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

2020 ◽  
Vol 48 (2) ◽  
pp. 359-369 ◽  
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.

scholarly journals An Objective Measure of Patellar Tendon Thickness Based on Ultrasonography and MRI in University Athletes

2021 ◽  
Vol 10 (18) ◽  
pp. 4092
Author(s):  
Yusuke Nishida ◽  
Tomofumi Nishino ◽  
Kenta Tanaka ◽  
Shinzo Onishi ◽  
Akihiro Kanamori ◽  
...  
Keyword(s):  
Patellar Tendon ◽  
Objective Measure ◽  
Patellar Tendinopathy ◽  
Evidence Based ◽  
Imaging Evaluation ◽  
Cutoff Value ◽  
Elite University ◽  
Tendon Thickness ◽  
The Relationship ◽  
University Athletes

Ultrasonography and MRI are used for imaging evaluation of patellar tendinopathy, and “thickening of the tendon” is known as one of the characteristic findings. However, there are no evidence-based quantitative criteria to help evaluate this phenomenon. The purpose of this study was to investigate an objective measure of patellar tendon thickness. Patellar tendon thickness was evaluated in 65 elite university athletes using both ultrasonography and MRI. The relationship between tendon thickness and clinical patellar tendinopathy was investigated, and the cutoff value of the tendon thickness was calculated. Of the 129 knees included in the analysis, clinical patellar tendinopathy was found in 16 knees (12.4%). The proximal patellar tendon was significantly thicker in athletes with clinical patellar tendinopathy on both ultrasonography (8.3 mm vs. 5.1 mm; p < 0.001) and MRI (9.9 mm vs. 5.5 mm; p < 0.001). Setting the cutoff value to a thickness of >7.0 mm was an accurate predictor of clinical patellar tendinopathy (ultrasonography: sensitivity 81.3%, specificity 95.6%; MRI: sensitivity 100%, specificity 89.4%). Both ultrasonography and MRI measurement of the proximal patellar tendon thickness reflected the presence of clinical patellar tendinopathy. Defining “thickening of the patellar tendon” as thicker than 7.0 mm on both ultrasonography and MRI therefore has clinical significance.

scholarly journals Partial Patellar Tendon Tears in Athletes: When Is Surgery Required?

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0030
Author(s):  
Mikhail Golman ◽  
Margaret L. Wright ◽  
Tony Wong ◽  
Thomas Sean Lynch ◽  
Christopher S. Ahmad ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Patellar Tendon ◽  
Surgical Intervention ◽  
Pearson Correlation ◽  
Activity Level ◽  
Mri Imaging ◽  
Tendon Tear ◽  
Tendon Thickness ◽  
Tendon Tears ◽  
Tear Size

Objectives: Partial patellar tendon tears (PPTTs) can be a frustrating injury for athletes and physicians. Determining the location and size of the PPTT are fundamental in understanding prognosis and selecting the most effective treatment. With recent enhancements in MRI quality, the size and dimensions of the tear can be more easily and accurately estimated. While some PPTTs respond to therapy, medication, bracing, biologic injections, and/or ultrasound procedures, other PPTTs in do not respond and require surgical intervention. The goal of this study is to correlate PPTT size and location to clinical outcomes, in order to create a classification system to help guide treatment decisions for athletes with PPTT. Methods: 112 athletic patients (range: 15-45 y/o, mean 23.9+7.2 y/o) who underwent knee MRI were included in this study. 85 of those patients (mean 24.9+8.1 y/o) presented with history and physical examination concerning for recalcitrant patellar tendonitis or suspicion of a partial patellar tendon tear. The other 27 athletic patients (mean 25.6+6.3 y/o) underwent MRI for other pathology and were included as age-matched controls. MR scans were evaluated for patellar tendon tear size, thickness, and location with respect to the entire patellar tendon. Descriptive statistics were used to evaluate tendon size and tear distributions. Pearson correlation, univariate regressions, and logistic regression were performed to correlate tendon geometry and tear sizes. Tear geometry variables were compared to patient outcome measures (return to previous activity level, surgical treatment) using t-tests. Results: 56 out of 85 symptomatic patients had partial patellar tendon tears. 91% of PPTTs involved the posterior and posteromedial region of the proximal patellar tendon (Figure 1). On axial MRI imaging, patients with PPTT had mean tendon thickness of 10 mm compared to 5.9 mm for athletes with no PPTT, including healthy controls (p<.0001). There was a significant correlation between patellar tendon thickness and PPTT size (R=0.85, p<0.0001). Logistic regression analysis showed that athletes with patellar tendon thickness above 7.45 mm are likely to have PPTTs (100% sensitivity). Tear distributions according to MRI grading are shown in Table 1. 11 out of 56 patients underwent surgery for PPTT. All 11 of these patients had tear sizes on axial images > 50% of tendon thickness (mean thickness of tear 6.3 mm). Logistic regression showed that patellar tendon thickness > 8.8 mm, and/or tear size > 55% correlated with surgical intervention. Five of the surgical patients did not make a return to sport at the same level. No patient in this series had surgery for tear thickness less than 4.5 mm. Basketball, track and field and soccer were the most common sports involved in the study. Conclusion: PPTTs are located posterior/posteromedially in the proximal patellar tendon. The most sensitive metric for PPTTs are patellar tendon thickness (anterior to posterior), where thickness more than 8.8 mm is strongly predictive of having a partial tear in the tendon. Athletes with greater than a 55% tear thickness on axial MRI imaging or with a tear measuring more than 4.5 mm on axial cuts are less likely to respond to non-operative treatment. Tracking thickness changes on axial views, specifically in the posterior/posteromedial region, may predict effectiveness of non-operative therapy. [Table: see text][Figure: see text]

