Management of patellar tendinopathy: a systematic review and network meta-analysis of randomised studies

Challoumas D, et al. · BMJ Open Sport & Exercise Medicine

37 RCTs covering 33 interventions, most of them represented by a single study. Isometric and isotonic exercise came out equally effective for immediate post-session pain (pooled MD 1.03 VAS points favouring isometric, 95% CI -2.6 to 0.5, p=0.19, I2=70%, low strength of evidence), and the pooling broke down at I2=83% once a four-week follow-up was added. Shockwave therapy alongside eccentric exercise was no better than sham shockwave alongside eccentric exercise, on moderate strength evidence. The network ranked topical glyceryl trinitrate or hyaluronic acid combined with eccentric exercise, and moderate slow resistance exercise, highest, on low to very low strength of evidence. The authors keep eccentric loading as first-line and name the absence of adequate high-quality evidence as their most striking finding.

Population

37 RCTs in patellar tendinopathy (33 interventions)

Intervention

Network meta-analysis of all conservative and adjunct treatments

Comparator

Across interventions

Limitations

Most of the 33 interventions rest on a single trial each, and the network rankings are built on studies at high overall risk of bias carrying low to very low strength of evidence. Three of the four isometric-and-isotonic trials were at high risk of bias, and the mid-term and long-term effects of isometric loading are unmeasured. Tendon population; no cartilage endpoint appears here.