Skip to main content
Top
Published in: International Orthopaedics 8/2014

01-08-2014 | Original Paper

 Surgery for unilateral and bilateral patellar tendinopathy: a seven year comparative study

Authors: Nicola Maffulli, Francesco Oliva, Gayle Maffulli, John B King, Angelo Del Buono

Published in: International Orthopaedics | Issue 8/2014

Login to get access

Abstract

Purpose

Open surgery for patellar tendinopathy allows patients with unilateral and bilateral tendinopathy to return to high levels of physical activity.

Materials

Two groups of 23 athletes each underwent open surgical exploration for management of patellar tendinopathy. One group suffered from unilateral patellar tendinopathy (unilateral group), and the other group had bilateral (bilateral group) patellar tendinopathy. Maximum voluntary isometric contraction and anthropometric measures were assessed pre-operatively and at an average follow-up of seven years. The Victorian Institute of Sport Assessment (VISA)-P scoring system was also administered; functional outcomes were classified from excellent to poor according to a modification of Kelly’s criteria.

Results

At the final follow-up, in both groups, VISA-P scores were significantly improved compared with preoperative values, with no intergroup differences. Clinical results were excellent or good in 21 patients in the unilateral and 19 in the bilateral group. Twenty of 23 patients in the unilateral group and 17 of 23 in the bilateral group were still active in sports (p = 0.2). In the unilateral group, at the last follow-up, thigh volume and strength were significantly improved compared with baseline, with significant difference between operated and nonoperated limbs. In the bilateral group, there were no significant differences in thigh volume and strength between the dominant and nondominant limbs both before and after the index procedure.

