The Effect of Positional Release Therapy on Intercollegiate Male Basketball Athletes Classified With Patella Tendinopathy

The 2007 review by Visnes and Bahr concluded that athletes with patella tendinopathy should be withdrawn from sport whilst engaging in eccentric exercise (EE) rehabilitation programs. However, deprivation of sport is associated with a number of negative psychological and physiological effects. Withdrawal from sport is therefore a decision that warrants due consideration of the risk/benefit ratio. The aim of this study was to determine whether sufficient evidence exists to warrant withdrawal of athletes from sport during an eccentric exercise rehabilitation program. A systematic review of the literature was performed to identify relevant randomised trials. Data was extracted to determine whether athletes were withdrawn from sport, what evidence was presented to support the chosen strategy and whether this affected the clinical outcome. Seven studies were included. None of these reported high quality evidence to support withdrawal. In addition, three studies were identified in which athletes were not withdrawn from sport and still benefited from EE. This review has demonstrated that there is no high quality evidence to support a strategy of withdrawal from sport in the management of patella tendinopathy.

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Endochondral ossification in Achilles and patella tendinopathy

Rheumatology ◽

10.1093/rheumatology/41.4.474 ◽

2002 ◽

Vol 41 (4) ◽

pp. 474-476 ◽

Cited By ~ 40

Author(s):

S. Fenwick

Keyword(s):

Endochondral Ossification ◽

Patella Tendinopathy

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Risk factors of patella tendinopathy: Comparison between normal tendons and those with unilateral and bilateral patellar tendinopathy

Journal of Science and Medicine in Sport ◽

10.1016/s1440-2440(03)80168-8 ◽

2003 ◽

Vol 6 (4) ◽

pp. 72

Keyword(s):

Risk Factors ◽

Patellar Tendinopathy ◽

Patella Tendinopathy

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Erratum: Niering, M.; Muehlbauer, T. Effects of Physical Training on Physical and Psychological Parameters in Individuals with Patella Tendinopathy: A Systematic Review and Meta-Analysis. Sports 2021, 9, 12

Sports ◽

10.3390/sports9110151 ◽

2021 ◽

Vol 9 (11) ◽

pp. 151

Author(s):

Marc Niering ◽

Thomas Muehlbauer

Keyword(s):

Systematic Review ◽

Physical Training ◽

Meta Analysis ◽

Published Paper ◽

Patella Tendinopathy ◽

Psychological Parameters

The authors would like to correct an error in the name of the condition in the recently published paper [...]

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Regional differences in the cellularity and vascularity of the patellar tendon

Anatomy Journal of Africa ◽

10.4314/aja.v7i2.174145 ◽

2018 ◽

Vol 7 (2) ◽

Author(s):

Brian Wambua ◽

Kirsteen Awori ◽

James Kigera ◽

Kevin Ongeti ◽

Beda Olabu

Keyword(s):

Patellar Tendon ◽

Regional Differences ◽

Regional Distribution ◽

Patellar Tendinopathy ◽

Fat Pad ◽

Patella Tendon ◽

Orthopedic Surgeons ◽

Tensile Forces ◽

High Cellularity ◽

Patella Tendinopathy

The patellar tendon (PT) attaches to the apex of the patella and tibial tuberosity. Its response to tensile forces is influenced by the distribution of fibroblasts and its vascularity. The vascularity and distribution of fibroblasts influence the tendons ability to repair microtears. Microtears of the PT result in patellar tendinopathy. There is however, paucity of data on the regional distribution of vascular and cellular elements in the PT which might explain why microtears occur in the posterior-proximal third. One hundred and two pairs of patellar tendons were obtained from postmortem specimens. Sections from the proximal, middle and distal third from the anterior and posterior lamina of 20 pairs of the patellar tendon (10 male, 10 female) were processed for microscopy to demonstrate the cellularity and vascularity of the tendon. The vascularity was highest in the middle third of the anterior lamina. The posterior lamina of the tendon was less vascular than the anterior lamina. The posterior lamina was more cellular than the anterior with the proximal third showing the highest number of nuclei. These findings indicate that the pre-patellar genicular anastomosis contributes significantly to the vascularity of the anterior lamina while the anastomosis located in Hoffa’s fat pad may be less rich and thus resulting in lower vascularity for the posterior lamina. Lower vascularity implies less healing ability after microtears. Therefore, orthopedic surgeons should be aware of this precarious pattern of vascularity to the posterior lamina. The posterior lamina’s high cellularity especially in the proximal third indicates that it may experience greater stress and via durotaxis more fibroblasts migrate to that region to produce more collagen fibers for resilience. The greater tensile stress experienced by the posterior-proximal third and its lower vascularity may explain why it is most susceptible to microtears.Key words: Patella tendon, regional differences, cellularity, vascularity, patella tendinopathy

