| Abstract | CILJ: Kronična patelarna tendinopatija ili skakačko koljeno je sindrom prenaprezanja (engl. overuse injury) koji najčešće pogađa profesionalne sportaše naročito često one koji sudjeluju u sportovima u kojima se često izvode skokovi poput primjerice odbojke, atletike i košarke. Patofiziološki bolest nastaje, kao posljedica nakupljanja mikrotrauma tijekom treninga i natjecanja, a povezana je s pojavom boli, izbivanjem sa sportskih terena i u izostanku odgovarajućeg liječenja s preranim prestankom profesionalne karijere. U novije vrijeme sve više važniju ulogu u terapiji skakačkog koljena ima ekscentrični trening. Pokazalo se da ekscentrični trening ima jednako učinkovite rezultate kao i kirurško liječenje. U posljednia dva desetljeća ekscentrične vježbe su standardna metoda liječenja kronične patelarne tendinopatije, a provode se vježbanjem na kosoj podlozi nagiba 25°. Cilj terapije nije samo smanjenje boli nego i ojačanje i cijeljenje tetive kako bi se sportaš mogao vratiti svojim normalnim aktivnostima. Rezultati istraživanja upućuju da najveću korist od ekscentričnih vježbi možemo očekivati kada se one izvode polaganom kretnjom ekscentričnim vježbanjem na kosoj podlozi.
Iako je vježbanje na podlozi nagiba 25°standardan način provođenja terapije ne postoje čvrsti znanstveni dokazi da je to idealan nagib podloge, a rezultati biomehaničkih studija su predložili da bi se smanjenjem nagiba možda mogli postići bolji rezultati. Biomehanička istraživanja provedena na zdravim dobrovoljcima su pokazala da se opterećenje zglobova i mišića znatno mijenja s promjenom nagiba podloge od 16 do 35°. Usprkos radovima koji govore u prilog smanjenju nagiba podloge do sada nisu provedena randomizirana klinička istraživanja na bolesnicima koja bi izravno usporedila utjecaj nagiba podloge na oporavak bolesnika oboljelih od kronične patelarne tendinopatije. U našem istraživanju smo usporedili učinkovitost ekscentričnih vježbi provedenih na podlozi standardnog nagiba od 25° s ekscentričnim vježbama provedenim na podlozi nagiba 17° prateći pacijente kroz razdoblje od 12 tjedana.
METODE: Ukupno je u studiju bilo uključeno 70 sportaša, 35 ih je vježbe provodilo na klasičnoj podlozi s nagibom od 25°, a 35 ih je provodilo vježbe na podlozi nagiba 17°. Svi ispitanici su u trajanju od 6 tjedna koristili isti specifični rehabilitacijski protokol za liječenje skakačkog koljena pisane upute i dodatno mogućnost korištenja uz pomoć web platforme fizikalne medicina i rehabilitacija kod kuće (videoreha.com). Na početku studije svi ispitanici su ispunili upitnike o zdravlju koljena; Victorian Institute of Sport Assessment Patella (VISA-P) i Knee Injury and Osteoarthritis Outcome Score (KOOS) upitnik. Funkcija koljena je procijenjena uporabom Lysholm Knee Questionnaire/Tegner Activity Scale, a bol pomoću procjene na skali boli (Visual Analog Scale, VAS). Kvalieteta života procijenjena je SF-36 upitnikom. Isti set upitnika pacijenti su ispunili nakon 6 tjedana terapije i nakon dodatnih šest tjedana.
REZULTATI: Pokazali smo da su ekscentrrične vježbe učinkovita terapija za kroničnu patelarnu tendinopatiju i da kod većine pacijenata nakon šest tjedana terapije dolazi do znatnog smanjenja boli u koljenu, poboljšanja funkcije koljena i kvalitete života što je potvrđeno poboljšanjem svih mjerenih indeksa. Dodatni stupanj poboljšanja se postiže nakon dodatnih šest tjedana. Usporedbom oporavka između pacijenata koji su vježbali na klupicama nagiba 17° i standardnim klupicama s nagibom od 25° nije pronađena statistički značajna razlika niti u jednom od određivanih pokazatelja pa smo zaključili da je terapija ekscentričnim vježbama na modificiranoj klupici s nagibom od 17° jednako učinkovita u terapiji kronične patelarne tendinopatije kao i standardna terapija koja se provodi vježbanjem na klupici nagiba 25°. Obje terapije podjednako dovode do smanjenja boli, poboljšanja funkcije koljenskog zgloba i kvalitete života pacijenata. U analizi ostalih ciljeva pokazali smo da pacijenti koji koriste platformu videoreha imaju jednak stupanj oporavka kao i ostali pacijenti, Nismo uspjeli pronaći povezanost između stupnja oporavka i ostalih potencijalnih prognostičkih čimbenika poput spola pacijenta ili BMI indeksa.
