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Article ; Online: Is there structural change on MRI in gluteal tendinopathy after treatment? Single outcome measure extension of an RCT.

Carney, Georgia / Fitzpatrick, Jane

2023 Volume 23, Issue 1, Page(s) 179

Abstract: Background: The etiology of tendinopathy remains controversial and it is unknown whether degenerative structural changes in tendinopathies are reversible.: Hypothesis: There will be no structural change on magnetic resonance imaging (MRI) taken > 2- ... ...

Abstract	Background: The etiology of tendinopathy remains controversial and it is unknown whether degenerative structural changes in tendinopathies are reversible. Hypothesis: There will be no structural change on magnetic resonance imaging (MRI) taken > 2-years after treatment for gluteal tendinopathy. Study design: Extension of a single site, double-blind, prospective randomized-controlled trial to analyze the additional outcome measure; MRI changes. Methods: University of Melbourne ethics approval number: 1852900, trial registration: ACTRN12613000677707. Participants with gluteal tendinopathy who had previously received a leukocyte-rich platelet-rich plasma injection (LR-PRP) or a corticosteroid injection (CSI) had a post treatment MRI between at least 2-years and up to 7 years following trial completion. A blinded, senior musculoskeletal radiologist graded all de-identified MRI scans using the Melbourne Hip Score (MHIP). The primary outcome measure was the change in overall pre- and post-treatment score. Results: Participants (n = 20) underwent MRI at mean time of 4.15 (SD 1.11; range 2-7) years after their initial treatment. There was no change in the overall mean MHIP score for the CSI group (Pre 4.3 (SD 2.3) Post 4.3 (SD 1.1), p = 1.00). Although there was an improvement in the LR-PRP group mean MHIP score (Pre 5.3 (SD 3.0) Post 4.77 (SD 2.5), p = 0.56) it was not statistically significant. However, in the LR-PRP intervention group, five out of nine of participants' MHIP score improved, with four of these improving by 2-4 points. Conclusion: The hypothesis that there would be no improvement in MHIP scores following treatment of gluteal tendinopathy was supported. Findings of improvement in the LR-PRP group at 4 years would support further studies powered to look for structural improvement. These findings suggest that structural change following treatment for tendinopathy may be possible supporting the inclusion of MRI as a core outcome for future studies. Clinical relevance: The study suggests that degenerative structural changes in tendons may be reversible.
MeSH term(s)	Humans ; Prospective Studies ; Tendinopathy/diagnostic imaging ; Tendinopathy/therapy ; Magnetic Resonance Imaging ; Adrenal Cortex Hormones ; Outcome Assessment, Health Care
Chemical Substances	toliprolol (DCP58J201D) ; Adrenal Cortex Hormones
Language	English
Publishing date	2023-11-08
Publishing country	England
Document type	Randomized Controlled Trial ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2061975-3
ISSN	1471-2342 ; 1471-2342
ISSN (online)	1471-2342
ISSN	1471-2342
DOI	10.1186/s12880-023-01150-y
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Article ; Online: Safety and efficacy of a single intra-articular injection of hyaluronic acid in osteoarthritis of the hip: a case series of 87 patients.

Long, David M / Fitzpatrick, Jane

BMC musculoskeletal disorders

2021 Volume 22, Issue 1, Page(s) 797

Abstract: Background: Osteoarthritis (OA) is the most prevalent form of joint disease and commonly affects the hip. Hip OA is associated with a high socioeconomic burden. Intra-articular hyaluronic acid (HA) injection may be of benefit but quality evidence for HA ...

