UK defence rehabilitation review of Achilles and patellar tendinopathy conservative management: a systematic review

Introduction Tendinopathy is a common condition affecting physically active populations, such as the military. Diagnosis is clinical, with no gold-standard tests. The role of imaging and functional assessment in subdiagnosis is an active area of research with the hope of delivering more nuanced and clinically effective management. A vast array of injectable and adjunctive therapies have been proposed with varying, and at times, conflicting evidence. Multiple methods for exercise therapy exist, but increasingly tendinopathy is recognised as a heterogeneous condition not suited to a one-size-fits-all approach. The aim was to complete a systematic review, to appraise the recent evidence for conservative management of Achilles and patellar tendinopathy.Methods A multidisciplinary team from across defence rehabilitation searched PubMed for literature dating from May 2017 to July 2023. Four key areas were searched: diagnosis and outcome measures, medical, exercise and adjuncts.Results A total of 840 articles were identified. Articles were screened using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Following screening and abstract review, a total of 143 were included for full review. Due to the breadth of literature and large heterogeneity of studies, meta-analysis of results was not feasible. Articles were assessed against the Oxford Centre for Evidence Based Medicine criteria.Conclusions The literature review found the strongest evidence for exercise-based rehabilitation as first-line treatment, with limited evidence for medical interventions and adjuncts. The primacy of stand-alone loading modalities is challenged by developing literature supporting a progressive tendon loading exercise protocol (PTLE). PTLE represents a framework where various exercise modalities are prescribed based on the individual's capacity and function. Novel interventions should be practised with caution and not conducted as monotherapy.