ZAKLJUČAK: Zaključak našeg istraživanja je da su ekscentrične vježbe na kosoj podlozi učinkovita terapija za liječenje kronične patelarne tendinopatije i da je terapija na podlozi nagiba 17° jednako učinkovita kao i terapija na standardnoj podlozi nagiba 25°. Promjenom kuta nagiba mogla bi se postići bolja suradljivost pacijenata. |
| Abstract (english) | AIM: Chronic patellar tendinopathy PT or jumper's knee is an overuse injury syndrome that most often affects professional athletes, especially those who participate in sports in which jumps are often performed, such as volleyball, athletics and basketball. Pathophysiologically, the disease occurs as a result of the accumulation of microtraumas during training and competition, and is associated with pain, weaker performance and inability to participate in sports activities. In the absence of appropriate treatment, it can result with the premature termination of a professional career. In recent period, eccentric training plays an increasingly important role in therapy. Eccentric training has been shown to have just as effective results as surgical treatment. In the last two decades, eccentric exercises have been a standard method of treating chronic patellar tendinopathy, and they are performed by exercising on the board with a 25° decline. The goal of therapy is not only to reduce pain, but also to strengthen and heal the tendon so that the athlete can return to normal activities. The results of the research indicate that we can expect the greatest benefit from eccentric exercises when they are performed with a slow movement by eccentric exercise on an declined surface.
Although exercising on a 25° decline board is the standard way to conduct therapy, there is no solid scientific evidence that this is the ideal angle of a decline, and the results of biomechanical studies have suggested that reducing the angle of the decline may lead to better results. Biomechanical research conducted on healthy volunteers has shown that the load on joints and muscles changes significantly with a change in the slope of the surface from 16 to 35°. Although the researches indicate on potential benefits of reduction of the angle of decline, so far no randomized clinical studies have been conducted on patients that would directly compare the influence of the decline angle on the recovery of patients suffering from chronic patellar tendinopathy. In our research, we compared the effectiveness of eccentric exercises performed
on a standard decline board of 25° with eccentric exercises performed on a board with 17° decline, following patients over a period of 12 weeks.
METHODS: In total, 70 athletes were included in the study, 35 of them performed exercises on a standard board with a decline of 25°, and 35 of them performed exercises on a board with a decline of 17°. All subjects used the same specific rehabilitation protocol for the treatment of jumping knee for six weeks, written instructions were given to all participants and additionally the possibility of using the physical medicine and rehabilitation web platform at home (videoreha.com) was oferred. At the beginning of this study, all patients filled out the Victorian Institute of Sport Assessment Patella (VISA-P) questionnaire and the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire. Functional knee activity was assessed using the Lysholm Knee Questionnaire/Tegner Activity Scale, and patients assessed their pain using the Visual Analog Scale (VAS). Quality of life was assesed by SF-36 questionairre. The same set of analyses was performed at the end of a 6-week therapy period and after an additional 6 weeks.
RESULTS: We have shown that eccentric exercises are an effective therapy for chronic patellar tendinopathy and that in most patients after six weeks of therapy there is a significant reduction in the level of pain, improvement in knee function and quality of life, as evidenced by improvement in all of the analysed indexes. Additional degree of improvement is achieved after a period of additional six weeks. By comparing the recovery between patients who exercised on boards with a 17° decline and standard boards with a 25° decline, we found no statistically significant difference in any of the determined indicators. Therefore, we concluded that therapy with eccentric exercises on a modified board with an 17° decline is equally effective in treatment of chronic patellar tendinopathy as standard therapy which is carried out by exercising on a 25°decline board. Both therapies equally lead to reduction of pain, improvement of knee joint function and quality of life of patients. In the analysis of other objectives, we showed that patients who use the videoreha platform have the same degree of recovery as other patients. We were unable to find an association between the degree of recovery and other potential prognostic factors such as the patient's sex or BMI index.
CONCLUSION: The conclusion of our research is that eccentric exercises on an inclined surface are an effective therapy for the treatment of chronic patellar tendinopathy and that
therapy on a 17° decline board is as effective as therapy on a standard 25° decline board. Our findings encourage changes in the decline angle of the board in the case of a patient’s discomfort in order to achieve better compliance without affecting the recovery. |
