionnaire. Thereafter, an ultrasound examination was performed, and platelet-rich plasma was injected. Immediately after injection, the plasma distribution was assessed visualizing the material in the tendon. The patients were re-evaluated at 3 and 6 months, computing pain and function values and the percentage of satisfactory outcomes in relation to the distance reached by the plasma from the point of injection. Results: The diffusion inside the tendon was longitudinal in all cases and cross-sectional only in 9. The mean distance from the tip of the needle increased significantly according to the severity of tendon damage. At follow-up, no relationship was found between plasma diffusion and clinical outcomes. Conclusions: Platelet-rich plasma diffusion has no effect on clinical outcome, which mainly depends on the metabolic activation of the whole structure of the tendon.

Treatment of Achilles tendinopathy: state of the art

2018 ◽  
Vol 3 (6) ◽  
pp. 367-376
Author(s):  
Paul W Ackermann ◽  
Phinit Phisitkul ◽  
Christopher J Pearce
Keyword(s):  
Platelet Rich Plasma ◽  
Power Doppler ◽  
Tendon Healing ◽  
Achilles Tendinopathy ◽  
Term Treatment ◽  
Quality Level ◽  
Treatment Protocols ◽  
Sclerosing Agents ◽  
Surgical Methods ◽  
Long Term Treatment

Achilles tendinopathy (AT) is a continued enigma for clinicians from all parts around the world. The increasing prevalence is related to physical activities, but additionally also to metabolic factors unrelated to activities that load the Achilles tendon. AT can comprise two different diagnosis: insertional AT and non-insertional AT (NIAT). This review will deal predominantly with the treatment of NIAT. The exact aetiology and pathophysiology of NIAT are not fully known, but seem to be a partly degenerative condition. This gap of knowledge is accountable for the highly variable principles of treatment. The diagnosis of NIAT can usually be made clinically but MRI scans may be used and ultrasound may be useful, with power Doppler to assess the level of neovascularisation, or to guide injection therapies. Current treatments of NIAT with highest evidence entail non-surgical methods to promote tendon healing with focused eccentric exercises and biophysical procedures. Injection therapies (cortisone, sclerosing agents, blood products including platelet-rich plasma) may have short-term effects, but have no proven long-term treatment effects. Targeted minimally invasive surgical procedures should be considered in specific recalcitrant cases to initiate healing and alleviate pain by removing pathological tissue or abnormal neoinnervation. Other surgical options including open debridement, gastrocnemius recession and plantaris tendon excision have been described. Overall, more high-quality level 1 studies are needed to define the optimal treatment protocols. Future therapies should target the differential underlying pathologies of NIAT using combined non-surgical and minimal-invasive including biological approaches.

Comparison of Leukocyte-Rich Platelet-Rich Plasma and Leukocyte-Poor Platelet-Rich Plasma on Achilles Tendinopathy at an Early Stage in a Rabbit Model

2020 ◽  
Vol 48 (5) ◽  
pp. 1189-1199 ◽  
Author(s):  
Guangyao Jiang ◽  
Yifan Wu ◽  
Jiahong Meng ◽  
Fengfeng Wu ◽  
Sihao Li ◽  
...  
Keyword(s):  
Early Stage ◽  
Platelet Rich Plasma ◽  
Biomechanical Testing ◽  
Rabbit Model ◽  
Tendon Repair ◽  
Polymerase Chain Reaction Analysis ◽  
Achilles Tendinopathy ◽  
Cross Sectional ◽  
Collagenase Injection

Background: Tendinopathy is still a great challenge in clinical practice, and the role of platelet-rich plasma (PRP) is controversial. The influence of leukocytes on tendinopathy at an early stage has not been defined so far. Purpose: To compare the effects of leukocyte-rich PRP (Lr-PRP) and leukocyte-poor PRP (Lp-PRP) on Achilles tendinopathy when applied at an early stage. Study Design: Controlled laboratory study. Methods: A rabbit Achilles tendinopathy model was induced by a collagenase injection. A week later, treatments were applied randomly on local Achilles tendon lesions: (1) 200 μL of Lr-PRP (16 legs), (2) 200 μL of Lp-PRP (16 legs), and (3) 200 μL of saline (16 legs). At 3 and 6 weeks after the collagenase injection, outcomes were evaluated by histology, magnetic resonance imaging (MRI), real-time polymerase chain reaction analysis, immunohistochemistry, and transmission electron microscopy (TEM). Results: The Lr-PRP group had a lower T2 signal intensity ( P = .0377) and smaller diameter ( P = .0193) and cross-sectional area ( P = .0194) than the Lp-PRP group on MRI. Histologically, the Lr-PRP group had better scores than the Lp-PRP group ( P = .0284 and P = .0188, respectively). Compared with the Lp-PRP group, higher gene expression and more protein synthesis of collagen I ( P = .0160 and P = .0309, respectively) and CD163 ( P < .0001 and P = .0411, respectively) were found in the Lr-PRP group. Considering TEM and biomechanical testing, the Lr-PRP group demonstrated more mature collagen fibers ( P < .0001), a larger fiber diameter ( P = .0005), a higher failure load ( P = .00417), and higher tensile stress ( P < .0001) than the Lp-PRP group. Conclusion: Lr-PRP had more beneficial effects than Lp-PRP when delivered at an early stage during tendon repair. Clinical Relevance: Here, we showed that tendinopathy influenced the curative effects of PRP in vivo. An early-stage application of Lr-PRP had more benefits for the repair of tendinopathy than Lp-PRP in a rabbit model, which will supplement guidelines of PRP treatment on tendinopathy clinically.

