Search

Background: Platelet-rich plasma (PRP) injections have been proposed as an additional therapy in the treatment of chronic midsubstance Achilles tendinopathy (AT). The use of PRP injections as pharmacological treatment added to a conservative approach has gained growing interest, but the efficacy remains highly debated. The varying methodological quality of the available studies may contribute to these contradictory results. The aim of this systematic review with meta-analysis was to establish the existing evidence of PRP injections for chronic midsubstance AT on the functional outcome, with a risk of bias assessment of each included study.Methods: According to the PRISMA guidelines systematic searches were performed in Embase, the Cochrane library and Pubmed on June 12, 2020 for relevant literature. Only clinical trials comparing PRP injections with placebo, additional to an eccentric training program, in midsubstance AT were included. The primary outcome was Victorian Institute of Sport Assessment - Achilles (VISA-A) score at 3, 6 and 12 months post-injection. Risk of bias was assessed using the Cochrane risk-of-bias tool for randomized trials (Rob 2). As secondary outcome we assessed reported changes in tendon structure after PRP injections.Results: A total of 367 studies were identified with the initial database search. Finally, four randomized controlled trials (RCTs) met inclusion criteria for systematic review and meta-analysis with data of 170 patients available for pooling. Results showed no difference in clinical outcome between the PRP and placebo group at different points in time using the VISA-A score as outcome parameter (3 months 0.23 (CI -0.45, 0.91); 6 months 0.83 (CI -0.26, 1.92); 12 months 0.83 (CI -0.77, 2.44)). The bias analysis showed a low or intermediate risk of bias profile for all studies which supports the good methodological quality of each included article. Finally, it is unclear whether PRP injections cause an improvement in tendon structure. However, no direct relationship between tendon structure and clinical presentation of AT could be found.Conclusion: PRP has no clear additional value in management of chronic midsubstance Achilles tendinopathy and therefore should not be used as a first-line treatment option. [ABSTRACT FROM AUTHOR]

Achilles tendinopathy remains one of the most prevalent overuse injuries in elite as well as recreational athletes. Regardless of the fact that the aetiology of tendinopathy has not been fully understood, therapeutic mechanical loading programs have emerged as being the treatment of choice. In this light, mechanical properties of the tendon and their response to changes in loading or unloading have been the subject of many previous investigations. One of these properties often investigated is strain, a measure of relative deformation. By means of a systematic review, an overview was given of research in this field, with a primary objective to list the methods used and secondary aim to synthesize data on strain mapping in the Achilles tendon. Following the guidelines of the PRISMA statement, 47 articles were found appropriate for qualitative assessment. Achilles tendon strain has been investigated across a variety of contexts, including the response to exercise, walking, unloading, ageing, hormonal changes and weight. Only three studies investigated the effect of the presence of tendinopathy on strain. Ultrasound was the most often used imaging modality to measure or estimate strain. Further methodological parameters, e.g. the location of measurement, differed greatly between all different studies. Nearly all studies considered global strain. Some studies investigated the transverse strain response of the Achilles tendon. Recently, however, the role of local – intratendinous – strain distribution has been found to be of critical importance and further studies should focus on imaging modalities to investigate these local changes. [ABSTRACT FROM AUTHOR]

Background Previous studies showed that the amount of hip flexion and the combination of knee valgus and lateral trunk motion, measured with two-dimensional video analysis, were related to three-dimensional measured knee joint moments during single-leg drop vertical jumps, but it remains unclear whether these measurements can be used to identify non-contact knee injury risk. Methods Fifty injury-free female athletes participated in the study. Two-dimensional video analysis was used to measure hip flexion, knee valgus and lateral trunk motion angles during single-leg drop vertical jumps. Time loss non-contact knee injuries were registered during a one-year follow-up. Independent t-tests and receiver operating characteristic analysis were used to analyze the predictive ability of the two-dimensional angles. Findings Seven participants sustained a time loss non-contact knee injury. Hip flexion was not significantly different between groups ( P > .05). The combination of knee valgus and lateral trunk motion was significantly smaller in the injured ( P = .036) and non-injured legs ( P = .009) of the future injured group compared with the respective matched leg of the non-injured group. The receiver operating characteristic analysis showed a significant discriminative accuracy between groups for the combination of knee valgus and lateral trunk motion of the uninjured leg of the future injured group with the matched leg of the non-injured group (area under curve = 0.803; P = .012). Interpretation The measurement of a combination of increased knee valgus and ipsilateral trunk motion during the single-leg drop vertical jump with two-dimensional video analysis can be used to help identify female athletes with increased non-contact knee injury risk. [ABSTRACT FROM AUTHOR]

Non-inflammatory thickening of the subsynovial connective tissue is a common histological finding in carpal tunnel syndrome. This subsynovial connective tissue thickening may precede changes in electrodiagnostic testing. Therefore, measuring subsynovial connective tissue thickness may help in detecting early changes in carpal tunnel syndrome. To provide an overview of subsynovial connective tissue thickness characteristics in subjects with and without carpal tunnel syndrome, a systematic review of articles, assessing human subsynovial connective tissue, was performed using MEDLINE, CENTRAL and EMBASE. Seven studies were included for qualitative analysis. Measurements were done ex vivo (laser (n = 3), photographic (n = 1), micrometric (n = 1)) and in vivo (ultrasound (n = 3)). All four case-control studies showed a significant difference in subsynovial connective tissue thickness between subjects with and without carpal tunnel syndrome. One study showed good correlation between ultrasound and anatomical measurements. No correlation was found between subsynovial connective tissue thickness and symptom duration, electrodiagnostic changes, age and sex. Subsynovial connective tissue thickness may be a valuable aid in diagnosing carpal tunnel syndrome. No factors influencing subsynovial connective tissue thickness are identified, although they are not well investigated. • Subsynovial connective tissue is thicker in patients with carpal tunnel syndrome. • No factors influencing subsynovial connective tissue thickness are identified. • Ultrasound may be a valid tool to assess subsynovial connective tissue thickness. [ABSTRACT FROM AUTHOR]