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J Knee Surg 2022; 35(10): 1071-1078
DOI: 10.1055/s-0042-1751266
Special Focus Section

A Population-Level Summary of Health Care Utilization for the Management of Patellar Tendinopathy in the Military Health System

Jodi L. Young 
1   Department of Physical Therapy Program, Bellin College, Green Bay, Wisconsin
,
Jeremy D. Schroeder
2   Sports and Exercise Medicine, Madigan Army Medical Center, Tacoma, Washington
,
Richard B. Westrick
3   Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, Massachusetts
,
Matthew Nowak
4   Department of Orthopaedic Surgery, Madigan Army Medical Center, Tacoma, Washington
,
Daniel I. Rhon 
3   Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, Massachusetts
› Author Affiliations Funding This research was supported in part by an appointment to the Department of Defense (DOD) Research Participation Program administered by the Oak Ridge Institute for Science and Education (ORISE) through an interagency agreement between the U.S. Department of Energy (DOE) and the DOD. ORISE is managed by ORAU under DOE contract number DE-SC0014664.
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Abstract

Patellar tendinopathy (PT) is a common nontraumatic orthopaedic disorder of the knee suffered by many service members. Understanding the make-up of usual care for PT at the system level can better frame current clinical gaps and areas that need improvement. Exercise therapy is recommended as a core treatment for PT, but it is unclear how often it is used as a part of usual care for PT within the Military Health System (MHS). The purpose of the study was to identify interventions used in the management of PT and the timing of these interventions. A secondary purpose was to determine if exercise therapy use was associated with reduced recurrence of knee pain. In total, 4,719 individuals aged 17 to 50 years in the MHS diagnosed with PT between 2010 and 2011 were included. Pharmacological and nonpharmacological interventions, visits to specialty providers, and imaging services were captured. Descriptive statistics were used to report the findings. Interventions were further categorized as being part of initial care (within the first 7 days), the initial episode of care (within the first 60 days), or the 2-year time period after diagnosis. Linear regression assessed the relationship between the number of exercise therapy visits in the initial episode of care and recurrences of knee pain. In total, 50.6% of this cohort had no more than one medical visit total for PT. Exercise therapy (18.2%) and nonsteroidal anti-inflammatory drugs (4.3%) were the two most used interventions in the initial episode of care. Radiographs were ordered for 23.1% of the cohort in the initial episode of care. The number of exercise therapy visits a patient received during the initial episode of care was not associated with recurrences of knee pain. Half of the individuals received no further care beyond an initial visit for the diagnosis of PT. Exercise therapy was the most common intervention used during the initial episode of care, but exercise therapy did not influence the recurrence of knee pain.

Keywords

patellar tendinopathy - knee pain - exercise therapy

Disclaimer

The view(s) expressed herein are those of the author(s) and do not necessarily reflect the official policy or position of the Uniformed Services University, Madigan Army Medical Center, US Army Research Institute of Environmental Medicine, the Department of the Army, the Department of Defense, or the United States Government.




Publication History

Received: 17 December 2021

Accepted: 23 May 2022

Article published online:
18 July 2022

© 2022. Thieme. All rights reserved.

