Current pharmacological approaches to the treatment of tendinopathy

ABSTRACT

Introduction

Tendinopathies are common in elite and recreational athletes: traditionally considered overuse injuries, they involve excessive tensile loading and subsequent breakdown of the loaded tendon. Many pharmacological treatments have been proposed for the management of tendinopathy, with no agreement regarding the overall best option available both for Achilles and patellar tendinopathy.

Areas covered

The present article reports the best scientific evidence regarding the efficacy and safety of different pharmacological treatments in different types of tendinopathy, focusing on Achilles and patellar tendinopathy, the conditions on which more studies have been published.

Expert opinion

No univocal evidence exists regarding the best non-operative management, which includes non-steroidal anti-inflammatory drugs, platelet-rich plasma, high volume image-guided injections, hyaluronic acid, and prolotherapy, for tendinopathy (in particular Achilles and patellar tendinopathies) as a suitable alternative to the commonly used eccentric loading rehabilitation regimen. It is unclear whether the combination of pharmacological substances with physical therapy would produce better results than physical therapy alone. There is an overall lack of published well-performed randomized controlled trials comparing the various options available for the management of tendinopathy, studying large cohorts of patients for adequately long follow-up periods and with well-validated standardized scores and scales.

KEYWORDS:

• Achilles
• Achilles tendinopathy
• conservative management
• patellar tendinopathy
• pharmacological therapy

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Article Highlights

• Tendinopathy refers to a clinical condition characterized by pain, swelling, and functional limitations in tendons and nearby structures. Achilles tendinopathy is common in football, tennis, badminton and jumping, with a prevalence in running athletes of 11%.

• Tendon damage can be caused by intrinsic or extrinsic factors. Intrinsic factors are increased age, the shift from cells aerobic to anaerobic energy production, increased matrix metalloproteinase imbalance between tendon catabolism and anabolism, increased weight and adiposity, repetitive workload, metabolic diseases (such as diabetes), and genetics.

• A growing number of pharmacotherapy treatments have been proposed for the management of tendinopathy, including injectable substances, such as corticosteroids, prolotherapy, autologous blood, platelet-rich plasma, polidocanol, but there is a lack of comparative analysis between these management modalities to establish which can be the best effective.

• In the initial acute phase, rest and immobilisation may be considered to try and control exacerbating factors, but prolonged immobilization should be avoided; training regimes modifications and specific exercises are necessary.

• No gold standard for the management of tendinopathies is documented, given the controversial clinical results between various studies conducted during the last few years. More level I studies are needed to establish the beneficial effect of these treatment options.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript was not funded.