scholarly journals Perspectives of future pharmacists on the potential for development and implementation of pharmacist prescribing in Qatar

2020 ◽  
Vol 42 (1) ◽  
pp. 110-123
Author(s):  
Mohammad Issam Diab ◽  
Angham Ibrahim ◽  
Oraib Abdallah ◽  
Alla El-Awaisi ◽  
Monica Zolezzi ◽  
...  
Keyword(s):  
Focus Group ◽  
Treatment Options ◽  
Developed Countries ◽  
Focus Group Discussions ◽  
Cross Sectional Survey ◽  
Group Discussions ◽  
Cross Sectional ◽  
Pharmacist Prescribing ◽  
Barriers To Implementation ◽  
Special Training Program

AbstractBackground Pharmacists in many developed countries have been granted prescribing authorities under what is known as “non-medical prescribing” or “pharmacist prescribing”. However, such prescribing privileges are not available in many developing countries. Objective The objective of this study was to determine the perspectives of future pharmacists (recent pharmacy graduates and pharmacy students) on pharmacist prescribing and its potential implementation in Qatar. Methods A convergent parallel mixed-methods design was used: (1) a cross-sectional survey using a pre-tested questionnaire and; (2) focus group discussions to allow for an in-depth understanding of the issue, with a focus on pharmacists prescribing competencies as well as barriers for its implementation. Main outcome measures Future pharmacists’ perspectives and attitudes towards pharmacist prescribing in Qatar. Results The majority of the respondents (94.4%) indicated awareness of the prescribing competency related to selecting treatment options. Furthermore, the majority (92.4%) believed that pharmacists should undergo prescribing training and accreditation before been legally allowed to prescribe, a point that was reiterated in the focus group discussions. Participants generally expressed support for collaborative and supplementary prescribing models when developing prescribing frameworks for Qatar. Four categories emerged under the theme barriers to implementation of pharmacist prescribing: lack of prescribing competency, pharmacist mindset, lack of accessibility to patient records and counseling rooms, and diversity of education and training background. Conclusion The majority of recent pharmacy graduates and students were in favor of pharmacist prescribing been implemented in Qatar. However, a special training program was deemed necessary to qualify pharmacists to prescribe safely and effectively.

scholarly journals Impact of Kinanthropometric Differences According to Non-Professional Sports Activity Practiced

2021 ◽  
Vol 11 (11) ◽  
pp. 5063
Author(s):  
Daniel J. Navas Harrison ◽  
Ana María Pérez Pico ◽  
Raquel Mayordomo
Keyword(s):  
Physical Activity ◽  
Body Composition ◽  
Professional Sports ◽  
Whole Body ◽  
Lower Body ◽  
Basketball Players ◽  
Sports Activity ◽  
Sedentary Population ◽  
Activity Performance ◽  
Amateur Athlete

Kinanthropometry allows us to analyze variations in physical dimensions and body composition. This study’s objective was to evaluate the kinanthropometric differences based on physical activity performance, depending on whether the lower body or the whole body is more or less potent and the differences with a sedentary population. We analyzed 131 individuals (74 men and 57 women), with an average age of 22.68 ± 2.98 years. We differentiated three populations: sedentary (n = 63), runners (n = 20), and basketball players (n = 48). Measurements and indices were obtained following the international protocol of the International Society for the Advancement of Kinanthropometry (ISAK). The results show differences between the populations regarding weight, height, wingspan, and certain perimeters, diameters, and morphotypes depending on the predominant training type and the sedentary population. These anthropometric measurements will allow the amateur athlete to compare between seasons or other moments of training, pay attention to their evolution, and assess the possibility of changes in training.

scholarly journals Comprehensive Review of Knee Osteoarthritis Pharmacological Treatment and the Latest Professional Societies’ Guidelines

