scholarly journals Decreasing patellar tendon stiffness during exercise therapy for patellar tendinopathy is associated with better outcome

2022 ◽  
Author(s):  
Stephan J. Breda ◽  
Robert-Jan de Vos ◽  
Gabriel P. Krestin ◽  
Edwin H.G. Oei
Keyword(s):  
Patellar Tendon ◽  
Exercise Therapy ◽  
Patellar Tendinopathy ◽  
Tendon Stiffness

scholarly journals Patellar and Achilles Tendon Stiffness in Elite Soccer Players Assessed Using Myotonometric Measurements

2019 ◽  
Vol 11 (2) ◽  
pp. 157-162 ◽  
Author(s):  
Iver Cristi-Sánchez ◽  
Claudia Danes-Daetz ◽  
Alejandro Neira ◽  
Wilson Ferrada ◽  
Roberto Yáñez Díaz ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Patellar Tendon ◽  
Professional Training ◽  
Soccer Players ◽  
Patellar Tendinopathy ◽  
Control Group ◽  
Force Transmission ◽  
Level Of Evidence ◽  
Tendon Stiffness ◽  
Handheld Device

Background: Tendon overuse injuries are an issue in elite footballers (soccer players) and may affect tendon function. Achilles and patellar tendinopathy are the most frequent pathologies. Tendon stiffness, the relationship between the force applied to a tendon and the displacement exerted, may help represent tendon function. Stiffness is affected by training and pathology. Nevertheless, information regarding this mechanical property is lacking for elite soccer athletes. Hypothesis: Achilles and patellar tendon stiffness assessed using myotonometric measurements will be greater in elite soccer athletes than in control participants. Study Design: Cross-sectional study. Level of Evidence: Level 4. Methods: Forty-nine elite soccer athletes and 49 control participants were evaluated during the 2017 preseason. A handheld device was used to measure Achilles and patellar tendon stiffness. Dominant and nondominant limbs were assessed for both groups. Results: A significantly stiffer patellar tendon was found for both the dominant and the nondominant limb in the elite soccer athletes compared with the control group. Nevertheless, no differences were found in Achilles tendon stiffness between groups. When comparing between playing positions in soccer athletes, no significant differences were found for both tendons. Conclusion: Greater patellar tendon stiffness may be related to an improvement in force transmission during muscle contraction. On the other hand, it seems that after years of professional training, Achilles tendon stiffness does not change, conserving the storing-releasing function of elastic energy. The nonsignificant differences between positions may be attributable to the years of homogeneous training that the players underwent. Clinical Relevance: The present study shows another technique for measuring mechanical properties of tendons in soccer athletes that could be used in clinical settings. In the future, this technique may help clinicians choose the best exercise protocol to address impairments in tendon stiffness.

scholarly journals The association between patellar tendon stiffness measured with shear-wave elastography and patellar tendinopathy—a case-control study

2020 ◽  
Vol 30 (11) ◽  
pp. 5942-5951 ◽  
Author(s):  
Stephan J. Breda ◽  
Arco van der Vlist ◽  
Robert-Jan de Vos ◽  
Gabriel P. Krestin ◽  
Edwin H. G. Oei
Keyword(s):  
Shear Wave ◽  
Patellar Tendon ◽  
Interobserver Reliability ◽  
Power Doppler ◽  
Shear Wave Elastography ◽  
Intraobserver Reliability ◽  
Patellar Tendinopathy ◽  
Altman Analysis ◽  
Tendon Stiffness ◽  
Bland Altman Analysis

