Effect of Ultrasonography-Guided Corticosteroid Injection vs Placebo Added to Exercise Therapy for Achilles Tendinopathy:A Randomized Clinical Trial

IMPORTANCE: Corticosteroid injections and exercise therapy are commonly used to treat chronic midportion Achilles tendinopathy, but the evidence for this combination is limited. OBJECTIVE: To investigate the effect of corticosteroid injection and exercise therapy compared with placebo injection and exercise therapy for patients with Achilles tendinopathy. DESIGN, SETTING, AND PARTICIPANTS: This was a participant-blinded, physician-blinded, and assessor-blinded randomized clinical trial of patients with Achilles tendinopathy verified by ultrasonography. Assessment of pain and function were conducted at baseline and at 1, 2, 3, 6, 12, and 24 months. Patients were recruited from a university medical clinic and a private rheumatology clinic in Denmark between April 2016 and September 2018. Data analysis was performed from June to September 2021. INTERVENTIONS: Corticosteroid injection and placebo injection were performed with ultrasonography guidance. Exercise therapy was based on previous trials and consisted of 3 exercises done every second day. MAIN OUTCOMES AND MEASURES: The primary outcome was the Victorian Institute of Sports Assessment–Achilles (VISA-A) score (range, 1-100, with 100 representing no symptoms) at 6 months. Secondary outcomes included pain measured using a 100-mm Visual Analog Scale for morning pain and pain during exercise (with higher scores indicating worse pain), global assessment (Likert scale), and tendon thickness. RESULTS: A total of 100 patients were included, with 52 randomized to placebo (mean age, 46 years [95% CI, 44-48 years]; 32 men [62%]) and 48 randomized to corticosteroid injection (mean age, 47 years [95% CI, 45-49 years]; 28 men [58%]). Patients in the 2 groups had similar height (mean [SD], 177 [8] cm), weight (mean [SD], 79 [12] kg), and VISA-A score (mean [SD], 46 [18]) at baseline. The group receiving exercise therapy combined with corticosteroid injections had a 17.7-point (95% CI, 8.4-27.0 points; P < .001) larger improvement in VISA-A score compared with patients receiving exercise therapy combined with placebo injections at 6 months. No severe adverse events were observed in either group, and there was no deterioration in the long term (2-year follow-up). CONCLUSIONS AND RELEVANCE: Corticosteroid injections combined with exercise therapy were associated with better outcomes in the treatment of Achilles tendinopathy compared with placebo injections and exercise therapy. A combination of exercise therapy and corticosteroid injection should be considered in the management of long-standing Achilles tendinopathy. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT0258063

Visual assessment of dynamic knee joint alignment in patients with patellofemoral pain:an agreement study

Background Assessment of knee kinematics plays an important role in the clinical examination of patients with patellofemoral pain (PFP). There is evidence that visual assessments are reliable in healthy subjects, but there is a lack of evidence in injured populations. The purpose of this study was to examine the intra- and interrater agreement in the visual assessment of dynamic knee joint alignment in patients with PFP. Methods The study was a cross-sectional agreement study. Sixty participants (42 females) were included. We assessed the intra- and interrater agreement of two functional tests: The single leg squat (SLS) and the forward lunge (FL). One investigator scored the movement according to preset criteria while video recording the movement for retest. Moreover, the performance was scored by another investigator using the video recording. Agreement was assessed using weighted kappa statistics. Results The intrarater agreement ranged from moderate to good (Kappa 0.58 (FL) to 0.70 (SLS)) whereas the interrater agreement ranged from fair to moderate (Kappa 0.22 (SLS) to 0.50 (FL)). Conclusion The agreement within raters was better than between raters, which suggests that assessments should preferably be performed by the same tester in research and in a clinical setting, e.g., to evaluate any treatment effect. We promote FL as a reliable clinical tool for evaluating dynamic knee alignment, since it shows equally good intra- and interrater agreement, and it is an inexpensive and easy method to use

The development of an informative leaflet for children and adolescents suffering from Osgood-Schlatter disease

The mainstay in the treatment of Osgood-Schlatter Disease (OSD) is guidance on activity modification alongside exercises. The purpose of this study was to create an informative leaflet for patients with OSD, based on evidence and stakeholders perspectives. A synthesis of the literature, including national reference work, clinical research, and systematic reviews informed the initial leaflet. Twelve children with OSD and four clinical experts provided feedback through semi-structured interviews. After incorporating stakeholder input, the leaflet ‘Osgood-Schlatter—Information and guidance’ was developed. This provides a resource to assist the provision of information and translation of the current evidence.</p

Reference data for hop tests used in pediatric ACL injury rehabilitation:A cross-sectional study of healthy children

In rehabilitation, four single‐leg hop tests are frequently used for evaluation of ACL‐injured children. However, reference values on single‐leg hop performance and the corresponding limb symmetry indexes (LSIs) of healthy children younger than 15 years of age are lacking. Thus, the purpose was to describe hop performance and LSIs in healthy Danish children, and to quantify the proportion of participants passing LSI values of ≥85% as well as ≥90%. Healthy children aged 9–15 years were invited to participate in the study. Hop performance (single hop, 6‐m timed hop, triple hop, and cross‐over hop) was assessed for each leg for each hop test and expressed as absolute, normalized (to body height), and LSI values. Descriptive statistics were applied to calculate mean ±SD for all outcomes within age and gender groups. Further, the 95% reference interval was calculated for each age and gender group. A total of 531 healthy children (52% girls) were included in the study, representing seven age groups (9‐15 years). The LSI group means across all participants for the four hop tests ranged between 84 and 95%. Between 70 and 83% of the children had an LSI of ≥85%, while 50 to 65% of the children had an LSI of ≥90%. The present reference material can be used in clinical practice when evaluating hop performance in pediatric ACL patients