Topical glyceryl trinitrate treatment of chronic patellar tendinopathy: a randomised, double-blind, placebo-controlled clinical trial
- Mirjam Steunebrink1,
- Johannes Zwerver2,
- Ruben Brandsema2,
- Petra Groenenboom3,
- Inge van den Akker-Scheek2,
- Adam Weir3
- 1Department of Steunebrink Sportsmedicine, Eelde, The Netherlands
- 2Department of Sportsmedicine, University Medical Center Groningen, Groningen, The Netherlands
- 3Department of Sportsmedicine, Medical Center Haaglanden, Leidschendam, The Netherlands
- Correspondence to Mirjam Steunebrink, Steunebrink Sportsmedicine, Vosbergerlaan 1, 9761 AK, Eelde, The Netherlands;
- Received 30 April 2012
- Revised 20 July 2012
- Accepted 2 August 2012
- Published Online First 28 August 2012
Objectives To assess if continuous topical glyceryl trinitrate (GTN) treatment improves outcome in patients with chronic patellar tendinopathy when compared with eccentric training alone.
Methods Randomised double-blind, placebo-controlled clinical trial comparing a 12-week programme of using a GTN or placebo patch in combination with eccentric squats on a decline board. Measurements were performed at baseline, 6, 12 and 24 weeks. Primary outcome measure was the Victorian Institute of Sports Assessment-Patella (VISA-P) questionnaire. Secondary outcome measures were patient satisfaction and pain scores during sports. Generalised estimated equation was used to analyse the treatment, time and treatment×time effect. Analyses were performed following the intention-to-treat principle.
Results VISA-P scores for both groups improved over the study period to 75.0±16.2 and 80.7±22.1 at 24 weeks. Results showed a significant effect for time (p<0.01) but no effect for treatment×time (p=0.80). Mean Visual Analogue Scores pain scores during sports for both groups increased over the study period to 6.6±3 and 7.8±3.1. Results showed a significant effect for time (p<0.01) but no effect for treatment×time (p=0.38). Patient satisfaction showed no difference between GTN and placebo groups (p=0.25) after 24 weeks, but did show a significant difference over time (p=0.01). Three patients in the GTN group reported some rash.
Conclusion It seems that continuous topical GTN treatment in addition to an eccentric exercise programme does not improve clinical outcome compared to placebo patches and an eccentric exercise programme in patients with chronic patellar tendinopathy.
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