Tendinopathy Clinical Trial
— TENDOSHOCKOfficial title:
TENDOSHOCK-2010 - Combined Sclerosing Therapy, Extracorporeal Shockwave Therapy, Eccentric Training and Topical Glyceryl Trinitrate for Athletic Tendinopathies
Athletic tendinopathies of the upper and lower extremity are often therapeutically
challenging. Colour and Power-Doppler-ultrasound visualizes pathological neovessels in
painful tendons, which are associated with pain-mediating nerve fibres in such
tendinopathies. These neovessels are represented by an increased capillary blood flow at the
point of pain. Painful eccentric training reduces pain and improves function in Achilles
tendinopathy substantially (evidence level Ib). Shock wave therapy in combination with
eccentric training is superior to eccentric training alone (evidence level Ib). Long-term
results suggest a collagen induction and reduced pain following topical glyceryl trinitrate
(NO) (evidence level Ib). Colour- and Power-Doppler-guided sclerosing therapy using
polidocanol reduces pain, improves function and may lead to tendon remodelling (evidence
level Ib). Pain-restricted sport beyond pain level 5/10 during therapy is recommended
(evidence level Ib). 3x10min of cryotherapy reduce pain and capillary blood flow (evidence
level Ib). The role of proprioceptive training in tendinopathy has to be determined in
future randomized-controlled trials (evidence level II).
The investigators thought to evaluate the combination of the aforementioned individually
successfully therapeutic options in athletes to shorten the recovery period and return to
play interval.
Status | Active, not recruiting |
Enrollment | 114 |
Est. completion date | December 2010 |
Est. primary completion date | August 2010 |
Accepts healthy volunteers | No |
Gender | Both |
Age group | 18 Years and older |
Eligibility |
Inclusion Criteria: - Painful tendons at the Achilles tendon (both insertional and mid-portion tendinopathy) - patella tendinopathy - elbow tendinopathy - informed consent Exclusion Criteria: - no informed consent - no painful tendons - allergy against Polidocanol - current treatment with Marcumar |
Allocation: Non-Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment
Country | Name | City | State |
---|---|---|---|
Germany | Hannover Medical School, Plastic, Hand and Reconstructive Surgery | Hannover |
Lead Sponsor | Collaborator |
---|---|
Hannover Medical School |
Germany,
Knobloch K, Grasemann R, Jagodzinski M, Richter M, Zeichen J, Krettek C. Changes of Achilles midportion tendon microcirculation after repetitive simultaneous cryotherapy and compression using a Cryo/Cuff. Am J Sports Med. 2006 Dec;34(12):1953-9. Epub 2006 Sep 22. — View Citation
Knobloch K, Grasemann R, Spies M, Vogt PM. Intermittent KoldBlue cryotherapy of 3x10 min changes mid-portion Achilles tendon microcirculation. Br J Sports Med. 2007 Jun;41(6):e4. Epub 2006 Nov 30. — View Citation
Knobloch K, Grasemann R, Spies M, Vogt PM. Midportion achilles tendon microcirculation after intermittent combined cryotherapy and compression compared with cryotherapy alone: a randomized trial. Am J Sports Med. 2008 Nov;36(11):2128-38. doi: 10.1177/0363546508319313. Epub 2008 Jul 18. — View Citation
Knobloch K, Kraemer R, Jagodzinski M, Zeichen J, Meller R, Vogt PM. Eccentric training decreases paratendon capillary blood flow and preserves paratendon oxygen saturation in chronic achilles tendinopathy. J Orthop Sports Phys Ther. 2007 May;37(5):269-76. — View Citation
Knobloch K, Schreibmueller L, Kraemer R, Jagodzinski M, Vogt PM, Redeker J. Gender and eccentric training in Achilles mid-portion tendinopathy. Knee Surg Sports Traumatol Arthrosc. 2010 May;18(5):648-55. doi: 10.1007/s00167-009-1006-7. Epub 2009 Dec 9. — View Citation
Knobloch K, Schreibmueller L, Longo UG, Vogt PM. Eccentric exercises for the management of tendinopathy of the main body of the Achilles tendon with or without an AirHeel Brace. A randomized controlled trial. B: Effects of compliance. Disabil Rehabil. 2008;30(20-22):1692-6. doi: 10.1080/09638280701785676. — View Citation
