Considering surgery for tendinopathy? Here’s an interesting read….

How does surgery compare to sham surgery or Physiotherapy as a treatment for tendinopathy?

A systematic review of randomized trials

BMJ Sport and exercise medicine  March 2019

What is already known?

► Much debate surrounds the role of surgical intervention in chronic tendon disease. Sham surgery trials are the gold standard against which to judge the effect of surgery on clinical conditions (such as tendinopathy). What are the new findings?

► In 12 eligible randomised controlled trials in patients with various tendinopathies,

surgery was not superior to sham surgery in patients with tendinopathy in the midterm and long term.

► Tendon loading exercises are as effective as surgery both in the midterm and long term for patients’ pain, function and quality of life.

► Surgery should be reserved for selected cases and only after a sufficiently long course (12 months) of evidence-based loading exercise has failed.

Abstract:

Purpose To assess the effectiveness of surgery on all tendinopathies by comparing it to no treatment, sham surgery and exercise-based therapies for both mid-term (12 months) and long-term (> 12 months) outcomes.

Methods Our literature search included EMBASE, Medline, CINAHL and Scopus. A combined assessment of internal validity, external validity and precision of each eligible study yielded its overall study quality. Results were considered significant if they were based on strong (Level 1) or moderate (Level 2) evidence.

Results 12 studies were eligible. Participants had the following types of tendinopathy: shoulder in seven studies, lateral elbow in three, patellar in one and Achilles in one. Two studies were of good, four of moderate and six of poor overall quality. Surgery was superior to no treatment or placebo, for the outcomes of pain, function, range of movement (ROM) and treatment success in the short and midterm. Surgery had similar effects to sham surgery on pain, function and range of motion in the midterm. Physiotherapy was as effective as surgery both in the midterm and long term for pain, function, ROM and tendon force, and pain, treatment success and quality of life, respectively.

Conclusion We recommend that healthcare professionals who treat tendinopathy encourage patients to comply with loading exercise treatment for at least 12 months before the option of surgery is seriously entertained.

For tendinopathy there are several conservative treatment options to help heal the tendon and reduce pain including soft tissue release techniques (Active Release Therapy), Low Level Laser therapy, and Shockwave therapy. These combined with strengthening exercises may be all you need to avoid surgery.

Contact us at 403-814-0841 to discuss your options.

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YYC Sport and Spine

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