Conclusions

This procedure is not technically demanding and provides a high rate of good and excellent outcomes in the long term.
Literature
1.
2.
go back to reference Filardo G, Kon E, Di Matteo B, Pelotti P, Di Martino A, Marcacci M (2013) Platelet-rich plasma for the treatment of patellar tendinopathy: clinical and imaging findings at medium-term follow-up. Int Orthop 37:1583–1589PubMedCrossRef Filardo G, Kon E, Di Matteo B, Pelotti P, Di Martino A, Marcacci M (2013) Platelet-rich plasma for the treatment of patellar tendinopathy: clinical and imaging findings at medium-term follow-up. Int Orthop 37:1583–1589PubMedCrossRef
3.
go back to reference Filardo G, Kon E, Della Villa S, Vincentelli F, Fornasari PM, Marcacci M (2010) Use of platelet-rich plasma for the treatment of refractory jumper’s knee. Int Orthop 34:909–915PubMedCentralPubMedCrossRef Filardo G, Kon E, Della Villa S, Vincentelli F, Fornasari PM, Marcacci M (2010) Use of platelet-rich plasma for the treatment of refractory jumper’s knee. Int Orthop 34:909–915PubMedCentralPubMedCrossRef
4.
go back to reference Gosens T, Den Oudsten BL, Fievez E, van’t Spijker P, Fievez A (2012) Pain and activity levels before and after platelet-rich plasma injection treatment of patellar tendinopathy: a prospective cohort study and the influence of previous treatments. Int Orthop 36:1941–1946PubMedCentralPubMedCrossRef Gosens T, Den Oudsten BL, Fievez E, van’t Spijker P, Fievez A (2012) Pain and activity levels before and after platelet-rich plasma injection treatment of patellar tendinopathy: a prospective cohort study and the influence of previous treatments. Int Orthop 36:1941–1946PubMedCentralPubMedCrossRef
5.
go back to reference Khan KM, Maffulli N, Coleman BD, Cook JL, Taunton JE (1998) Patellar tendinopathy: some aspects of basic science and clinical management. Br J Sports Med 32:346–355PubMedCentralPubMedCrossRef Khan KM, Maffulli N, Coleman BD, Cook JL, Taunton JE (1998) Patellar tendinopathy: some aspects of basic science and clinical management. Br J Sports Med 32:346–355PubMedCentralPubMedCrossRef
6.
go back to reference Shelbourne KD, Henne TD, Gray T (2006) Recalcitrant patellar tendinosis in elite athletes: surgical treatment in conjunction with aggressive postoperative rehabilitation. Am J Sports Med 34:1141–1146PubMedCrossRef Shelbourne KD, Henne TD, Gray T (2006) Recalcitrant patellar tendinosis in elite athletes: surgical treatment in conjunction with aggressive postoperative rehabilitation. Am J Sports Med 34:1141–1146PubMedCrossRef
7.
go back to reference Pascarella A, Alam M, Pascarella F, Latte C, Di Salvatore MG, Maffulli N (2011) Arthroscopic management of chronic patellar tendinopathy. Am J Sports Med 39:1975–1983PubMedCrossRef Pascarella A, Alam M, Pascarella F, Latte C, Di Salvatore MG, Maffulli N (2011) Arthroscopic management of chronic patellar tendinopathy. Am J Sports Med 39:1975–1983PubMedCrossRef
8.
go back to reference Durnin JV, Womersley J (1974) Body fat assessed from total body density and its estimation from skinfold thickness: measurements on 481 men and women aged from 16 to 72 years. Br J Nutr 32:77–97PubMedCrossRef Durnin JV, Womersley J (1974) Body fat assessed from total body density and its estimation from skinfold thickness: measurements on 481 men and women aged from 16 to 72 years. Br J Nutr 32:77–97PubMedCrossRef
9.
go back to reference Cameron N (1984) The measurement of human growth. Croom Helm, Beckenham 56–99 Cameron N (1984) The measurement of human growth. Croom Helm, Beckenham 56–99
10.
go back to reference Jones PR, Pearson J (1969) Anthropometric determination of leg fat and muscle plus bone volumes in young male and female adults. J Physiol 204:63–66 Jones PR, Pearson J (1969) Anthropometric determination of leg fat and muscle plus bone volumes in young male and female adults. J Physiol 204:63–66
11.
go back to reference Jones DA, Parker DF (1989) Development of a portable strain gauge to measure human isometric muscle strength. J Physiol 145:11 Jones DA, Parker DF (1989) Development of a portable strain gauge to measure human isometric muscle strength. J Physiol 145:11
12.
13.
go back to reference Pecina M, Bojanic I, Ivkovic A, Brcic L, Smoljanovic T, Seiwerth S (2010) Patellar tendinopathy: histopathological examination and follow-up of surgical treatment. Acta Chir Orthop Traumatol Cech 77:277–83PubMed Pecina M, Bojanic I, Ivkovic A, Brcic L, Smoljanovic T, Seiwerth S (2010) Patellar tendinopathy: histopathological examination and follow-up of surgical treatment. Acta Chir Orthop Traumatol Cech 77:277–83PubMed
14.
go back to reference Visentini PJ, Khan KM, Cook JL, Kiss ZS, Harcourt PR, Wark JD (1998) The VISA score: an index of severity of symptoms in patients with jumper’s knee (patellar tendinosis). victorian institute of sport tendon study group. J Sci Med Sport 1:22–28PubMedCrossRef Visentini PJ, Khan KM, Cook JL, Kiss ZS, Harcourt PR, Wark JD (1998) The VISA score: an index of severity of symptoms in patients with jumper’s knee (patellar tendinosis). victorian institute of sport tendon study group. J Sci Med Sport 1:22–28PubMedCrossRef
15.
go back to reference Kelly DW, Carter VS, Jobe FW, Kerlan RK (1984) Patellar and quadriceps tendon ruptures–jumper’s knee. Am J Sports Med 12:375–380PubMedCrossRef Kelly DW, Carter VS, Jobe FW, Kerlan RK (1984) Patellar and quadriceps tendon ruptures–jumper’s knee. Am J Sports Med 12:375–380PubMedCrossRef
16.
go back to reference Basso O, Amis AA, Race A, Johnson DP (2002) Patellar tendon fiber strains: their differential responses to quadriceps tension. Clin Orthop Relat Res 246–253 Basso O, Amis AA, Race A, Johnson DP (2002) Patellar tendon fiber strains: their differential responses to quadriceps tension. Clin Orthop Relat Res 246–253
17.