2021 ◽  
Vol 14 (3) ◽  
pp. 205
Author(s):  
Dragan Primorac ◽  
Vilim Molnar ◽  
Vid Matišić ◽  
Damir Hudetz ◽  
Željko Jeleč ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Platelet Rich Plasma ◽  
Symptom Relief ◽  
Topical Administration ◽  
Symptomatic Therapy ◽  
Therapy Options ◽  
Professional Societies ◽  
Inflammatory Drugs ◽  
The Right

Osteoarthritis is the most common musculoskeletal progressive disease, with the knee as the most commonly affected joint in the human body. While several new medications are still under research, many symptomatic therapy options, such as analgesics (opioid and non-opioid), nonsteroid anti-inflammatory drugs, symptomatic slow-acting drugs in osteoarthritis, and preparations for topical administration, are being used, with a diverse clinical response and inconsistent conclusions across various professional societies guidelines. The concept of pharmacogenomic-guided therapy, which lies on principles of the right medication for the right patient in the right dose at the right time, can significantly increase the patient’s response to symptom relief therapy in knee osteoarthritis. Corticosteroid intra-articular injections and hyaluronic acid injections provoke numerous discussions and disagreements among different guidelines, even though they are currently used in daily clinical practice. Biological options, such as platelet-rich plasma and mesenchymal stem cell injections, have shown good results in the treatment of osteoarthritis symptoms, greatly increasing the patient’s quality of life, especially when combined with other therapeutic options. Non-inclusion of the latter therapies in the guidelines, and their inconsistent stance on numerous therapy options, requires larger and well-designed studies to examine the true effects of these therapies and update the existing guidelines.

scholarly journals Use of monoclonal antibody therapy for nosocomial SARS-CoV-2 infection in patients at high risk for severe COVID-19: experience from a tertiary-care hospital in Germany

Infection ◽  
2021 ◽  
Author(s):  
Johanna Koehler ◽  
Barbara Ritzer ◽  
Simon Weidlich ◽  
Friedemann Gebhardt ◽  
Chlodwig Kirchhoff ◽  
...  
Keyword(s):  
High Risk ◽  
Tertiary Care Hospital ◽  
Severe Disease ◽  
Treatment Options ◽  
Tertiary Care ◽  
Antibody Therapy ◽  
Additional Treatment ◽  
Care Hospital ◽  
Cross Sectional ◽  
Asymptomatic Patients

AbstractAdditional treatment options for coronavirus disease (COVID-19) are urgently needed, particularly for populations at high risk of severe disease. This cross-sectional, retrospective study characterized the outcomes of 43 patients with nosocomial severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection with and without treatment using monoclonal SARS-CoV-2 spike antibodies (bamlanivimab or casirivimab/imdevimab). Our results indicate that treatment with monoclonal antibodies results in a significant decrease in disease progression and mortality when used for asymptomatic patients with early SARS-CoV-2 infection.

scholarly journals Extracorporeal shockwave therapy versus musculoskeletal mesotherapy for Achilles tendinopathy in athlete

2020 ◽  
Vol 47 (1) ◽  
Author(s):  
Reem EL-Mallah ◽  
Enas A. Elattar
Keyword(s):  
Treatment Options ◽  
Visual Analogue Score ◽  
Achilles Tendinopathy ◽  
Extracorporeal Shockwave Therapy ◽  
Extracorporeal Shockwave ◽  
Shockwave Therapy ◽  
Tendon Thickness ◽  
Vas Scores ◽  
Tendon Pathology

Abstract Background Achilles tendinopathy (AT) is considered the commonest tendon pathology, occurring mainly in athletes. Different conservative treatment options have been introduced but with short-term effects; however, extracorporeal shockwave therapy (ESWT) and mesotherapy (MT) injections were claimed to provide longer effects and could be used in cases failure of response to conservative treatments. The objective of our prospective 12-week study was to compare the effect of ESWT and MT on chronic Achilles tendinopathy in athletes by both clinical and ultrasonographical assessment. Results Forty patients with chronic AT diagnosed clinically and with high-resolution ultrasound (US) randomly allocated in two groups first received weekly ESWT session, and the other group underwent weekly MT sessions for 4 consecutive weeks. Both groups improved during the treatment and follow-up period. The mean visual analogue score (VAS) decreased in both the ESWT group and the MT group. Mean American Orthopedic Foot and Ankle Society (AOFAS) hindfoot score and VAS scores were not significantly different between ESWT and MT groups at the 4th and the 12th week of follow-up. However, US assessment significantly improved after 12 weeks in the ESWT group (as regards tendon thickness, calcifications, and Doppler signal), and for the mesotherapy group, there was the only improvement of tendon thickness. Conclusion ESWT showed improvement of pain and inflammation and calcifications of AT than MT injections, which was documented by US improved findings at week 12 follow up.

