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Therapeutic interventions in children and adolescents with patellar tendon related pain: a systematic review
  1. George Cairns1,
  2. Timothy Owen2,
  3. Stefan Kluzek3,4,
  4. Neal Thurley1,5,
  5. Sinead Holden6,
  6. Michael Skovdal Rathleff7,
  7. Benjamin John Floyd Dean3,4
  1. 1 Bristol Medical School, University of Bristol Medical School, Bristol, UK
  2. 2 Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
  3. 3 Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Botnar Research Centre, University of Oxford, Oxford, UK
  4. 4 Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  5. 5 Bodleian Health Care Libraries, Cairns Library, John Radcliffe Hospital, Oxford, UK
  6. 6 Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
  7. 7 Research Unit for General Practice in Aalborg, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
  1. Correspondence to Dr Benjamin John Floyd Dean; bendean1979{at}gmail.com

Abstract

Objective Evaluate effectiveness and harms of interventions for patellar tendon related pain in children and adolescents.

Design Systematic review and meta-analysis.

Data sources Medline via Pubmed, Embase via OVID, CINAHL via Ebsco, SportDiscus up until 24 November 2017 were searched.

Eligibility criteria for selecting studies Inclusion criteria were (1) controlled or randomised controlled clinical trials (RCTs), (2) participants with diagnosis of patellar tendon related disorder, (3) participants≤18 years of age at enrolment and (4) published in a peer-reviewed English or Scandinavian language journal.

Results Of 530 studies identified, eight were included after screening, with three included in data synthesis. To be included in data synthesis, we required studies to have included (and have data available for) a minimum of 10 participants under 18 years. All studies were rated as being at high risk of bias. For adolescents with patellar tendinopathy, one RCT compared eccentric exercises to usual care and found no difference between groups. In adolescents with Osgood-Schlatter disease (OSD), injection of local anaesthetic with dextrose proved superior to either usual care or local anaesthetic alone (three armed RCTs). In a retrospective case controlled study in adolescents with OSD, surgery provided no benefit over conservative management in terms of persistent symptoms and had a higher complication rate.

Conclusion There is weak evidence to support the use of dextrose injection with local anaesthetic and no evidence to support the use of specific types of exercises to treat children/adolescents with OSD/patellar tendinopathy. Until further evidence arises, clinicians should include load modification and advise on a return to sport based on symptoms.

  • tendinopathy
  • tendinosis
  • tendon
  • children
  • adolescent

This is an Open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

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Footnotes

  • Contributors BJFD, SH, SK and MSR contributed to study conception and design, data analysis, drafting of the article and critical revision of the article. GC and TO contributed to study design, data collection and analysis and the critical revision of the article. NT contributed to study design, data collection and critical revision of the article.

  • Funding The TRYG Foundation is acknowledged for provided support for this project (Grant ID: 118547).

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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