Clinical improvements are not explained by changes in tendon structure on UTC following an exercise program for patellar tendinopathy

Objectives The aim of this study was to investigate the effects of a 4-week in-season exercise program of isometric or isotonic exercises on tendon structure and dimensions as quantified by Ultrasound Tissue Characterization (UTC). Design Randomized clinical trial. Volleyball and basketball players (16-31 years, n=29) with clinically diagnosed patellar tendinopathy were randomized to a 4-week isometric or isotonic exercise program. The programs were designed to decrease patellar tendon pain. A baseline and 4-week UTC scan was used to evaluate change in tendon structure. Results No significant change in tendon structure or dimensions on UTC was detected after the exercise program, despite patellar tendinopathy symptoms improving. The percentage and mean cross-sectional area (mCSA) of aligned fibrillar structure (echo-types I+II) (Z=-0.414,p=0.679) as well as disorganized structure (echo-types III + IV) (Z=-0.370,p=0.711) did not change over the 4-week exercise program. Change in tendon structure and dimensions on UTC did not differ significantly between the groups. Conclusion Structural properties and dimensions of the patellar tendon on UTC did not change after a 4-week isometric or isotonic exercise program for athletes with patellar tendinopathy in-season, despite an improvement of symptoms. It seems that structural improvements are not required for a positive clinical outcome. Corresponding author: M. van Ark. m.van.ark@pl.hanze.nl; tel +31 (0)50 361 77 0, fax +31 (0)50 361 77 17 Author disclosures Mathijs van Ark has been supported by Foundation "De Drie Lichten", "Wetenschappelijk College Fysiotherapie" and "Anna Foundation | NOREF" in The Netherlands for this project. This study has also been supported by the Australian Institute of Sport (Clinical Research Fund). Jill Cook, Sean Docking and Ebonie Rio were supported by the Australian Collaboration for research into sports injury and its prevention (ACRISP), which is one of the International Research Centres for the Prevention of Injury and Protection of Athlete Health supported by the International Olympic Committee (IOC). Jill Cook is a NHMRC practitioner fellow (ID 105849). Sean Docking has been supported by the Monash Postgraduate Publication Award. Jill Cook is a director and shareholder in Trackside Technologies, the applicant of a patent directed to using ultrasound to monitor connective tissue and compositions for treating connective tissue. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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