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Scientific Articles   |    
Surgical Treatment Compared with Eccentric Training for Patellar Tendinopathy (Jumper's Knee)A Randomized, Controlled Trial
Roald Bahr, MD, PhD1; Bjørn Fossan, PT2; Sverre Løken, MD1; Lars Engebretsen, MD, PhD1
1 Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, P.O. Box 4014 Ullevaal Stadion, 0806 Oslo, Norway. E-mail address for R. Bahr: roald.bahr@nih.no
2 Health Department, Olympic Training Center, P.O. Box 4004 Ullevaal Station, 0806 Oslo, Norway
View Disclosures and Other Information
Note: The Oslo Sports Trauma Research Center has been established at the Norwegian School of Sport Sciences through generous grants from the Norwegian Eastern Health Corporate, the Royal Norwegian Ministry of Culture, the Norwegian Olympic Committee & Confederation of Sport, Norsk Tipping AS, and Pfizer AS. The authors thank Øystein Lian, MD, for his valuable input to the study protocol; Oddvar Knutsen, PT, for his contributions in adapting the eccentric training program; and Klas Eliasson, PT, for excellent patient follow-up. They also thank Ingar Holme, PhD, for conducting the randomization and for statistical advice; Thomas Haugen for performing the jump tests; Christian Mørdre, RN, and Monica Viker Brekke, RN, for patient management; and Thomas Krog and Tone R. Øritsland, MSc, for their help with data management.
In support of their research for or preparation of this manuscript, one or more of the authors received grants or outside funding from Norwegian Eastern Health Corporate, Royal Norwegian Ministry of Culture, Norwegian Olympic Committee and Confederation of Sport, Norsk Tipping AS, and Pfizer AS. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Investigation performed at the Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences; the Health Department, Olympic Training Center; and the Department of Orthopaedic Surgery, Ullevål University Hospital, Oslo, Norway

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2006 Aug 01;88(8):1689-1698. doi: 10.2106/JBJS.E.01181
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Abstract

Background: Although the surgical treatment of patellar tendinopathy (jumper's knee) is a common procedure, there have been no randomized, controlled trials comparing this treatment with forms of nonoperative treatment. The purpose of the present study was to compare the outcome of open patellar tenotomy with that of eccentric strength training in patients with patellar tendinopathy.

Methods: Thirty-five patients (forty knees) who had been referred for the treatment of grade-IIIB patellar tendinopathy were randomized to surgical treatment (twenty knees) or eccentric strength training (twenty knees). The eccentric training group performed squats on a 25° decline board as a home exercise program (with three sets of fifteen repetitions being performed twice daily) for a twelve-week intervention period. In the surgical treatment group, the abnormal tissue was removed by means of a wedge-shaped full-thickness excision, followed by a structured rehabilitation program with gradual progression to eccentric training. The primary outcome measure was the VISA (Victorian Institute of Sport Assessment) score (possible range, 0 to 100), which was calculated on the basis of answers to a symptom-based questionnaire that was developed specifically for patellar tendinopathy. The patients were evaluated after three, six, and twelve months of follow-up.

Results: There was no difference between the groups with regard to the VISA score during the twelve-month follow-up period, but both groups had improvement (p < 0.001). The mean combined VISA score for the two groups increased from 30 (95% confidence interval, 25 to 35) before the start of treatment to 49 (95% confidence interval, 42 to 55) at three months, 58 (95% confidence interval, 51 to 65) at six months, and 70 (95% confidence interval, 62 to 78) at twelve months. In the surgical treatment group, five knees had no symptoms, twelve had improvement but were still symptomatic, two were unchanged, and one was worse after twelve months (p = 0.49 compared with the eccentric training group). In the eccentric training group, five knees did not respond to treatment and underwent secondary surgery after three to six months. Of the remaining fifteen knees in the eccentric training group, seven had no symptoms and eight had improvement but were still symptomatic after twelve months.

Conclusions: No advantage was demonstrated for surgical treatment compared with eccentric strength training. Eccentric training should be tried for twelve weeks before open tenotomy is considered for the treatment of patellar tendinopathy.

Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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