scholarly journals Pain Relief after Extracorporeal Shock Wave Therapy for Patellar Tendinopathy: An Ultrasound Evaluation of Morphology and Blood Flow

2021 ◽  
Vol 11 (18) ◽  
pp. 8748
Author(s):  
Toshihiro Maemichi ◽  
Toshiharu Tsutsui ◽  
Takumi Okunuki ◽  
Takuma Hoshiba ◽  
Tsukasa Kumai
Keyword(s):  
Shock Wave ◽  
Blood Flow ◽  
Patellar Tendon ◽  
Ultrasound Imaging ◽  
Patellar Tendinopathy ◽  
Extracorporeal Shock Wave ◽  
Ultrasound Evaluation ◽  
Significant Difference ◽  
Before And After ◽  
Tendon Thickness

We aimed to investigate the changes caused by focused extracorporeal shock wave pain therapy (f-ESWT) in patients with patellar tendinopathy by means of ultrasound imaging. We included 18 knees from 11 college athletes with patellar tendinopathy. We assessed the tendon thickness and blood flow of the patellar tendon using ultrasound imaging, rest pain using NRS and tenderness using a pressure pain gauge. We recorded four measurements: immediately before f-ESWT (PRE①) and after f-ESWT (POST①) and two weeks after the first irradiation before f-ESWT (PRE②) and after f-ESWT (POST②). Only the resting pain in both the first and second irradiations showed a significant difference immediately before and after the treatment. In terms of pain changes after two weeks later, we observed significant differences in the resting pain between PRE① and PRE② and also in the resting pain, tenderness and blood flow area between PRE① and POST②. No significant difference was seen in the tendon thickness. We concluded that pain in the patellar tendon at rest decreased before and after irradiation, suggesting that f-ESWT may have influenced the nociceptive structures and had an analgesic effect.

PELAYANAN PUBLIK KESEHATAN PUSKESMAS DALAM MEMBERIKAN KEPUASAN MASYARAKAT DI KABUPATEN SUMENEP

2018 ◽  
Vol 3 (3) ◽  
Author(s):  
Aryo Wibisono ◽  
R. Amilia Destryana
Keyword(s):  
Public Health ◽  
Logistic Regression ◽  
Patient Satisfaction ◽  
Health Center ◽  
Public Service ◽  
Public Health Center ◽  
The Public ◽  
Regression Methods ◽  
Total Satisfaction ◽  
The Relationship

This study aims to determine the index of public satisfaction in public health center services in Sumenep Regency and the relationship between the services to the public satisfaction. The analysis measured the index of public satisfaction and logistic regression methods to determine the effect of the relationship on total satisfaction in the health services of Public Health Center. The results of the study are the alignment between interests and patient satisfaction is still not aligned, there are still differences between interests and satisfaction, the pattern of the result is the relationship between the assurance dimension to the service satisfaction of the public health center, and the results of the index of public satisfaction  values show that the results of the community assess the public health center performance is very good by getting an A grade. Keywords: public service, logistic regretion, index of public satisfaction

Whos Chatting?: Interplay between Personality and WhatsApp Use

2015 ◽  
Vol 4 (4) ◽  
Author(s):  
Himanshu Rajput
Keyword(s):  
Logistic Regression ◽  
Multiple Regression ◽  
Big Five ◽  
Personality Assessment ◽  
The Internet ◽  
Big Five Inventory ◽  
Significant Relationships ◽  
Indian Context ◽  
High Penetration ◽  
The Relationship