Knobloch K, Schreibmueller L, Longo UG, Vogt PM. Eccentric exercises for the management of tendinopathy of the main body of the Achilles tendon with or without the AirHeel Brace. A randomized controlled trial. A: effects on pain and microcirculation. Disabil Rehabil. 2008;30(20-22):1685-91. doi: 10.1080/09638280701786658. — View Citation
Knobloch K, Schreibmueller L, Meller R, Busch KH, Spies M, Vogt PM. Superior Achilles tendon microcirculation in tendinopathy among symptomatic female versus male patients. Am J Sports Med. 2008 Mar;36(3):509-14. Epub 2007 Oct 30. — View Citation
Knobloch K, Spies M, Busch KH, Vogt PM. Sclerosing therapy and eccentric training in flexor carpi radialis tendinopathy in a tennis player. Br J Sports Med. 2007 Dec;41(12):920-1. Epub 2007 May 11. — View Citation
Knobloch K, Thermann H, Hüfner T. [Achilles tendon rupture--early functional and surgical options with special emphasis on rehabilitation issues]. Sportverletz Sportschaden. 2007 Mar;21(1):34-40. German. — View Citation
Knobloch K, Thermann H. [Achilles tendinopathy--modern evidence-based recommendations]. MMW Fortschr Med. 2008 Jun 26;150(26-27):46-9; quiz 50. German. — View Citation
Knobloch K, Yoon U, Vogt PM. Acute and overuse injuries correlated to hours of training in master running athletes. Foot Ankle Int. 2008 Jul;29(7):671-6. — View Citation
Knobloch K. Eccentric training in Achilles tendinopathy: is it harmful to tendon microcirculation? Br J Sports Med. 2007 Jun;41(6):e2; discussion e2. Epub 2006 Nov 24. — View Citation
Knobloch K. Sclerosing polidocanol injections in Achilles tendinopathy in high level athletes. Knee Surg Sports Traumatol Arthrosc. 2008 Nov;16(11):1061-2; author reply 1063. doi: 10.1007/s00167-008-0613-z. Epub 2008 Sep 13. — View Citation
Knobloch K. The role of tendon microcirculation in Achilles and patellar tendinopathy. J Orthop Surg Res. 2008 Apr 30;3:18. doi: 10.1186/1749-799X-3-18. — View Citation
Kraemer R, Knobloch K. A soccer-specific balance training program for hamstring muscle and patellar and achilles tendon injuries: an intervention study in premier league female soccer. Am J Sports Med. 2009 Jul;37(7):1384-93. doi: 10.1177/0363546509333012. — View Citation
Osadnik R, Redeker J, Kraemer R, Vogt PM, Knobloch K. Microcirculatory effects of topical glyceryl trinitrate on the Achilles tendon microcirculation in patients with previous Achilles tendon rupture. Knee Surg Sports Traumatol Arthrosc. 2010 Jul;18(7):977-81. doi: 10.1007/s00167-009-0958-y. Epub 2009 Oct 31. — View Citation
* Note: There are 17 references in all — Click here to view all references
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Functional impairment of the Achilles tendon using VISA-A score [0=worse, 100=perfect] | Score of patient-related outcome measure: Achilles tendon: VISA-A [0=worse, 100=perfect] derived from eight validated questions on pain and function during activities of daily living | up to 4 years | No |
Primary | Functional impairment of the patella tendon according to the VISA-P score [0=worse, 100=perfect] | Score of patient-related outcome measure: Patella tendon: VISA-P [0=worse, 100=perfect] derived from eight validated questions on pain and function during daily activities | up to 4 years | No |
Primary | Functional impairment due to epicondylitis measured by the DASH score [0=perfect, 100=worse] | Score of patient-related outcome measure: Epicondylitis: DASH score [0=perfect, 100=worse] derived from 30 validated questions regarding the impairment in activities of daily living | up to four years | No |
Secondary | Pain level at rest [VAS 0-10] | up to 4 years | No | |
Secondary | Pain level at exertion [VAS 0-10] | up to 4 years | No | |
Secondary | Patient satisfaction on Likert scale [1-6] | Patient satisfaction on Likert scale from 1=perfect, wholy satisfied, to 6=worst, dissatisfied | up to 4 years | No |
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