Patellapeestendinopathie of ‘jumpers knee’ is een chronische sportblessure die hoge prevalentiecijfers heeft bij sporters betrokken in loop- en springsporten (1,2). Voornamelijk volleybal- en basketbalspelers worden hier frequent door getroffen. Patellapeestendinopathie ontstaat hoofdzakelijk op basis van mechanische overbelasting en heeft een weefseldegeneratief karakter (3,7,11). Hiernaast spelen tal van intrinsieke en extrinsieke risicofactoren (2,7,8,9,11) een rol in ontstaan en onderhoud van het peesletsel, dat zich in de meerderheid der gevallen voordoet ter hoogte van de proximale peesinsertie aan de inferieure patellapool (2,4,5). Door deze complexe, individueel sterk variabele etiopathogenese en het chronische karakter van peesproblemen (te wijten aan de zeer lage metabole activiteitsgraad van peesweefsel en een daaruit volgend vertraagde regeneratierespons), vormt de pathologie van jumpers knee een grote uitdaging voor menig (para)medicus (6). Ook bij de sporter zorgt patellapeestendinopathie, door aanzienlijke pijn , dysfunctie, verlies aan trainingsuren en competitie die ermee gepaard gaan, voor frustratie en ontevredenheid (1,7,12).
Snelle, accurate diagnostiek en adequate, causaal georiënteerde therapie zijn in deze gevallen dan ook essentieel. Kinesitherapie vormt tot op heden de 1e lijn behandeling bij deze sportspecifieke overbelastingblessures. Excentrische oefentherapie door middel van uni- en bipodale squats op een 25° gedeclineerd plankje vormen momenteel de gouden standaard binnen de medische trainingstherapie en het conservatief kinesitherapeutisch management (10,13,14,15). Ondanks de frequent aangetoonde therapeutische successen, vertoont een bepaald patiëntenpercentage relatieve of absolute resistentie aan dit primair conservatief beleid. Dergelijke patiënten zijn genoodzaakt meer invasieve medische behandelingen en zelfs chirurgische interventies te ondergaan, zonder zekerheid op definitief herstel (12,16).
Wat maakt dat sommige patiënten een goede therapierespons vertonen en anderen daarentegen (bijna) geen klinische en/of functionele vooruitgang boeken, is niet geweten. Binnen deze studie werd op zoek gegaan naar factoren die, naast een rol in ontstaan en onderhoud van patellapeestendinopathie, mogelijks ook verband houden met (de mate van) therapierespons. 14 patiënten (18 knieën) die gediagnosticeerd werden met patellapeestendinopathie werden geëvalueerd, op een aantal met letselrisico en –onderhoud geassocieerde parameters, voor en na een kinesitherapeutische (excentrische oefentherapie) behandelperiode van 6 weken.
De deelnemers werden getest op quadricepskracht, lenigheid van quadriceps en hamstrings (2,8,9), mate van intratendineuze patellapeesdoorbloeding (17,18), echografische peespresentatie (weefselkwaliteit), pijnintensiteit en functionaliteit (unipodale vertesprong en maximum aantal unipodale gedeclineerde squats). Veranderingen binnen de geteste parameters over de 6 weken durende trainingsperiode werden vervolgens vergeleken met klinische en functionele vooruitgang of achteruitgang.
Er kon worden geconcludeerd dat een positieve therapierespons, op basis van zowel klinische als functionele verbetering, in verband gebracht kan worden met een verbetering in quadricepskracht, quadricepsflexibiliteit en een toename in intratendineuze doorbloeding (bloodflow), geregistreerd ter hoogte van de proximale peesinsertie (i.e. de dominante letselregio). Deze factoren dienen dus goed onderzocht en adequaat geremedieerd te worden binnen conservatief management in geval van patellapeestendinopathie.
Dat voldoende lenigheid en kracht een voorwaarde zijn voor degelijk functioneel en klinisch herstel hoeft geen betoog, het feit dat deze verbetering ook effectief gepaard gaat met een significante toename in intratendineuze doorbloeding ter hoogte van de proximale peesinsertie (letsellocatie) werd met deze studie voor het eerst aangetoond. Gezien onvoldoende intratendineuze doorbloeding mede verantwoordelijk is voor het degeneratieve en chronische karakter van (patellapees)tendinopathieën en hier kon worden aangetoond dat excentrische oefentherapie effectief resulteert in een toegenomen bloodflow (en zodoende waarschijnlijk ook een toegenomen metabole activiteitsgraad), mag laatste dus beschouwd worden als zijnde een essentieel onderdeel van het oefentherapeutisch management binnen een kinesitherapeutische interventie.
Gezien de ware toedracht van de toename in intratendineuze doorbloeding ter hoogte van de patellaire apex, in relatie tot verbetering in kliniek en functionaliteit, nooit eerder onderzocht werd en het hier slechts een pilootstudie betreft, is verder onderzoek inzake dit onderwerp absoluut noodzakelijk om tot gefundeerde conclusies en suggesties te komen.
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