go back to reference Crossley KM, Thancanamootoo K, Metcalf BR, Cook JL, Purdam CR, Warden SJ (2007) Clinical features of patellar tendinopathy and their implications for rehabilitation. J Orthop Res 25:1164–1175PubMedCrossRef Crossley KM, Thancanamootoo K, Metcalf BR, Cook JL, Purdam CR, Warden SJ (2007) Clinical features of patellar tendinopathy and their implications for rehabilitation. J Orthop Res 25:1164–1175PubMedCrossRef
18.
go back to reference Gaida JE, Cook JL, Bass SL, Austen S, Kiss ZS (2004) Are unilateral and bilateral patellar tendinopathy distinguished by differences in anthropometry, body composition, or muscle strength in elite female basketball players? Br J Sports Med 38:581–585PubMedCentralPubMedCrossRef Gaida JE, Cook JL, Bass SL, Austen S, Kiss ZS (2004) Are unilateral and bilateral patellar tendinopathy distinguished by differences in anthropometry, body composition, or muscle strength in elite female basketball players? Br J Sports Med 38:581–585PubMedCentralPubMedCrossRef
19.
go back to reference Cook JL, Khan KM, Harcourt PR, Grant M, Young DA, Bonar SF (1997) A cross sectional study of 100 athletes with jumper’s knee managed conservatively and surgically. The Victorian institute of sport tendon study group. Br J Sports Med 31:332–336PubMedCentralPubMedCrossRef Cook JL, Khan KM, Harcourt PR, Grant M, Young DA, Bonar SF (1997) A cross sectional study of 100 athletes with jumper’s knee managed conservatively and surgically. The Victorian institute of sport tendon study group. Br J Sports Med 31:332–336PubMedCentralPubMedCrossRef
20.
go back to reference Khan KM, Maffulli N (1998) Tendinopathy: an Achilles’ heel for athletes and clinicians. Clin J Sport Med 8:151–154PubMedCrossRef Khan KM, Maffulli N (1998) Tendinopathy: an Achilles’ heel for athletes and clinicians. Clin J Sport Med 8:151–154PubMedCrossRef
21.
go back to reference Maffulli N, Khan KM, Puddu G (1998) Overuse tendon conditions: time to change a confusing terminology. Arthroscopy 14:840–843PubMedCrossRef Maffulli N, Khan KM, Puddu G (1998) Overuse tendon conditions: time to change a confusing terminology. Arthroscopy 14:840–843PubMedCrossRef
22.
go back to reference Blazina ME, Kerlan RK, Jobe FW, Carter VS, Carlson GJ (1973) Jumper’s knee. Orthop Clin North Am 4:665–678PubMed Blazina ME, Kerlan RK, Jobe FW, Carter VS, Carlson GJ (1973) Jumper’s knee. Orthop Clin North Am 4:665–678PubMed
23.
go back to reference Coleman BD, Khan KM, Maffulli N, Cook JL, Wark JD (2000) Studies of surgical outcome after patellar tendinopathy: clinical significance of methodological deficiencies and guidelines for future studies. Victorian Institute of Sport Tendon Study Group. Scand J Med Sci Sports 10:2–11PubMedCrossRef Coleman BD, Khan KM, Maffulli N, Cook JL, Wark JD (2000) Studies of surgical outcome after patellar tendinopathy: clinical significance of methodological deficiencies and guidelines for future studies. Victorian Institute of Sport Tendon Study Group. Scand J Med Sci Sports 10:2–11PubMedCrossRef
24.
go back to reference Cucurulo T, Louis ML, Thaunat M, Franceschi JP (2009) Surgical treatment of patellar tendinopathy in athletes. A retrospective multicentric study. Orthop Traumatol Surg Res 95:S78–84PubMedCrossRef Cucurulo T, Louis ML, Thaunat M, Franceschi JP (2009) Surgical treatment of patellar tendinopathy in athletes. A retrospective multicentric study. Orthop Traumatol Surg Res 95:S78–84PubMedCrossRef
25.
go back to reference Testa V, Capasso G, Maffulli N, Bifulco G (1999) Ultrasound-guided percutaneous longitudinal tenotomy for the management of patellar tendinopathy. Med Sci Sports Exerc 31:1509–1515PubMedCrossRef Testa V, Capasso G, Maffulli N, Bifulco G (1999) Ultrasound-guided percutaneous longitudinal tenotomy for the management of patellar tendinopathy. Med Sci Sports Exerc 31:1509–1515PubMedCrossRef
26.
go back to reference Pierets K, Verdonk R, De Muynck M, Lagast J (1999) Jumper’s knee: postoperative assessment. A retrospective clinical study. Knee Surg Sports Traumatol Arthrosc 7:239–242PubMedCrossRef Pierets K, Verdonk R, De Muynck M, Lagast J (1999) Jumper’s knee: postoperative assessment. A retrospective clinical study. Knee Surg Sports Traumatol Arthrosc 7:239–242PubMedCrossRef
27.
go back to reference Karlsson J, Lundin O, Lossing IW, Peterson L (1991) Partial rupture of the patellar ligament. Results after operative treatment. Am J Sports Med 19:403–408PubMedCrossRef Karlsson J, Lundin O, Lossing IW, Peterson L (1991) Partial rupture of the patellar ligament. Results after operative treatment. Am J Sports Med 19:403–408PubMedCrossRef
28.
go back to reference Coleman BD, Khan KM, Kiss ZS, Bartlett J, Young DA, Wark JD (2000) Open and arthroscopic patellar tenotomy for chronic patellar tendinopathy. A retrospective outcome study. Victorian institute of sport tendon study group. Am J Sports Med 28:183–190PubMed Coleman BD, Khan KM, Kiss ZS, Bartlett J, Young DA, Wark JD (2000) Open and arthroscopic patellar tenotomy for chronic patellar tendinopathy. A retrospective outcome study. Victorian institute of sport tendon study group. Am J Sports Med 28:183–190PubMed
29.
go back to reference Panni AS, Tartarone M, Maffulli N (2000) Patellar tendinopathy in athletes. Outcome of nonoperative and operative management. Am J Sports Med 28:392–397PubMed Panni AS, Tartarone M, Maffulli N (2000) Patellar tendinopathy in athletes. Outcome of nonoperative and operative management. Am J Sports Med 28:392–397PubMed
Metadata
Title
 Surgery for unilateral and bilateral patellar tendinopathy: a seven year comparative study
Authors
Nicola Maffulli
Francesco Oliva
Gayle Maffulli
John B King
Angelo Del Buono
Publication date
01-08-2014
Publisher
Springer Berlin Heidelberg
Published in
International Orthopaedics / Issue 8/2014
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-014-2390-2

Other articles of this Issue 8/2014

International Orthopaedics 8/2014 Go to the issue