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  • References

  • 1 Malliaras P, Cook J, Purdam C, Rio E. Patellar tendinopathy: clinical diagnosis, load management, and advice for challenging case presentations. J Orthop Sports Phys Ther 2015; 45 (11) 887-898
    CrossrefPubMedGoogle Scholar
  • 2 Owens BD, Wolf JM, Seelig AD. et al; Millennium Cohort Study Team. Risk factors for lower extremity tendinopathies in military personnel. Orthop J Sports Med 2013; 1 (01) 2325967113492707
    CrossrefPubMedGoogle Scholar
  • 3 Glaviano NR, Boling MC, Fraser JJ. Anterior knee pain risk in male and female military tactical athletes. J Athl Train 2021; 56 (11) 1180-1187
    CrossrefPubMedGoogle Scholar
  • 4 Cook JL, Khan KM, Harcourt PR, Grant M, Young DA, Bonar SF. The Victorian Institute of Sport Tendon Study Group. A cross sectional study of 100 athletes with jumper's knee managed conservatively and surgically. Br J Sports Med 1997; 31 (04) 332-336
    CrossrefPubMedGoogle Scholar
  • 5 Kettunen JA, Kvist M, Alanen E, Kujala UM. Long-term prognosis for jumper's knee in male athletes. A prospective follow-up study. Am J Sports Med 2002; 30 (05) 689-692
    CrossrefPubMedGoogle Scholar
  • 6 Gaida JE, Cook J. Treatment options for patellar tendinopathy: critical review. Curr Sports Med Rep 2011; 10 (05) 255-270
    CrossrefPubMedGoogle Scholar
  • 7 Aicale R, Oliviero A, Maffulli N. Management of Achilles and patellar tendinopathy: what we know, what we can do. J Foot Ankle Res 2020; 13 (01) 59
    CrossrefPubMedGoogle Scholar
  • 8 Andres BM, Murrell GAC. Treatment of tendinopathy: what works, what does not, and what is on the horizon. Clin Orthop Relat Res 2008; 466 (07) 1539-1554
    CrossrefPubMedGoogle Scholar
  • 9 Reinking MF. Current concepts in the treatment of patellar tendinopathy. Int J Sports Phys Ther 2016; 11 (06) 854-866
    PubMedGoogle Scholar
  • 10 Vander Doelen T, Jelley W. Non-surgical treatment of patellar tendinopathy: A systematic review of randomized controlled trials. J Sci Med Sport 2020; 23 (02) 118-124
    CrossrefPubMedGoogle Scholar
  • 11 Challoumas D, Pedret C, Biddle M. et al. Management of patellar tendinopathy: a systematic review and network meta-analysis of randomised studies. BMJ Open Sport Exerc Med 2021; 7 (04) e001110
    CrossrefPubMedGoogle Scholar
  • 12 Bahr MA, Bahr R. Jump frequency may contribute to risk of jumper's knee: a study of interindividual and sex differences in a total of 11,943 jumps video recorded during training and matches in young elite volleyball players. Br J Sports Med 2014; 48 (17) 1322-1326
    CrossrefPubMedGoogle Scholar
  • 13 Young JL, Rhon DI, Cleland JA, Snodgrass SJ. The influence of exercise dosing on outcomes in patients with knee disorders: a systematic review. J Orthop Sports Phys Ther 2018; 48 (03) 146-161
    CrossrefPubMedGoogle Scholar
  • 14 Benchimol EI, Smeeth L, Guttmann A. et al; RECORD Working Committee. The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) statement. PLoS Med 2015; 12 (10) e1001885
    CrossrefPubMedGoogle Scholar
  • 15 Rhon DI, Clewley D, Young JL, Sissel CD, Cook CE. Leveraging healthcare utilization to explore outcomes from musculoskeletal disorders: methodology for defining relevant variables from a health services data repository. BMC Med Inform Decis Mak 2018; 18 (01) 10
    CrossrefPubMedGoogle Scholar
  • 16 Pascarella A, Alam M, Pascarella F, Latte C, Di Salvatore MG, Maffulli N. Arthroscopic management of chronic patellar tendinopathy. Am J Sports Med 2011; 39 (09) 1975-1983
    CrossrefPubMedGoogle Scholar
  • 17 Boland GWL, Guimaraes AS, Mueller PR. Radiology report turnaround: expectations and solutions. Eur Radiol 2008; 18 (07) 1326-1328
    CrossrefPubMedGoogle Scholar
  • 18 Hauschild VD, Hauret K, Richardson M, Jones BH. A Taxonomy of Injuries for Public Health Monitoring and Reporting. MD: Army Public Health Center; 2018
    Google Scholar
  • 19 Mihaylova B, Briggs A, O'Hagan A, Thompson SG. Review of statistical methods for analysing healthcare resources and costs. Health Econ 2011; 20 (08) 897-916
    CrossrefPubMedGoogle Scholar
  • 20 Young JL, Snodgrass SJ, Cleland JA, Rhon DI. Usual medical care for patellofemoral pain does not usually involve much care: 2-year follow-up in the Military Health System. J Orthop Sports Phys Ther 2021; 51 (06) 305-313
    CrossrefPubMedGoogle Scholar
  • 21 Berthelot JM, Darrieutort-Lafitte C, Le Goff B, Maugars Y. Strong opioids for noncancer pain due to musculoskeletal diseases: not more effective than acetaminophen or NSAIDs. Joint Bone Spine 2015; 82 (06) 397-401