Abstract Objectives (1) To determine the association between patellar tendon stiffness and the presence of patellar tendinopathy (PT). (2) To evaluate the reliability of shear-wave elastography (SWE). Methods Participants were consecutively enrolled between January 2017 and June 2019. PT was diagnosed clinically and confirmed by either grayscale US or power Doppler US, or both. Controls had no history of anterior knee pain and no clinical signs of PT. Patellar tendon stiffness (kilopascal, kPa) was assessed using SWE. Logistic regression was used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Reliability analyses included coefficients-of-variation (CV), coefficients-of-repeatability (CR), intraclass correlation coefficient (ICC) for intraobserver and interobserver reliability, and Bland-Altman analysis. Results In total, 76 participants with PT (58 men, mean age 24.4 ± 3.8 years) and 35 asymptomatic controls (16 men, mean age 21.5 ± 3.8 years) were included. Univariate analyses (OR 1.094, 95% CI 1.061–1.128, p < .001) and adjusted multivariate analyses (OR 1.294, 95% CI 1.044–1.605, p = .018) showed that athletes with PT had significantly increased patellar tendon stiffness. ICC for intraobserver reliability was 0.95 (95% CI 0.92–0.97), CR (CV) 12 kPa (10%) and 0.79 (95% CI 0.65–0.88), CR (CV) 18 kPa (21%) for interobserver reliability. Mean differences from Bland-Altman analysis were 5.6 kPa (95% CI 3.1–8.1, p < .001) for intraobserver reliability and 4.6 kPa (95% CI 1.9–7.2, p < .001) for interobserver reliability. Conclusions PT is associated with significantly higher patellar tendon stiffness. SWE measurements demonstrate excellent intraobserver reliability and good interobserver reliability. Therefore, SWE is a promising tool to implement in longitudinal studies and future studies should evaluate its prognostic value and utility as a monitoring tool in athletes with PT. Key Points • Patellar tendon stiffness measured with shear-wave elastography (SWE) is higher in athletes with patellar tendinopathy than in healthy controls, also after adjusting for potential confounders. • Excellent intraobserver reliability and good interobserver reliability were found for the quantitative assessment of patellar tendon stiffness using SWE.

scholarly journals A Novel Method for Assessing Regional Tendon Stiffness and Its Significance

2018 ◽  
Vol 8 (7) ◽  
pp. 1156
Author(s):  
Siu Fu ◽  
Hsing-Kuo Wang ◽  
Chen Huang
Keyword(s):  
Shear Modulus ◽  
Patellar Tendon ◽  
Patellar Tendinopathy ◽  
Differential Modulation ◽  
Patella Tendon ◽  
Tendon Stiffness ◽  
Linear Transducer ◽  
Novel Method ◽  
The Impact

Elastography can be used to estimate the regional shear modulus of a tendon. This can advance our knowledge on the impact of patellar alignment and regional patellar tendon stiffness. This is important as patellar tendon abnormality is mainly found in the medial portion of the tendon in subjects with proximal patellar tendinopathy. This paper aims to assess the effect of patellar displacement on differential modulation on the shear modulus of the patellar tendon. Shear modulus is captured on the medial and lateral half of the patella tendon using the Axiplorer® ultrasound unit in conjunction with a 4–15 MHz, 50 mm linear transducer with the patellar being positioned in its resting, medio- and laterally displaced positions on 40 adults (19 females, 21 males). When the patellar is displaced laterally, the shear modulus is significantly increased at the medial half in both genders but decreased at the lateral half only in females. Conclusions: Elastography detects changes in regional tendon stiffness associated with alteration in patellar positions. The modulation on the shear modulus is gender and region specific.

Distalising tibial tubercle osteotomy decreases patellar tendon force — A treatment rationale for recalcitrant patellar tendinopathy

The Knee ◽  
2020 ◽  
Vol 27 (3) ◽  
pp. 871-877 ◽  
Author(s):  
Michael J. Dan ◽  
Joseph Cadman ◽  
James McMahon ◽  
William C.H. Parr ◽  
David Broe ◽  
...  
Keyword(s):  
Patellar Tendon ◽  
Patellar Tendinopathy ◽  
Tibial Tubercle ◽  
Tibial Tubercle Osteotomy ◽  
Tendon Force

scholarly journals Morpho-textural changes of the patellar tendon in professional volleyball players: a six month longitudinal study

2019 ◽  
Vol 02 (02) ◽  
pp. 126-126
Author(s):  
de Groot Ferrando A.
Keyword(s):  
Patellar Tendon ◽  
Effect Size ◽  
Repeated Measures ◽  
Structural Changes ◽  
Patellar Tendinopathy ◽  
Average Effect ◽  
Average Effect Size ◽  
Significant Difference ◽  
Volleyball Players ◽  
Textural Changes