Abstract	Background: Osteoarthritis (OA) is the most prevalent form of joint disease and commonly affects the hip. Hip OA is associated with a high socioeconomic burden. Intra-articular hyaluronic acid (HA) injection may be of benefit but quality evidence for HA use in hip OA is lacking. The purpose of this study was to assess the safety and efficacy of ultrasound guided injection of a high molecular weight, non-animal derived, stabilised HA (NASHA) in patients with mild to moderate hip OA. Methods: This single site study is an analysis of prospectively collected outcome data for 87 consecutive patients over a 2-year period who received a single HA (Durolane) injection for symptomatic hip OA. Inclusion criteria were male or female patients over 18-years of age with mild to moderate hip OA on x-ray. Patients with severe hip OA were excluded. The primary outcome measure was a modified Harris Hip Score (mHHS) questionnaire at baseline and 6-weeks with a minimal clinically important difference (MCID) of 10 points. All adverse events were recorded and assessed. Results: Data from 87 patients, 49 women and 38 men with mean age of 54 (SD = 10.8) were analysed. At baseline, mean mHHS was 58.47 (SD 14.31). At the 6 week follow up, mean mHHS improved to 71.30 (SD 16.46), a difference of 12.83 (p < 0.01). This was greater than the MCID of 10. No significant adverse events were encountered. Five patients reported short-lived injection site pain. Conclusion: A single injection of HA (NASHA) in the setting of hip joint OA was both safe and efficacious in this 87 patient cohort. Improvement in pain and function as measured with mHHS was statistically significant and reached the MCID of 10. Trial registration: The study was retrospectively registered on the 1st of February 2021 in the Australian New Zealand Clinical Trials Registry with registry number ACTRN12621000098831 . All research was performed in accordance with the Declaration of Helsinki.
MeSH term(s)	Adult ; Australia ; Female ; Humans ; Hyaluronic Acid/adverse effects ; Injections, Intra-Articular/adverse effects ; Male ; Middle Aged ; Osteoarthritis, Hip/diagnostic imaging ; Osteoarthritis, Hip/drug therapy ; Osteoarthritis, Knee/drug therapy ; Treatment Outcome
Chemical Substances	Hyaluronic Acid (9004-61-9)
Language	English
Publishing date	2021-09-16
Publishing country	England
Document type	Journal Article ; Observational Study
ZDB-ID	2041355-5
ISSN	1471-2474 ; 1471-2474
ISSN (online)	1471-2474
ISSN	1471-2474
DOI	10.1186/s12891-021-04672-0
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Article ; Online: Assessment of the reliability and validity of imaging measurements for patellofemoral instability: an updated systematic review.

Geraghty, Liam / Humphries, David / Fitzpatrick, Jane

Skeletal radiology

2022 Volume 51, Issue 12, Page(s) 2245–2256

Abstract: Objective: To provide an update on the reliability and validity of all radiological measures used to assess patients presenting with patellofemoral instability.: Methods: A search of the CINHAL, EMBASE, MEDLINE, and SCOPUS databases and the Cochrane ... ...

Abstract	Objective: To provide an update on the reliability and validity of all radiological measures used to assess patients presenting with patellofemoral instability. Methods: A search of the CINHAL, EMBASE, MEDLINE, and SCOPUS databases and the Cochrane library was conducted. All studies assessing the validity, reliability, sensitivity, and specificity of radiological measures of the patellofemoral joints of patients with patellofemoral instability from 2010 onwards were considered for inclusion. Discrimination validity, inter- and intra-observer reliability, and the sensitivity and specificity of specific imaging measures were evaluated. Results: Seventy-three studies met the selection criteria and were included for analysis. We identified eight radiological measures in four categories with good reliability and validity: the tibial tubercle to trochlear groove distance, specific measures of patellar height (Blackburne-Peel index, Caton-Deschamps index and Insall-Salvati ratios), three measures of trochlear dysplasia (sulcus angle, trochlear depth, and lateral trochlear inclination), and the tibial tubercle to posterior cruciate ligament distance. No included studies examined the reliability and validity of patellofemoral instability ultrasound measures. Conclusion: Our updated review demonstrated good inter- and intra-observer reliability and discrimination validity for the tibial tubercle-trochlear groove distance, specific patellar height, and trochlear dysplasia measures on MRI. The tibial tubercle to posterior cruciate ligament distance, an indirect measure of rotational asymmetry, was a valid and reliable measure on MRI. Due to a lack of assessments across more than one study, there are a variety of proposed measures with insufficient evidence to determine their validity, reliability, sensitivity, and specificity.
MeSH term(s)	Humans ; Joint Instability/diagnostic imaging ; Magnetic Resonance Imaging/methods ; Patella ; Patellofemoral Joint/diagnostic imaging ; Posterior Cruciate Ligament ; Reproducibility of Results ; Tibia
Language	English
Publishing date	2022-07-07
Publishing country	Germany
Document type	Journal Article ; Review ; Systematic Review
ZDB-ID	527592-1
ISSN	1432-2161 ; 0364-2348
ISSN (online)	1432-2161
ISSN	0364-2348
DOI	10.1007/s00256-022-04110-9
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Article: The Biathlon Injury and Illness Surveillance (BIIS) project protocol: a prospective cohort study across two World Cup seasons.