    CrossrefPubMedGoogle Scholar
  • 22 Fredberg U, Bolvig L, Pfeiffer-Jensen M, Clemmensen D, Jakobsen BW, Stengaard-Pedersen K. Ultrasonography as a tool for diagnosis, guidance of local steroid injection and, together with pressure algometry, monitoring of the treatment of athletes with chronic jumper's knee and Achilles tendinitis: a randomized, double-blind, placebo-controlled study. Scand J Rheumatol 2004; 33 (02) 94-101
    CrossrefPubMedGoogle Scholar
  • 23 Kongsgaard M, Kovanen V, Aagaard P. et al. Corticosteroid injections, eccentric decline squat training and heavy slow resistance training in patellar tendinopathy. Scand J Med Sci Sports 2009; 19 (06) 790-802
    CrossrefPubMedGoogle Scholar
  • 24 Rutland M, O'Connell D, Brismée JM, Sizer P, Apte G, O'Connell J. Evidence-supported rehabilitation of patellar tendinopathy. N Am J Sports Phys Ther 2010; 5 (03) 166-178
    PubMedGoogle Scholar
  • 25 Rudavsky A, Cook J. Physiotherapy management of patellar tendinopathy (jumper's knee). J Physiother 2014; 60 (03) 122-129
    CrossrefPubMedGoogle Scholar
  • 26 Larsson MEH, Käll I, Nilsson-Helander K. Treatment of patellar tendinopathy–a systematic review of randomized controlled trials. Knee Surg Sports Traumatol Arthrosc 2012; 20 (08) 1632-1646
    CrossrefPubMedGoogle Scholar
  • 27 van Rijn D, van den Akker-Scheek I, Steunebrink M, Diercks RL, Zwerver J, van der Worp H. Comparison of the effect of 5 different treatment options for managing patellar tendinopathy: a secondary analysis. Clin J Sport Med 2019; 29 (03) 181-187
    CrossrefPubMedGoogle Scholar
  • 28 Schwartz A, Watson JN, Hutchinson MR. Patellar tendinopathy. Sports Health 2015; 7 (05) 415-420
    CrossrefPubMedGoogle Scholar
  • 29 Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain—United States, 2016. MMWR Recomm Rep 2016; 65 (01) 1-49
    CrossrefPubMedGoogle Scholar
  • 30 Sardana V, Burzynski J, Hasan K, Zalzal P. Are non-steroidal anti-inflammatory drug injections an alternative to steroid injections for musculoskeletal pain?: A systematic review. J Orthop 2018; 15 (03) 812-816
    CrossrefPubMedGoogle Scholar
  • 31 Niemeijer A, Lund H, Stafne SN. et al. Adverse events of exercise therapy in randomised controlled trials: a systematic review and meta-analysis. Br J Sports Med 2020; 54 (18) 1073-1080
    CrossrefPubMedGoogle Scholar
  • 32 Cuff A, Parton S, Tyer R, Dikomitis L, Foster N, Littlewood C. Guidelines for the use of diagnostic imaging in musculoskeletal pain conditions affecting the lower back, knee and shoulder: a scoping review. Musculoskelet Care 2020; 18 (04) 546-554
    CrossrefPubMedGoogle Scholar
  • 33 Keller JM, Levine WN. Evaluation and imaging of the patellofemoral joint. Oper Tech Orthop 2007; 17 (04) 204-210
    CrossrefPubMedGoogle Scholar
  • 34 Jackson JL, O'Malley PG, Kroenke K. Evaluation of acute knee pain in primary care. Ann Intern Med 2003; 139 (07) 575-588
    CrossrefPubMedGoogle Scholar
  • 35 Bunt CW, Jonas CE, Chang JG. Knee pain in adults and adolescents: the initial evaluation. Am Fam Physician 2018; 98 (09) 576-585
    PubMedGoogle Scholar
  • 36 Culvenor AG, Øiestad BE, Hart HF, Stefanik JJ, Guermazi A, Crossley KM. Prevalence of knee osteoarthritis features on magnetic resonance imaging in asymptomatic uninjured adults: a systematic review and meta-analysis. Br J Sports Med 2019; 53 (20) 1268-1278
    CrossrefPubMedGoogle Scholar
  • 37 Collins NJ, Barton CJ, van Middelkoop M. et al. 2018 Consensus statement on exercise therapy and physical interventions (orthoses, taping and manual therapy) to treat patellofemoral pain: recommendations from the 5th International Patellofemoral Pain Research Retreat, Gold Coast, Australia, 2017. Br J Sports Med 2018; 52 (18) 1170-1178
    CrossrefPubMedGoogle Scholar
  • 38 Kane SF, Olewinski LH, Tamminga KS. Management of chronic tendon injuries. Am Fam Physician 2019; 100 (03) 147-157
    PubMedGoogle Scholar
  • 39 Korakakis V, Whiteley R, Tzavara A, Malliaropoulos N. The effectiveness of extracorporeal shockwave therapy in common lower limb conditions: a systematic review including quantification of patient-rated pain reduction. Br J Sports Med 2018; 52 (06) 387-407
    CrossrefPubMedGoogle Scholar
  • 40 Rabago D, Nourani B. Prolotherapy for osteoarthritis and tendinopathy: a descriptive review. Curr Rheumatol Rep 2017; 19 (06) 34
    CrossrefPubMedGoogle Scholar