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Biomedical subjects

C Purdam

Publications and source records attributed to C Purdam.

6 recordsLinked to original sources
PubMed2004

Patellar tendinosis as an adaptive process: a new hypothesis.

BACKGROUND: Patellar tendinosis (PT), or "jumper's knee" is a common condition in athletes participating in jumping sports, and is characterised by proximal patellar tendon pain and focal tenderness to palpation. Hypoechoic lesions observed in the proximal patellar tendon associated with the tendinosis are typically described as being a result of degenerative change or "failed healing". We propose a new model for the development of the hypoechoic lesion observed in PT, in which the aetiology is an adaptive response to differential forces within the tendon. METHODS: We assessed the clinical, histopathological, and biomechanical literature surrounding the patellar tendon and integrated this with research into the response of tendons to differential forces. RESULTS AND CONCLUSIONS: We propose that the hypoechoic lesion commonly described in PT is the result of adaptation or partial adaptation of the proximal patellar tendon to a compressive load. We postulate that the biomechanics of the patellar-patellar tendon interface creates this compressive environment. Secondary failure of the surrounding tensile adapted tendon tissue may result in tissue overload and failure, with resultant stimulation of nociceptors. We believe that this "adaptive model" of patellar tendinosis is consistent with the clinical and histological findings.

Adaptation, Physiological↗
PubMed2002

Achilles tendinopathy.

Achilles tendon injury (tendinopathy) and pain occur in active individuals, when the tendon is subject to high or unusual load. Achilles tendinopathy can be resistant to treatment, and symptoms may persist despite both conservative and surgical intervention. The pathology of overuse tendinopathy is non-inflammatory, with a degenerative or failed healing tendon response. The diagnosis of Achilles tendinopathy requires excellent differential diagnosis and an understanding of the role of tendon imaging. Conservative treatment must include exercise, with a bias to eccentric contractions. Surgical treatment is effective after complete tendon rupture, but may not assist recovery from overuse tendinopathy. Further research into the clinical aspects of Achilles tendinopathy is required.

Achilles Tendon↗
PubMed2001

The VISA-A questionnaire: a valid and reliable index of the clinical severity of Achilles tendinopathy.

BACKGROUND: There is no disease specific, reliable, and valid clinical measure of Achilles tendinopathy. OBJECTIVE: To develop and test a questionnaire based instrument that would serve as an index of severity of Achilles tendinopathy. METHODS: Item generation, item reduction, item scaling, and pretesting were used to develop a questionnaire to assess the severity of Achilles tendinopathy. The final version consisted of eight questions that measured the domains of pain, function in daily living, and sporting activity. Results range from 0 to 100, where 100 represents the perfect score. Its validity and reliability were then tested in a population of non-surgical patients with Achilles tendinopathy (n = 45), presurgical patients with Achilles tendinopathy (n = 14), and two normal control populations (total n = 87). RESULTS: The VISA-A questionnaire had good test-retest (r = 0.93), intrarater (three tests, r = 0.90), and interrater (r = 0.90) reliability as well as good stability when compared one week apart (r = 0.81). The mean (95% confidence interval) VISA-A score in the non-surgical patients was 64 (59-69), in presurgical patients 44 (28-60), and in control subjects it exceeded 96 (94-99). Thus the VISA-A score was higher in non-surgical than presurgical patients (p = 0.02) and higher in control subjects than in both patient populations (p<0.001). CONCLUSIONS: The VISA-A questionnaire is reliable and displayed construct validity when means were compared in patients with a range of severity of Achilles tendinopathy and control subjects. The continuous numerical result of the VISA-A questionnaire has the potential to provide utility in both the clinical setting and research. The test is not designed to be diagnostic. Further studies are needed to determine whether the VISA-A score predicts prognosis.

Achilles Tendon↗