Fitzpatrick, Jane / Panagodage Perera, Nirmala

BMJ open sport & exercise medicine

2020 Volume 6, Issue 1, Page(s) e000862

Abstract: Introduction: Reliably and accurately establishing injury and illness epidemiology in biathletes will provide insight into seasonal changes, provide potential to better embed innovative prevention strategies and advance sports medicine through the ... ...

Abstract	Introduction: Reliably and accurately establishing injury and illness epidemiology in biathletes will provide insight into seasonal changes, provide potential to better embed innovative prevention strategies and advance sports medicine through the provision of effective healthcare to biathletes. The main objective of the Biathlon Injury and Illness Study (BIIS) is to provide the first comprehensive epidemiological profile of injury and illness in biathlon athletes during two consecutive Biathlon World Cup seasons over 2-years. Methods: The BIIS study methodology is established in line with the International Olympic Committee (IOC) injury and illness surveillance protocols using a biathlon-specific injury and illness report form. Team medical staff will provide weekly data using injury and illness definitions of any injury or illness that receives medical attention regardless of time loss. Injuries or illness must be diagnosed and reported by a qualified medical professional (eg, team physician, physiotherapist) to ensure accurate and reliable diagnoses. Descriptive statistics will be used to identify the type, body region and nature of the injury or illness and athlete demographics such as age and gender. Summary measures of injury and illnesses per 1000 athlete-days will be calculated whereby the total number of athletes will be multiplied by the number of days in the season to calculate athlete-days. Ethics and dissemination: This study has been approved by the Bellbery Human Research Ethics Committee (HREC reference: 2017-10-757). Results will be published irrespective of negative or positive outcomes and disseminated through different platforms to reach a wide range of stakeholders.
Language	English
Publishing date	2020-11-26
Publishing country	England
Document type	Journal Article
ZDB-ID	2817580-3
ISSN	2055-7647
ISSN	2055-7647
DOI	10.1136/bmjsem-2020-000862
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Article: Long-Term Outcome Measures of Repeated Non-Animal Stabilized Hyaluronic Acid (Durolane) Injections in Osteoarthritis: A 6-Year Cohort Study with 623 Consecutive Patients.

Carney, Georgia / Harrison, Andrew / Fitzpatrick, Jane

Open access rheumatology : research and reviews

2021 Volume 13, Page(s) 285–292

Abstract: Purpose: To determine the duration of symptom relief following repeated administration of hyaluronic acid injections for osteoarthritis.: Patients and methods: This was a 6-year observational study with 623 consecutive patients who had received ... ...

