ORIGINAL ARTICLE

Eccentric treatment for patellar tendinopathy: a prospective randomised short-term pilot study of two rehabilitation protocols

Anna Frohm¹, Tönu Saartok¹, Kjartan Halvorsen², Per Renström¹

¹ Department of Molecular Medicine and Surgery, Section of Orthopedics and Sports Medicine & Stockholm Sport Trauma Research Center, Karolinska Institutet, Stockholm, Sweden
² Biomechanics and Motor Control Laboratory, Department of Sport and Health Sciences, Swedish School of Sport and Health Sciences, Stockholm, Sweden; Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden

Correspondence to:
Dr A Frohm
Department of Molecular Medicine and Surgery, Section of Orthopedics and Sports Medicine, Karolinska Institutet M:3, SE-171 76 Stockholm, Sweden; anna.frohm{at}telia.com

Objective: To compare the efficacy and safety of two eccentric rehabilitation protocols for patients with symptomatic patellar tendinopathy. A new eccentric overload training device was compared with the present standard eccentric rehabilitation programme on a decline board.

Design: Prospective, randomised clinical trial.

Setting: Sports rehabilitation clinic, university sports laboratory, supplemented with home exercises.

Patients: 20 competitive and recreational athletes, all with clinical diagnosis of patellar tendinopathy, verified by MRI or ultrasound imaging.

Interventions: A 12-week rehabilitation period, either with bilateral eccentric overload strength training using the Bromsman device twice a week or with unilateral eccentric body load training using a decline board twice a week, supplemented with daily home exercises.

Outcome measures: The primary outcome was pain and function, assessed by the Swedish Victorian Institute of Sport Assessment for Patella (VISA-P) score. Secondary outcome measures were isokinetic muscle torque, dynamic function and muscle flexibility, as well as pain level estimations using visual analogue scale (VAS). Side effects were registered.

Results: Both treatment groups improved in the short term according to the VISA-P scores during the 12-week rehabilitation period. However, there were no significant differences between the groups in terms of pain and function. After a 3-month rehabilitation period, most patients could be regarded as improved enough to be able to return to training and sports. No serious side effects were detected in either group.

Conclusion: In patients with patellar tendinopathy pain, two-legged eccentric overload training twice per week, using the new device (Bromsman), was as efficient and safe as the present standard daily eccentric one-legged rehabilitation-training regimen using a decline board.

Abbreviations: CMJ, counter movement jumps; GEE, generalised estimating equations; IST, isokinetic strength testing; VAS, visual analogue scale; VISA-P, Victorian Institute of Sport Assessment for Patella; US, ultrasonography

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