Smartphone-based messaging applications have shown phenomenal growth with the proliferation of the internet coupled with the high penetration of smartphones into masses. The current study is an attempt to understand the relationship between the individuals personality and their use of WhatsApp, a popular smartphone-based messaging application in Indian context. For personality assessment the study takes Big Five Inventory. A questionnaire consisting items on individual WhatsApp use and Big Five Inventory was administered to students in an Indian University. Multiple regression and logistic regression revealed significant relationships between personality and WhatsApp usage and use of its different inbuilt functions.

scholarly journals Study on the relationship of depression, anxiety, lifestyle and eating habits with the severity of reflux esophagitis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rongxin Wang ◽  
Jing Wang ◽  
Shuiqing Hu
Keyword(s):  
Quality Of Life ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Logistic Regression Analysis ◽  
Reflux Esophagitis ◽  
Eating Habits ◽  
Positive Correlation ◽  
Relationship Of ◽  
The Relationship

Abstract Background The etiology of reflux esophagitis (RE) is multi-factorial. This study analyzed the relationship of depression, anxiety, lifestyle and eating habits with RE and its severity and further explored the impact of anxiety and depression on patients’ symptoms and quality of life. Methods From September 2016 to February 2018, a total of 689 subjects at Xuanwu Hospital Capital Medical University participated in this survey. They were divided into the RE group (patients diagnosed with RE on gastroscopy, n = 361) and the control group (healthy individuals without heartburn, regurgitation and other gastrointestinal symptoms, n = 328). The survey included general demographic information, lifestyle habits, eating habits, comorbidities, current medications, the gastroesophageal reflux disease (GERD) questionnaire (GerdQ), the Patient Health Questionnaire-9 depression scale and the General Anxiety Disorder-7 anxiety scale. Results The mean age and sex ratio of the two groups were similar. Multivariate logistic regression analysis identified the following factors as related to the onset of RE (p < 0.05): low education level; drinking strong tea; preferences for sweets, noodles and acidic foods; sleeping on a low pillow; overeating; a short interval between dinner and sleep; anxiety; depression; constipation; history of hypertension; and use of oral calcium channel blockers. Ordinal logistic regression analysis revealed a positive correlation between sleeping on a low pillow and RE severity (p = 0.025). Depression had a positive correlation with the severity of symptoms (rs = 0.375, p < 0.001) and patients’ quality of life (rs = 0.306, p < 0.001), whereas anxiety showed no such association. Conclusions Many lifestyle factors and eating habits were correlated with the onset of RE. Notably, sleeping on a low pillow was positively correlated with RE severity, and depression was positively related to the severity of symptoms and patients’ quality of life.

785 Reported Restful Sleep Predicting Emotional Distress: Does Exercise (and its modalities) moderate?

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A305-A306
Author(s):  
Jesse Moore ◽  
Ellita Williams ◽  
Collin Popp ◽  
Anthony Briggs ◽  
Judite Blanc ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Aerobic Exercise ◽  
Regression Models ◽  
Regression Analyses ◽  
Logistic Regression Models ◽  
The Past ◽  
Strengthening Exercise ◽  
Waking Up ◽  
The Relationship ◽  
Age And Sex

Abstract Introduction Literature shows that exercise moderates the relationship between sleep and emotional distress (ED.) However, it is unclear whether different types of exercise, such as aerobic and strengthening, affect this relationship differently. We investigated the moderating role of two types of exercise (aerobic and strengthening) regarding the relationship between ED and sleep. Methods Our analysis was based on data from 2018 National Health Interview Survey (NHIS), a nationally representative study in which 2,814 participants provided all data. Participants were asked 1) “how many days they woke up feeling rested over the past week”, 2) the Kessler 6 scale to determine ED (a score &gt;13 indicates ED), and 3) the average frequency of strengthening or aerobic exercise per week. Logistic regression analyses were performed to determine if the reported days of waking up rested predicted level of ED. We then investigated whether strengthening or aerobic exercise differentially moderated this relationship. Covariates such as age and sex were adjusted in the logistic regression models. Logistic regression analyses were performed to determine if subjective reporting of restful sleep predicted level of ED. We investigated whether strengthening exercise or aerobic exercise differentially moderated this relationship. Covariates such as age and sex were adjusted in the logistic regression models. Results On average, participants reported 4.41 restful nights of sleep (SD =2.41), 3.43 strengthening activities (SD = 3.19,) and 8.47 aerobic activities a week (SD=5.91.) We found a significant association between days over the past week reporting waking up feeling rested and ED outcome according to K6, Χ2(1) = -741, p= &lt;.001. The odds ratio signified a decrease of 52% in ED scores for each unit of restful sleep (OR = .48, (95% CI = .33, .65) p=&lt;.001.) In the logistic regression model with moderation, aerobic exercise had a significant moderation effect, Χ2(1) = .03, p=.04, but strengthening exercise did not. Conclusion We found that restful sleep predicted reduction in ED scores. Aerobic exercise moderated this relationship, while strengthening exercise did not. Further research should investigate the longitudinal effects of exercise type on the relationship between restful sleep and ED. Support (if any) NIH (K07AG052685, R01MD007716, K01HL135452, R01HL152453)