scholarly journals The Effect of Platelet-Rich Plasma on the Intra-Articular Microenvironment in Knee Osteoarthritis

2021 ◽  
Vol 22 (11) ◽  
pp. 5492
Author(s):  
Dawid Szwedowski ◽  
Joanna Szczepanek ◽  
Łukasz Paczesny ◽  
Jan Zabrzyński ◽  
Maciej Gagat ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Operative Treatment ◽  
Animal Studies ◽  
Platelet Rich Plasma ◽  
Treatment Options ◽  
Treatment Protocols ◽  
Metabolic Functions ◽  
Inflammatory Drugs ◽  
Positive Effect

Knee osteoarthritis (KOA) represents a clinical challenge due to poor potential for spontaneous healing of cartilage lesions. Several treatment options are available for KOA, including oral nonsteroidal anti-inflammatory drugs, physical therapy, braces, activity modification, and finally operative treatment. Intra-articular (IA) injections are usually used when the non-operative treatment is not effective, and when the surgery is not yet indicated. More and more studies suggesting that IA injections are as or even more efficient and safe than NSAIDs. Recently, research to improve intra-articular homeostasis has focused on biologic adjuncts, such as platelet-rich plasma (PRP). The catabolic and inflammatory intra-articular processes that exists in knee osteoarthritis (KOA) may be influenced by the administration of PRP and its derivatives. PRP can induce a regenerative response and lead to the improvement of metabolic functions of damaged structures. However, the positive effect on chondrogenesis and proliferation of mesenchymal stem cells (MSC) is still highly controversial. Recommendations from in vitro and animal research often lead to different clinical outcomes because it is difficult to translate non-clinical study outcomes and methodology recommendations to human clinical treatment protocols. In recent years, significant progress has been made in understanding the mechanism of PRP action. In this review, we will discuss mechanisms related to inflammation and chondrogenesis in cartilage repair and regenerative processes after PRP administration in in vitro and animal studies. Furthermore, we review clinical trials of PRP efficiency in changing the OA biomarkers in knee joint.

scholarly journals Quality of Life in Opioid Replacement Therapy: A Naturalistic Cross-Sectional Comparison of Methadone/Levomethadone, Buprenorphine, and Diamorphine Patients

2021 ◽  
pp. 1-10
Author(s):  
Stephanie Paula Elisabeth Guillery ◽  
Rainer Hellweg ◽  
Golo Kronenberg ◽  
Ulrich Bohr ◽  
Hagen Kunte ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Replacement Therapy ◽  
Psychological Functioning ◽  
Treatment Options ◽  
Chronically Ill ◽  
Cross Sectional ◽  
Life Improvement ◽  
Methadone Patients ◽  
Opioid Replacement Therapy

<b><i>Background:</i></b> Research on quality of life (QoL) of chronically ill patients provides an opportunity to evaluate the efficacy of long-term treatments. Although it is established that opioid replacement therapy is an effective treatment for opioid-dependent patients, there is little knowledge about physical and psychological functioning of QoL for different treatment options. <b><i>Objectives:</i></b> Altogether, 248 opioid-dependent patients receiving substitution treatment with either methadone/levomethadone (<i>n</i> = 126), diamorphine (<i>n</i> = 85), or buprenorphine (<i>n</i> = 37) were recruited in 6 German therapy centers. <b><i>Methods:</i></b> Sociodemographic data were collected. QoL – physical and psychological functioning – for different substitutes was assessed using the <i>Profile of the Quality of Life in the Chronically Ill</i> (PLC) questionnaire. <b><i>Results:</i></b> Patient groups were similar regarding age and duration of opioid dependence. Employment rate was significantly higher (<i>p</i> &#x3c; 0.005, φ = 0.22) in the buprenorphine group (46%) compared to methadone (18%). Dosage adjustments were more frequent (<i>p</i> &#x3c; 0.001, φ = 0.29) in diamorphine (55%) than in methadone (30%) or buprenorphine (19%) patients. Buprenorphine and diamorphine patients rated their physical functioning substantially higher than methadone patients (<i>p</i> &#x3c; 0.001, η<sup>2</sup> = 0.141). Diamorphine patients reported a higher psychological functioning (<i>p</i> &#x3c; 0.001, η<sup>2</sup> = 0.078) and overall life improvement (<i>p</i> &#x3c; 0.001, η<sup>2</sup> = 0.060) compared to methadone, but not compared to buprenorphine patients (both <i>p</i> &#x3e; 0.25). <b><i>Conclusion:</i></b> Measurement of important QoL aspects indicates significant differences for physical and psychological functioning in patients receiving the substitutes methadone/levomethadone, diamorphine, and buprenorphine. This could be relevant for the differential therapy of opioid addiction.

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