A PIONEERING STUDY IN PATELLAR TENDINOPATHY: TREATMENT WITH BONE MARROW MESENCHYMAL STEM CELLS
Patellar tendinopathy – pain and degeneration in the patellar tendon – is a frequent injury among athletes.
Muscle injuries account for more than 30% of all injuries in sports like soccer. Their significance is therefore enormous in terms of training sessions and lost game time. A correct diagnosis is essential for minimizing the problem, establishing the appropriate prognosis and treatment times and the risk of re-injury.
Imaging techniques – such as ultrasound or MRI – are very helpful in this process. Recently, Dr. Gil Rodas, a specialist physician at FC Barcelona, published an article in Healthmanagement.org magazine, in which he describes the main uses of these techniques, their significance and some new areas of research.
Diagnosis is Crucial
“The most important factor in treating a muscle injury is to make a good diagnosis,” says Rodas. “To do this, it is essential to consider what the patient and the physical examination tell you, but today we are lucky in that we also have tests, such as ultrasound or magnetic resonance imaging, which help us gain more accuracy.”
The challenge is complex, and the classification of muscle injuries is still a matter of debate. In 2017, FC Barcelona’s own medical team, in collaboration with Aspetar Hospital and other European and US centers, proposed a new system which took into account both the injury mechanism and its location, the degree of severity and the number of previous injuries. “We are moving from a very simple classification to one with many layers of information, somewhat similar to what is happening with cancer diagnosis. But we are still in this process,” says Rodas.
As for imaging tests, ultrasound is now the most widely used. “It is an easy and inexpensive system that we can use at any sports club, like a stethoscope for a cardiologist.” Using an ultrasound enables you to follow the healing process, the evolution of the hematoma or to check whether or not the muscle architecture is restored correctly. Right now it is the best tool for regular monitoring.
MRI is more expensive and less suitable for daily practice, but in return it provides a greater degree of accuracy. These imaging tests complement each other and are very useful. However, they have not yet been shown to help in deciding when the right and safe time to return to competition is. That is the next big challenge.
To make this decision, “today we rely on our own clinical evaluation and field tests based on GPS analysis,” says Rodas. “Somehow this data tell us if the vehicle, which has been stationary, is going to reach the same speeds, the same accelerations again.”
The aim is that, in future, imaging tests will also help with this decision. With new technologies, we are moving from merely being able to observe anatomy to being able to study in detail the structure of the muscle and tendon, and even its metabolism and functioning. Although there are still not enough studies, there is hope that new, more powerful MRIs (called ‘3-Tesla’ MRIs) will help by improving image definition. Another type of MRI being studied is elastography, which would allow us to study the muscles in motion, their function and flexibility. Even positron emission tomography (PET) scans, now particularly used in the study of cancer and heart disease, may provide information on muscle metabolism and recovery.
Right now, the main conclusion is that imaging tests improve the diagnosis of muscle lesions, they give a report on the prognosis and enable treatments to be adjusted. With time and research, they will probably also help decide the right time to return to competition.
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