Abstract Introduction Tendinopathy is a term used to describe a clinical presentation of pain and dysfunction, which, at times, is accompanied by pathologic structural changes in the tendon matrix. Jumper's knee has been studied for some time, however the etiology is still unknown. The deep fibers of the proximal region are the most affected area in tendinopathies affecting the patellar tendon. Ultrasound (US) scanning may have the greatest sensitivity for confirming clinically diagnosed patellar tendinopathy compared with other imaging techniques such as magnetic resonance. Some studies have found that a minimum of six months is required to observe significant structural changes, although other studies reveal that structural changes can be visible in a shorter period of time. Thus, sonography has been used to evaluate quantitative variables such as thickness, echogenicity, texture measures and the internal tendon matrix. Objective The purpose of this study was to evaluate the sonographic behavior of morpho-textural changes of the patellar tendon in professional male volleyball players over a one year season. Material and Methods This is an observational, longitudinal and analytical study. A sample of 66 patellar tendons from 33 volleyball players of the Spanish super league was recruited, with an average of: 28 years, 86kg and 192cm. An ultrasound scan was performed using the Sonosite Titan ultrasound system, L38, 5–10 MHz, with a cross section of 5mm from the lower pole of the patella. Two depths were analyzed: a.39mm: echogenicity, echogenicity variation, circularity, width and thickness. b.24mm: entropy and contrast. Statistical analysis and analysis of variance (ANOVA) was performed for repeated measures and, in addition, the effect size was calculated with Cohen's d. The confidence interval was 95%. SPSS Statistics software was used. Results For textural variables: contrast increased significantly with an average effect size, and entropy showed no significant difference. Circularity was significantly lower. Width was shown to be significantly greater, with an average effect size, while thickness was reduced significantly. Regarding echogenicity, no significant changes were detected and variation in echogenicity did not show significant changes. Conclusions Imaging analysis could be a potential tool to detect changes in the pattern of patellar tendons. Some morpho-textural changes were found in male volleyball players: the textural contrast variable increases significantly throughout the annual season, meaning that the tendon becomes slightly flatter and loses circularity in its transverse section. The entropy and echogenic parameters obtained from the gray-scale histogram did not reveal any significant changes.

scholarly journals Mechanical properties of the patellar tendon in elite volleyball players with and without patellar tendinopathy

2013 ◽  
Vol 47 (13) ◽  
pp. 862-868 ◽  
Author(s):  
Christian Helland ◽  
Jens Bojsen-Møller ◽  
Truls Raastad ◽  
Olivier R Seynnes ◽  
Marie M Moltubakk ◽  
...  
Keyword(s):  
Mechanical Properties ◽  
Patellar Tendon ◽  
Patellar Tendinopathy ◽  
Volleyball Players

scholarly journals Ultrasound Characterization of Patellar Tendon in Non-Elite Sport Players with Painful Patellar Tendinopathy: Absolute Values or Relative Ratios? A Pilot Study

Diagnostics ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. 882
Author(s):  
José L. Arias-Buría ◽  
César Fernández-de-las-Peñas ◽  
Jorge Rodríguez-Jiménez ◽  
Gustavo Plaza-Manzano ◽  
Joshua A. Cleland ◽  
...  
Keyword(s):  
Pilot Study ◽  
Patellar Tendon ◽  
Operating Characteristic ◽  
Diagnostic Value ◽  
Patellar Tendinopathy ◽  
Width Ratio ◽  
Elite Sport ◽  
Cross Sectional ◽  
Blinded Assessor

Imaging findings in patellar tendinopathy are questioned. The aim of this pilot study was to characterize ultrasound measures, by calculating ultrasound ratio and neovascularization of the patellar tendon in non-elite sport players with unilateral painful patellar tendinopathy. Cross-sectional area (CSA), width, and thickness of the patellar tendon were assessed bilaterally in 20 non-elite sport-players with unilateral painful patellar tendinopathy and 20 asymptomatic controls by a blinded assessor. Ultrasound ratios were calculated to discriminate between symptomatic and asymptomatic knees. The Ohberg score was used for characterizing neovascularization. We found that non-elite sport players with patellar tendinopathy exhibited bilateral increases in CSA, width, and thickness of the patellar tendon compared to asymptomatic controls (Cohen d > 2). The ability of ultrasound ratios to discriminate between painful and non-painful patellar tendons was excellent (receiver operating characteristic, ROC > 0.9). The best diagnostic value (sensitivity: 100% and specificity: 95%) was observed when a width ratio ≥ 1.29 between the symptomatic and asymptomatic patellar tendon was used as a cut-off. Further, neovascularization was also observed in 70% of non-elite sport players with unilateral patellar tendinopathy. A greater CSA ratio was associated with more related-disability and higher tendon neovascularization. This study reported that non-elite sport players with painful unilateral patellar tendinopathy showed structural ultrasound changes in the patellar tendon when compared with asymptomatic controls. Ultrasound ratios were able to discriminate between symptomatic and asymptomatic knees. Current results suggest that ultrasound ratios could be a useful imaging outcome for identifying changes in the patellar tendon in sport players with unilateral patellar tendinopathy.

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