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Vancouver, Canada
Friday 28th September 2012

After a long day of travelling from New York & arriving late into Vancouver, I woke on Thursday morning to a vivid reminder of how much I have missed living in this city & just what a magical place it really is.  The soul & bustle of Cambie Street was energising as I grabbed a late brunch with my friend Gerald, before heading off to Vancouver General Hospital for the round table session at the International Scientific Tendinopathy Symposium.

The session was opened by two of the guys that have been instrumental in hosting the event, Karim Khan & Alex Scott, with a handful of taster presentations that are a sign of things to come!  We then split into 6 tables to discuss the various components of tendinopathy management & current physiological understanding.  The rehabilitation collective was chaired by Craig Purdam, the Deputy Director of the Australian Institute of Sport & co-author of several tendinopathy papers with Jill Cook.  Our think tank also included Sam Rosengarten, the sports physiotherapist from the Carlton FC Aussie Rules team & a group of clinicians from Spain - some great guys, from a variety of clinical & research backgrounds, which ensured we had a good debate on the current practice & issues thereof.

It was a great start to the weekend ahead & make sure to check back, as I will post my notes on the blog.  Below are my summaries from the taster presentations plus links to the journal articles (well, the ones I have, at least) that were cited by each speaker.  


International Scientific Tendinopathy Symposium, 2012

Round Table Session Chaired by Karim Khan

Discussed the importance of publishing a summary paper with consensus, where possible & highlighting requirements for future research where debate still remains, as to where the current thoughts are in terms of diagnosis, outcome measures, imaging, models of presentation & treatment

 

Bill Vincenzino

Discussed the need for developing a battery of standardised outcome measures

References:

Williamson, P.R. et al (2012) Developing core outcome sets for clinical trials: issues to consider.  Trials; 13(1): pp132


Dworkin, R.H. et al (2012)  Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials:  IMMPACT Recommendations.  J of Pain; 9 (2): pp105 121

 

Hans van Schie

Discussed the importance of selecting an appropriate imaging technique that will discriminate between tendons that are pre-symptomatic & at risk of breakdown & those that are healthy

Presented the method of ultrasound tissue characterisation

Analysis of these images provides much more accurate information on the nature, extent & duration of injuries in addition to their state of repair & response to treatment

References:

Bosch, G. et al (2011)  Computerised analysis of standardised ultrasonographic images to monitor the repair of surgically created core lesions in equine superficial digital flexor tendons following treatment with intratendinous platelet rich plasma or placebo.  Veterinary Journal; 187 (1): pp92-98


Van Schie, H.T.M. et al (2009) Monitoring of the repair process of surgically created lesions in equine superficial digital flexor tendons by use of computerised ultrasonography.  Am J Vet Res; 70 (1): pp37-48


Van Schie JTM, Bakker EM, Jonker AM, Weeren PR (2003) Computerized ultrasonographic tissue characterization of equine superficial digital flexor tendons by means of stability quantification of echo patterns in contiguous transverse ultrasonographic images. Am J Vet Res; 64: pp366-375.

 

Jill Cook

Discussed her existing continuum model of tendon pathology & discussed the neurogenic inflammation model

Highlighted the fact that not all presentations fit one model

References:

Cook, J.L. & Purdam, C.R. (2009)  Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy.  Br J Sports Med43: pp409-416.  


Abate, M. et al (2009).  Pathogenesis of tendinopathy: inflammation or degeneration?  Arth Res & Therapy; 11 (3): pp235-250

 

Fermin Valera

Discussed therapeutic intervention of tendon pathology & proposed the method of percutaneous intra-tissue electrolysis

 

Alex Scott

Discussed the inflammatory component of tendinopathy & suggested this area should be revisited to address the use of anti-inflamatory agents in treating tendinopathic symptoms

Introduced Dr Hildebrand from University of Calgary who discussed his work on the early post-injury administration of Ketotifen, a mass cell stabiliser, in reducing scar tissue contracture by preventing release of growth factor

References:

Legerlotz, K. et al (2012) Increased expression of IL-6 family members in tendon pathology.  Rheumatology; 51: pp1161-1165


Riley, G. (2008) Tendinopathy.  From Basic Science to Treatment. Nature; 4 (2): pp82-89

 

 

 

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