Low prevalence of patellar tendon abnormality and low incidence of patellar tendinopathy in female collegiate volleyball players

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.

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

British Journal of Sports Medicine ◽

10.1136/bjsports-2013-092275 ◽

2013 ◽

Vol 47 (13) ◽

pp. 862-868 ◽

Cited By ~ 53

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

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Relationship between the anteroposterior diameter of the patellar tendon. Pain and functionality in volleyball players

Revista Fisioterapia Invasiva ◽

10.1055/s-0039-3401888 ◽

2019 ◽

Vol 02 (02) ◽

pp. 067-067

Author(s):

Calvo Gonell A. ◽

Macia Soler L. ◽

Moncho J.

Keyword(s):

Patellar Tendon ◽

Sports Injuries ◽

Cross Sectional Study ◽

Musculoskeletal Ultrasound ◽

Patellar Tendinopathy ◽

Ground Substance ◽

Linear Regression Models ◽

Cross Sectional ◽

Anteroposterior Diameter ◽

Volleyball Players

Abstract Introduction and Aim Overuse injuries in volleyball represent between 50% and 80% of total injuries, of which, 80% are patellar tendinopathies. Volleyball is the sport with the greatest prevalence of patellar tendinopathy, estimated at 44.6%, followed by basketball with 31.9%. The tendon thickness bears a close and direct relationship with abnormal and diffuse images with accumulation of ground substance, and affecting both sexes, although less marked in women. Aim To determine whether the antero-posterior diameter of the patellar tendon in volleyball players is associated with a greater sensation of pain and reduced functionality. Material and Methods An observational, descriptive, cross-sectional study on volleyball players. The scores on the VISA-P scale, the visual analog scale (VAS) and, using musculoskeletal ultrasound, the anteroposterior diameter of the patellar tendon at 5 and 10 mm distal to the inferior pole of the patella. Multiple linear regression models were constructed to adjust the effect of the anteroposterior diameter on the VAS and the VISA-P scores. Results The final sample comprised 112 players. The anteroposterior diameter was greater in men and was significantly associated with scores on the VAS and the VISA-P for both tendons, and therefore, the greater the score of the diameter, the greater the score on the VAS and the lesser the score on the VISA-P. Conclusions The measurement of the antero-posterior diameter of the patellar tendon using musculoskeletal ultrasound may be useful for the prevention of sports injuries in volleyball players, as it is significantly associated with a greater perception of pain and reduced functionality.

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Patellar Tendon Force Differs Depending on Jump-Landing Tasks and Estimation Methods

Applied Sciences ◽

10.3390/app12010488 ◽

2022 ◽

Vol 12 (1) ◽

pp. 488

Author(s):

Sébastien Garcia ◽

Nicolas Delattre ◽

Eric Berton ◽

Guillaume Rao

Keyword(s):

Patellar Tendon ◽

Vertical Jump ◽

Vertical Component ◽

Forward Direction ◽

Estimation Methods ◽

Patellar Tendinopathy ◽

Static Optimization ◽

Jump Landing ◽

Volleyball Players ◽

Tendon Force

Patellar tendinopathy is a chronic overuse injury of the patellar tendon which is prevalent in jump-landing activities. Sports activities can require jumping not only with a vertical component but also in a forward direction. It is yet unknown how jumping in the forward direction may affect patellar tendon forces. The main purpose of this study was to compare PTF between landings preceded by a vertical jump and a forward jump in volleyball players. The second purpose was to compare two different estimation methods of the patellar tendon force. Fifteen male volleyball players performed vertical and forward jump-landing tasks at a controlled jump height, while kinetics and kinematics were recorded. Patellar tendon forces were calculated through two estimation methods based on inverse dynamic and static optimization procedures, using a musculoskeletal model. Results showed that forward jump-landing generated higher patellar tendon forces compared to vertical jump-landing for both estimation methods. Surprisingly, although the static optimization method considered muscle co-contraction, the inverse kinematic method provided statistically significant higher patellar tendon force values. These findings highlight that limiting the forward velocity component of the aerial phase appears to reduce the load on the patellar tendon during landing and may help to prevent patellar tendinopathy.