Abstract	Purpose: To determine the duration of symptom relief following repeated administration of hyaluronic acid injections for osteoarthritis. Patients and methods: This was a 6-year observational study with 623 consecutive patients who had received hyaluronic acid injections. The primary outcome measure was the mean time between injections measured in days. Classical one-sample 2-sided Results: The analysis included 727 joints (mean Kellgren-Lawrence grade, 2.9 ± 0.8 (range 2-4)) in 623 patients (297 (47.7%) male; mean age at first injection, 57.8 ± 12.7 years (range 21.2-92.1)). Patients ranged from having 1-8 injections per joint. The mean time between injections in days was 466.8 ± 321.7 (2nd injection, 157 joints), 400.5 ± 164.7 (3rd injection, 58 joints), 378.2 ± 223.1 (4th injection, 27 joints), 405.3 ± 216.3 (5th injection, 7 joints), 268.4 ± 104.4 (6th injection, 5 joints), 289.8 ± 99.4 (7th injection, 4 joints), and 272.5 ± 33.2 (8th injection, 2 joints). Patients with grades 2 and 3 compared to grade 4 osteoarthritis experienced a longer time between injections (F (2, 154) = 3.53, p = 0.0316). No statistically significant differences were observed between age, gender, or joint groups. The survey included 233 participants (109 (46.8% male)). A total of 144 respondents (64.9%) recommended hyaluronic acid injections for osteoarthritis. Conclusion: Pain relief from hyaluronic acid injections was sustained for on average 466.8 days post initial treatment. Patients who received subsequent 3rd, 4th, and 5th injections also experienced extended duration of benefit. Patients with grades 2 or 3 osteoarthritis are more likely to experience a longer duration of relief.
Language	English
Publishing date	2021-09-18
Publishing country	New Zealand
Document type	Journal Article
ZDB-ID	2508169-X
ISSN	1179-156X
ISSN	1179-156X
DOI	10.2147/OARRR.S331562
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Article: Treatment of Gluteal Tendinopathy: A Systematic Review and Stage-Adjusted Treatment Recommendation.

Ladurner, Andreas / Fitzpatrick, Jane / O'Donnell, John M

Orthopaedic journal of sports medicine

2021 Volume 9, Issue 7, Page(s) 23259671211016850

Abstract: Background: Gluteal tendinopathy is the most common lower limb tendinopathy. It presents with varying severity but may cause debilitating lateral hip pain.: Purpose: To review the therapeutic options for different stages of gluteal tendinopathy, to ... ...

Abstract	Background: Gluteal tendinopathy is the most common lower limb tendinopathy. It presents with varying severity but may cause debilitating lateral hip pain. Purpose: To review the therapeutic options for different stages of gluteal tendinopathy, to highlight gaps within the existing evidence, and to provide guidelines for a stage-adjusted therapy for gluteal tendinopathy. Study design: Systematic review; Level of evidence, 4. Methods: We screened Scopus, Embase, Web of Science, PubMed, PubMed Central, Ovid MEDLINE, CINAHL, UpToDate, and Google Scholar databases and databases for grey literature. Patient selection, diagnostic criteria, type and effect of a therapeutic intervention, details regarding aftercare, outcome assessments, complications of the treatment, follow-up, and conclusion of the authors were recorded. An assessment of study methodological quality (type of study, level of evidence) was also performed. Statistical analysis was descriptive. Data from multiple studies were combined if they were obtained from a single patient population. Weighted mean and range calculations were performed. Results: A total of 27 studies (6 randomized controlled trials) with 1103 patients (1106 hips) were included. The mean age was 53.7 years (range, 17-88 years), and the mean body mass index was 28.3. The ratio of female to male patients was 7:1. Radiological confirmation of the diagnosis was most commonly obtained using magnetic resonance imaging. Reported treatment methods were physical therapy/exercise; injections (corticosteroids, platelet-rich plasma, autologous tenocytes) with or without needle tenotomy/tendon fenestration; shockwave therapy; therapeutic ultrasound; and surgical procedures such as bursectomy, iliotibial band release, and endoscopic or open tendon repair (with or without tendon augmentation). Conclusion: There was good evidence for using platelet-rich plasma in grades 1 and 2 tendinopathy. Shockwave therapy, exercise, and corticosteroids showed good outcomes, but the effect of corticosteroids was short term. Bursectomy with or without iliotibial band release was a valuable treatment option in grades 1 and 2 tendinopathy. Insufficient evidence was available to provide guidelines for the treatment of partial-thickness tears. There was low-level evidence to support surgical repair for grades 3 (partial-thickness tears) and 4 (full-thickness tears) tendinopathy. Fatty degeneration, atrophy, and retraction can impair surgical repair, while their effect on patient outcomes remains controversial.
Language	English
Publishing date	2021-07-29
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2706251-X
ISSN	2325-9671
ISSN	2325-9671
DOI	10.1177/23259671211016850
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Article ; Online: ICON 2020-International Scientific Tendinopathy Symposium Consensus: the development of a core outcome set for gluteal tendinopathy.

