Abstract

Lecture 21

Patella tendinopathy is still a potentially career ending injury if not accurately diagnosed and actively managed. Prevalence has been reported to be in the range of 7–40% in the athletic population. There are still concerns regarding the aetiology, although the mechanical strain theory is the most accepted – repeat heavy loading initiating pathological extracellular and cellular dysfunction with eventual collagen disruption and tendon degeneration.

Musculoskeletal extracorporeal shockwave therapy (ESWT) involves the use of low, medium and high energy focused or non-focused (radial) sound waves that have been shown to have a therapeutic value for certain orthopaedic conditions. ESWT in patella tendinopathy ‘seems to be a safe and promising treatment’ was the conclusion reached by Leeuwen et al in a review of the literature which appeared in the BJSM last year (BJSM 2009;43:163–8).

The mechanism of action of shockwaves remains unknown. It has been postulated that shockwaves induce hyperstimulation analgesia by increasing the threshold of pain. It also seems to increase vascularity and leads to increases in cellular signalling. Focused shockwave therapy has been used in my practice with good results in a number of mild to moderately severe cases.