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Speaker: Causes of tendinopathy problems should direct any treatment
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AMSTERDAM — Orthopaedic surgeons should be aware of what caused any tendinopathy they diagnose in patients prior to treatment, especially if consider a surgical procedure, according to a presenter at the European Society of Sports Traumatology, Knee Surgery and Arthroscopy Congress, here.
In his highlight lecture, Michael Kjær, MD, clinical professor in the Department of Clinical Medicine, at Bispebjerg Hospital, in Copenhagen, Denmark, discussed eleven possible causes for tendinopathy that have been researched and put forth as theories.
“Four explanations have stronger support than the others. The mechanical damage is certainly out there still and if that is one we should concentrate on surgery getting away some of the degenerative parts. We should maybe do mechanical loading so we can load the part that is shielded off,” said Kjaer, who specializes in rheumatology. However, he noted, there is no proof for this approach.
Neuronal stimulation is another explanation of tendinopathy, he said. The neuronal stimulation theory supports attacking pain much earlier than is done now and it “is favoring the anti-angiogenesis treatments, both surgically and nonsurgical.”
He also discussed the constant overload theory of tendinopathy. “You constantly overload it so it is a gradual disturbance of homeostasis,” which, Kjaer said, implies the need for either gross stimulation or better mechanical loading of the tendon.
The fourth explanation for tendinopathy he presented is the compressive load theory, which can be counteracted by a surgical intervention or another approach to reduce the load, according to Kjaer.
“There are questions of stress or no stress. There is question of intervention, medical intervention and others, and then there’s the question of surgical intervention,” he said.
“One hundred percent effective treatment, we don’t have. But we have strength training that is about 75% effective and that is what you are going to have to beat if you have other approaches. I think the future will be the combination maybe between surgery and training and other things, but only the future can tell,” Kjaer said. – by Susan M. Rapp
Reference:
Kjaer M. Lecture #IL12-9003. Presented at: European Society of Sports Traumatology, Knee Surgery and Arthroscopy Congress; May 14-17, 2014. Amsterdam.
Disclosure: Orthopaedics Today Europe was unable to determine Kjaer’s relevant financial disclosures.