Fearon, Angela M / Grimaldi, Alison / Mellor, Rebecca / Nasser, Anthony Michael / Fitzpatrick, Jane / Ladurner, Andreas / Vicenzino, Bill

British journal of sports medicine

2024 Volume 58, Issue 5, Page(s) 245–254

Abstract: Gluteal tendinopathy (GT) is common and can be debilitating and challenging to manage. A lack of condition specific and appropriate outcome measures compromise evidence synthesis for treatment and limits clinical guideline development. Our objective was ... ...

Abstract	Gluteal tendinopathy (GT) is common and can be debilitating and challenging to manage. A lack of condition specific and appropriate outcome measures compromise evidence synthesis for treatment and limits clinical guideline development. Our objective was to develop a core outcome measurement set for GT (COS-GT). Participants were patients with GT and expert health professionals (HPs). A scoping review identified measures used in GT research, which were mapped to the nine International Scientific Tendinopathy Symposium Consensus core domains, and included in two surveys of HPs. The first survey identified the feasible and true measures for each domain. The second survey refined the list which a patient focus group then considered. Meeting online, HPs reached consensus (agreement ≥70%) on the most appropriate COS-GT measures. 34 HPs and seven patients were recruited. 57 measures were mapped to the nine core domains. Six measures did not proceed past survey one. Of those that progressed, none had adequate clinimetric properties for a COS-GT. Thus, participants decided on interim measures: the global rating of change, pain at night, time to pain onset with single limb stance, pain with stair walking, pain self-efficacy and hip abduction strength. HP participants additionally recommended that pain over the last week, the European Quality of Life-5 dimensions-5 levels and the Victorian Institute of Sport Assessment-Gluteal be considered in clinical trials, as they currently provide best easures of the relevant tendinopathy domains. In conclusion this interim COS-GT should guide outcome measure selection in clinical practice and future research trials in patients with GT.
MeSH term(s)	Humans ; Quality of Life ; Walking ; Pain ; Musculoskeletal Diseases ; Tendinopathy/therapy ; Outcome Assessment, Health Care ; Treatment Outcome ; Delphi Technique
Language	English
Publishing date	2024-03-08
Publishing country	England
Document type	Review ; Journal Article
ZDB-ID	600592-5
ISSN	1473-0480 ; 0306-3674
ISSN (online)	1473-0480
ISSN	0306-3674
DOI	10.1136/bjsports-2023-107150
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Article ; Online: The Effectiveness of Platelet-Rich Plasma Injections in Gluteal Tendinopathy: Response.

Fitzpatrick, Jane / O'Donnell, John

The American journal of sports medicine

2018 Volume 46, Issue 8, Page(s) NP33–NP34

MeSH term(s)	Adrenal Cortex Hormones ; Double-Blind Method ; Humans ; Injections ; Platelet-Rich Plasma ; Tendinopathy
Chemical Substances	Adrenal Cortex Hormones
Language	English
Publishing date	2018-06-27
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	197482-8
ISSN	1552-3365 ; 0363-5465
ISSN (online)	1552-3365
ISSN	0363-5465
DOI	10.1177/0363546518773719
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Article ; Online: Life after COVID-19: The importance of a safe return to physical activity.

