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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

The evolution of eccentric training as treatment for patellar tendinopathy (jumper's knee): a critical review of exercise programmes

H Visnes and R Bahr.

Review published: 2007.

CRD summary

This review found that eccentric training may have positive effects on patellar tendinopathy, but the results were not sufficient to recommend a specific protocol. These conclusions are supported by the data presented, but should be interpreted with extreme caution given the limited search, failure to address study quality, and inadequate synthesis of the results.

Authors' objectives

To determine the effects of eccentric training as a treatment for patellar tendinopathy.

Searching

MEDLINE was searched from inception to September 2006 for publications in the English language; the keywords were reported. The reference lists of retrieved studies and relevant review articles were screened for additional relevant studies.

Study selection

Study designs of evaluations included in the review

Prospective studies, including randomised controlled trials (RCTs), were eligible for inclusion.

Specific interventions included in the review

Studies of eccentric training were eligible for inclusion. The specific interventions evaluated by the included trials were eccentric drop squats, eccentric training on a decline board, and eccentric training and stretching. The comparator treatments included leg extension or curls (concentric training), eccentric training on a flat floor, ultrasound and transverse friction, eccentric training drop squats with flat heel on a step, regular sports training, concentric training on a decline board and surgical treatment. Most interventions were home-based programmes with twice daily training for 12 weeks; in one study treatment duration was 4 weeks.

Participants included in the review

Studies of patients with patellar tendinopathy were eligible for inclusion. The included studies recruited patients from different sports, sports medicine clinics, rehabilitation and rheumatology centres, and high-level volleyball players.

Outcomes assessed in the review

Studies had to focus on a defined clinical outcome to be eligible for inclusion. The outcomes assessed by the included studies were pain (based on visual analogue scales or patient satisfaction), return to sport, and Victoria Institute of Sport Assessment. The duration of follow-up post-treatment ranged from 0 to 33 months.

How were decisions on the relevance of primary studies made?

The authors did not state how the papers were selected for the review, or how many reviewers performed the selection. However, they stated that the studies were judged on their contribution to the body of knowledge.

Assessment of study quality

The authors did not state that they assessed validity.

Data extraction

The authors did not state how the data were extracted for the review, or how many reviewers performed the data extraction.

Methods of synthesis

How were the studies combined?

The studies were not combined; the results of each study were discussed individually.

How were differences between studies investigated?

Differences between the studies were not formally investigated but differences, especially in treatment programmes, were discussed in the text and were apparent from the table.

Results of the review

Seven studies (n=152) were included: 6 RCTs (n=135) and a non-randomised pilot study (n=17).

There was a significant beneficial effects of eccentric training on a decline board compared with eccentric training on a flat floor (1 non-randomised study) and concentric training on a decline board (1 RCT). There was no difference between eccentric training on a decline board and eccentric training drop squats with flat heel on a step (1 RCT), regular sports training (1 RCT) and surgical treatment (1 RCT). An RCT found no difference between eccentric drop squats and leg extension/curls. An RCT found a significant beneficial effect of eccentric training and stretching compared with pulsed ultrasound and transverse friction.

Authors' conclusions

Eccentric training may have a positive effect, but the results were not sufficient to recommend a specific protocol.

CRD commentary

The review addressed a focused question that was supported by clearly defined inclusion criteria. The search was limited to studies published in English identified through one electronic database, and did not include attempts to locate unpublished studies. It is therefore likely that relevant studies have been missed and the review may be subject to language and publication bias. Details of the review process were not reported, so it is not possible to determine whether appropriate steps were taken to minimise bias and error. The validity of the included studies was not assessed, thus the reliability of the findings from these studies is unclear.

The studies were described in detail in the text and appropriately summarised in a table. No attempts were made to synthesise findings across studies; the ‘Results’ section is simply a summary of the eccentric training technique employed and findings from each individual study. Although meta-analysis would have been inappropriate given the differences between the studies, some attempts to synthesise findings across studies would have helped to draw overall conclusions about the effectiveness of the intervention. The authors’ cautious conclusions are supported by the data presented, but should be interpreted with extreme caution given the limited search, failure to address study quality, and inadequate synthesis of the results.

Implications of the review for practice and research

Practice: The authors stated that treatment programmes should include a decline board, be performed with some level of discomfort, and athletes should be removed from sporting activities.

Research: The authors stated that the specific aspects of treatment programmes need further study.

Funding

Norwegian Eastern Health Corporate; Royal Norwegian Ministry of Culture; Norwegian Olympic Committee and Confederation of Sport; and Norsk Tipping As.

Bibliographic details

Visnes H, Bahr R. The evolution of eccentric training as treatment for patellar tendinopathy (jumper's knee): a critical review of exercise programmes British Journal of Sports Medicine 2007; 41(4): 217-223. [PMC free article: PMC2658948] [PubMed: 17261559]

Indexing Status

Subject indexing assigned by NLM

MeSH

Athletic Injuries /physiopathology /therapy; Exercise Therapy /methods; Humans; Patella /injuries /physiopathology; Prospective Studies; Randomized Controlled Trials as Topic; Tendinopathy /physiopathology /therapy; Treatment Outcome

AccessionNumber

12007005640

Database entry date

01/12/2008

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2014 University of York.

PMID: 17261559

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