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Case Study: The Conservative Management and Rehabilitation of Insertional Patella Tendinopathy in an Elite Footballer

Journal of Elite Sport Performance ◽

10.54080/rzzh8526 ◽

2021 ◽

Vol 1 (1) ◽

Author(s):

David Rhodes ◽

◽

Mark Leather ◽

Andrew Proctor

Keyword(s):

Sports Medicine ◽

Objective Assessment ◽

Return To Sport ◽

Assessment Process ◽

Return To Play ◽

Level Of Evidence ◽

Clearance Level ◽

Design Case Study ◽

Patella Tendinopathy

Background and Purpose: Chronic insertional patella tendinopathy is a complex condition to manage within elite athletes. Pain and symptoms increase when spikes or changes in relation to training or game load are experienced. These spikes are often seen in football on return to training or in periods of fixture congestion, presenting a contemporary challenge for the sports medicine team. Study Design: Case Study. Case Description: The presented case summarises the conservative rehabilitation and pain free return to play of a 24 years (yrs) old elite professional footballer with a long-standing history of patella tendinopathy. Symptoms returned post a spike in training load during pre-season, with a diagnosis of a 7.4 mm insertional thickening detected through magnetic resonance imaging. Presented is a summary of the assessment process, 24-week treatment and rehabilitation protocol and subsequent 12-week pre-habilitation plan, routinely completed on return to training and game play. Outcomes: The implemented management strategy led to the successful symptom free return to play of the athlete. Conclusion: The management of this injury was facilitated through subjective and objective assessment markers and imaging obtained to manage the athlete’s symptoms. The authors suggest that medical and conditioning based specialists could apply a rounded loading approach with prescribed isometric and isotonic drills before progression to energy release and pitch-based training to advance the athlete through a safe and controlled return to sport clearance. Level of Evidence: 5.

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Refractory patella tendinopathy with failed conservative treatment—shock wave or arthroscopy?

Journal of Orthopaedic Surgery ◽

10.1177/2309499016684700 ◽

2017 ◽

Vol 25 (1) ◽

pp. 230949901668470 ◽

Cited By ~ 1

Author(s):

HLM Williams ◽

SA Jones ◽

C Lyons ◽

C Wilson ◽

A Ghandour

Keyword(s):

Shock Wave ◽

Extracorporeal Shock Wave Therapy ◽

Arthroscopic Debridement ◽

Fat Pad ◽

Mri Scan ◽

Extracorporeal Shock Wave ◽

Group A ◽

Group B ◽

Treatment Shock ◽

Patella Tendinopathy

Aim: To identify whether the location of refractory patella tendinopathy (PT) has an effect on treatment modality (radial extracorporeal shock wave therapy (rESWT) or arthroscopic debridement). Methods: Between 2012 and 2014, 40 patients with PT underwent a magnetic resonance imaging (MRI) scan. This confirmed the diagnosis as either involving the tendon itself (group A, 20) or with retropatella fat pad extension (group B, 20). All patients underwent rESWT. If there was no improvement patients proceeded with surgery in the form of arthroscopic debridement (by senior authors CW and AG). Outcomes were assessed before and after treatment using the Victorian Institute of Sports Assessment-Patella (VISA-P) score. Results: There were 18 males and 2 females in group A and 15 males and 5 females in group B. The mean age was 41.4 years in group A (23–59) and 34.7 in group B (19–52). Seventeen of 20 in group A reported good or excellent outcomes and did not require surgical intervention (remaining three improved after second course of ESWT). All patients in group B failed to improve with rESWT, resulting in arthroscopic debridement and reported good or excellent outcomes. After 6 months, group A mean VISA-P score increased from 50.2 to 65.0 ( p = 0.01) and group B from 39.6 to 78.4 ( p = <0.001). Conclusion: An MRI should be performed to determine the precise location of tendinosis in patients with refractory PT who fail standard conservative management. If the MRI scan shows intratendon changes only, ESWT should be performed and those with extension into the fat pad should proceed to arthroscopic debridement without rESWT.

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