Jewson, Jacob / McNamara, Alice / Fitzpatrick, Jane

Australian journal of general practice

2020 Volume 49

Abstract: The Australasian College of Sport and Exercise Physicians has developed a guideline for primary care practitioners to assist with safe return of patients to physical activity after COVID-19. ...

Abstract	The Australasian College of Sport and Exercise Physicians has developed a guideline for primary care practitioners to assist with safe return of patients to physical activity after COVID-19.
MeSH term(s)	COVID-19 ; Exercise ; Humans ; SARS-CoV-2 ; Sports
Language	English
Publishing date	2020-11-25
Publishing country	Australia
Document type	Journal Article
ZDB-ID	2924889-9
ISSN	2208-7958 ; 2208-794X
ISSN (online)	2208-7958
ISSN	2208-794X
DOI	10.31128/AJGP-COVID-40
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Article: Reliability of a Novel Scoring System for MRI Assessment of Severity in Gluteal Tendinopathy: The Melbourne Hip MRI Score.

Tso, Chi Kin Nathan / O'Sullivan, Richard / Khan, Hussain / Fitzpatrick, Jane

Orthopaedic journal of sports medicine

2021 Volume 9, Issue 4, Page(s) 2325967121998389

Abstract: Background: Gluteal tendinopathy is commonly reported in the literature, but there is a need for a validated magnetic resonance imaging (MRI)-based scoring system to grade the severity of the tendinopathy.: Purpose: To use intra- and interobserver ... ...

Abstract	Background: Gluteal tendinopathy is commonly reported in the literature, but there is a need for a validated magnetic resonance imaging (MRI)-based scoring system to grade the severity of the tendinopathy. Purpose: To use intra- and interobserver reliability to validate a new scoring system, the Melbourne Hip MRI (MHIP) score, for assessing the severity of gluteal tendinopathy. Study design: Cohort study (diagnosis); Level of evidence, 3. Methods: The MHIP score assesses gluteal tendinopathy according to each 1 of 5 categories: (1) extent of tendon pathology (maximum 5 points); (2) muscle atrophy (maximum 4 points); (3) trochanteric bursitis (maximum 4 points); (4) cortical irregularity (maximum 3 points); and (5) bone marrow edema (maximum 1 point), with an overall range of 0 to 17 (most severe). A total of 41 deidentified MRI scans from 40 patients diagnosed with gluteal tendinopathy (mean baseline age, 57.44 ± 25.26 years; 4 male, 36 female) were read and graded according to MHIP criteria by 2 experienced musculoskeletal radiologists. The radiologists were blinded to previous reports, and the scans were read twice within a 2-month period. Statistical analysis using the intraclass correlation coefficient (ICC) was used to determine intra- and interobserver reliability and mean/range for the MHIP scores. Results: Of a total of 123 readings, the mean MHIP score (±SD) was 3.93 ± 2.24 (range, 0-17 points). The MHIP score demonstrated excellent reliability for determining the severity of gluteal tendinopathy on MRI. The ICC for intra- and interobserver reliability was 0.81 (95% CI, 0.67-0.89) and 0.78 (95% CI, 0.62-0.87), respectively. Conclusion: The MHIP score had excellent intra- and interobserver reliability in scoring gluteal tendinopathy. This score allows gluteal tendon pathology to be graded prior to treatment and to be used for standardized comparisons between results in future research undertaking radiological review of gluteal tendinopathy.
Language	English
Publishing date	2021-04-22
Publishing country	United States
Document type	Journal Article
ZDB-ID	2706251-X
ISSN	2325-9671
ISSN	2325-9671
DOI	10.1177/2325967121998389
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