scholarly journals Relationship between Oral Hypofunction and Sarcopenia in Community-Dwelling Older Adults: The Otassha Study

2021 ◽  
Vol 18 (12) ◽  
pp. 6666
Author(s):  
Yoshihiro Kugimiya ◽  
Masanori Iwasaki ◽  
Yuki Ohara ◽  
Keiko Motokawa ◽  
Ayako Edahiro ◽  
...  
Keyword(s):  
Older Adults ◽  
Logistic Regression ◽  
Cross Sectional Study ◽  
Albumin Level ◽  
Community Dwelling ◽  
Tongue Pressure ◽  
Swallowing Function ◽  
Cross Sectional ◽  
Community Dwelling Older Adults ◽  
The Relationship

Oral hypofunction, resulting from a combined decrease in multiple oral functions, may affect systemic-condition deterioration; however, few studies have examined the association between oral hypofunction and general health among older adults. In this cross-sectional study, we examined the relationship between oral hypofunction and sarcopenia in community-dwelling older adults. We included 878 adults (268 men and 610 women, mean age 76.5 ± 8.3 years). Tongue coating index, oral moisture, occlusal force, oral diadochokinesis (/pa/,/ta/,/ka/), tongue pressure, mas-ticatory function, and swallowing function were evaluated as indicators of oral hypofunction. Grip strength, gait speed, and skeletal muscle mass index were measured as diagnostic sarcopenia parameters. The association between oral hypofunction and sarcopenia was examined via logistic regression using sarcopenia as the dependent variable. Oral hypofunction prevalence was 50.5% overall, 40.3% in men, and 54.9% in women. The prevalence of sarcopenia was 18.6% overall, 9.7% in men, and 22.5% in women. A logistic regression showed oral hypofunction, age, body mass index, higher-level functional capacity, and serum albumin level were significantly associated with sarcopenia. Sarcopenia occurred at an increased frequency in patients diagnosed with oral hypofunction (odds ratio: 1.59, 95% confidence interval: 1.02–2.47); accordingly, oral hypofunction appears to be significantly associated with sarcopenia.

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 LDH, CRP and ALB predict nucleic acid turn negative within 14 days in symptomatic patients with COVID-19

2021 ◽  
pp. 003693302199424
Author(s):  
Gaoli Liu ◽  
Bicheng Zhang ◽  
Shaowen Zhang ◽  
Haifeng Hu ◽  
TingTing Liu
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Nucleic Acid ◽  
Hospital Stay ◽  
Prognostic Marker ◽  
Roc Curve ◽  
Prognostic Value ◽  
Statistical Significance ◽  
Biochemical Indicators ◽  
The Relationship

Aims To search for biochemical indicators that can identify symptomatic patients with COVID-19 whose nucleic acid could turn negative within 14 days, and assess the prognostic value of these biochemical indicators in patients with COVID-19. Patients and methods We collected the clinical data of patients with COVID-19 admitted to our hospital, by using logistic regression analysis and AUC curves, explored the relationship between biochemical indicators and nucleic acid positive duration, the severity of COVID-19, and hospital stay respectively. Results A total of two hundred and thirty-three patients with COVID-19 were enrolled in the study. We found patients whose nucleic acid turned negative within 14 days had lower LDH, CRP and higher ALB ( P < 0.05). ROC curve results indicated that lower LDH, TP, CRP and higher ALB predicted the nucleic acid of patients turned negative within 14 days with statistical significance( P < 0.05), AST, LDH, CRP and PCT predicted the severe COVID-19 with statistical significance, and CRP predicted hospital stay >31days with statistical significance ( P < 0.05). After verification, the probability of nucleic acid turning negative within 14 days in patients with low LDH (<256 U/L), CRP (<44.5 mg/L) and high ALB (>35.8 g/L) was about 4 times higher than that in patients with high LDH, CRP and low ALB ( P < 0.05). Conclusions LDH, CRP and ALB are useful prognostic marker for predicting nucleic acid turn negative within 14 days in symptomatic patients with COVID-19.

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