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

The Knee ◽

10.1016/j.knee.2020.02.022 ◽

2020 ◽

Vol 27 (3) ◽

pp. 871-877 ◽

Cited By ~ 1

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

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

Sports Health A Multidisciplinary Approach ◽

10.1177/1941738118820517 ◽

2019 ◽

Vol 11 (2) ◽

pp. 157-162 ◽

Cited By ~ 4

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.

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THE RELATION BETWEEN LOAD AND PATELLAR TENDON STRUCTURE DURING PRESEASON IN VOLLEYBALL PLAYERS

British Journal of Sports Medicine ◽

10.1136/bjsports-2016-097372.182 ◽

2017 ◽

Vol 51 (4) ◽

pp. 356.1-356

Author(s):

Lucas Maciel Rabello ◽

Ruth Ijtsma ◽

Johannes Zwerver ◽

Michel S Brink

Keyword(s):

Patellar Tendon ◽

Volleyball Players

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

Diagnostics ◽

10.3390/diagnostics10110882 ◽

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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Patellar tendon structure responds to load over a 7‐week preseason in elite male volleyball players

Scandinavian Journal of Medicine and Science in Sports ◽

10.1111/sms.13428 ◽

2019 ◽

Cited By ~ 2

Author(s):

Lucas Maciel Rabello ◽

Johannes Zwerver ◽

Roy E. Stewart ◽

Inge den Akker‐Scheek ◽

Michel S. Brink

Keyword(s):

Patellar Tendon ◽

Volleyball Players

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Rethinking Patellar Tendinopathy and Partial Patellar Tendon Tears: A Novel Classification System

The American Journal of Sports Medicine ◽

10.1177/0363546519894333 ◽

2020 ◽

Vol 48 (2) ◽

pp. 359-369 ◽

Cited By ~ 1

Author(s):

Mikhail Golman ◽

Margaret L. Wright ◽

Tony T. Wong ◽

T. Sean Lynch ◽

Christopher S. Ahmad ◽

...

Keyword(s):

Logistic Regression ◽

Patellar Tendon ◽

Classification System ◽

Treatment Guidelines ◽

Patellar Tendinopathy ◽

Partial Tear ◽

Partial Thickness ◽

Tendon Thickness ◽

Tendon Tears ◽

The Relationship

Background: Patellar tendinopathy is an overuse injury of the patellar tendon frequently affecting athletes involved in jumping sports. The tendinopathy may progress to partial patellar tendon tears (PPTTs). Current classifications of patellar tendinopathy are based on symptoms and do not provide satisfactory evidence-based treatment guidelines. Purpose: To define the relationship between PPTT characteristics and treatment guidelines, as well as to develop a magnetic resonance imaging (MRI)–based classification system for partial patellar tendon injuries. Study Design: Cohort study (prognosis); Level of evidence, 2. Methods: MRI characteristics and clinical treatment outcomes were retrospectively reviewed for 85 patients with patellar tendinopathy, as well as 86 physically active control participants who underwent MRI of the knee for other conditions. A total of 56 patients had a PPTT and underwent further evaluation for tear size and location. The relationship between tear characteristics and clinical outcome was defined with use of statistical comparisons and univariate and logistic regression models. Results: Of the 85 patients, 56 had partial-thickness patellar tendon tears. Of these tears, 91% involved the posterior and posteromedial regions of the proximal tendon. On axial MRI views, patients with a partial tear had a mean tendon thickness of 10 mm, as compared with 6.2 mm for those without ( P < .001). Eleven patients underwent surgery for their partial-thickness tear. All of these patients had a tear >50% of tendon thickness (median thickness of tear, 10.3 mm) on axial views. Logistic regression showed that tendon thickness >8.8 mm correlated with the presence of a partial tear, while tendon thickness >11.45 mm and tear thickness >55.7% predicted surgical management. Conclusion: Partial-thickness tears are located posterior or posteromedially in the proximal patellar tendon. The most sensitive predictor for detecting the presence of a partial tear was patellar tendon thickness, in which thickness >8.8 mm was strongly correlated with a tear of the tendon. Tracking thickness changes on axial MRI may predict the effectiveness of nonoperative therapy: athletes with patellar tendon thickness >11.5 mm and/or >50% tear thickness on axial MRI were less likely to improve with nonoperative treatment. A novel proposed classification system for partial tears, the Popkin-Golman classification, can be used to guide treatment decisions for these patients.

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