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

Lower limb movement asymmetry exists during volleyball stop-jump landing: Insights from markerless motion capture

Patellar tendinopathy is a highly prevalent injury associated with high knee angular accelerations. However, collecting kinematic data on the volleyball court remains challenging. This study investigated landing kinematics between dominant and non-dominant lower limbs during stop-jumps on the volleyball court and analysed landing variables to identify biomechanical patterns associated with high knee angular accelerations. Landing kinematics were quantified using 3D markerless motion capture (OpenCap) with two cameras. Fourteen male and 5 female elite volleyball players performed 10 stop-jump landings while approaching the net to spike a ball over the net. Asymmetry was found with the dominant limb landing in greater plantarflexion and hip flexion but less knee flexion. The dominant limb exhibited higher knee angular velocities (mean ± standard deviation: dominant = 274 ± 62°/s, non-dominant = 169 ± 84°/s; p < 0.001) and accelerations (dominant = 3924 ± 2221°/s2, non-dominant = 1441 ± 4278°/s2; p = 0.032), suggesting greater biomechanical load. High knee accelerations were significantly correlated with limited knee and hip flexion in the dominant limb, closer foot position, greater trunk flexion at non-dominant limb touchdown, and longer contact time with the non-dominant limb (Pearson's correlation coefficient; |0.55| ≤ r ≤ |0.79|, p < 0.018). OpenCap provided valuable insights into volleyball stop-jump kinematics. Therefore, markerless motion capture can provide coaches and scientists with a deeper understanding of landing performance and related injury mechanisms.

Ultrasound as a predictor of time-loss injury for the patellar tendon, Achilles tendon and plantar fascia in division I collegiate athletes

OBJECTIVES

Tendinopathy and fasciopathy are common conditions that can result in time-loss injury in athletes. This study aimed to determine if preseason sonographic abnormalities of the patellar tendon, Achilles tendon and plantar fascia are associated with future time-loss injuries in collegiate athletes.

METHODS

National Collegiate Athletic Association Division I athletes from three institutions participated in this 3-year prospective, observational study. Each athlete completed a questionnaire, self-reporting current and prior symptoms and underwent an ultrasound examination of bilateral patellar tendons, Achilles tendons and plantar fasciae during annual preseason examinations. Ultrasound evaluations assessed for tendon and fascia thickening, hypoechogenicity and neovascularisation. Athletes were monitored for time-loss injury over the subsequent year.

RESULTS

A total of 695 athletes across 18 sporting disciplines (61.1% female, age 20.0±1.6, body mass index 23.1±2.9 kg/m2) were analysed over 3 years. Sonographic abnormalities were identified in 36.6%, 7.5% and 2.8% of the patellar tendons, Achilles tendons and plantar fasciae, respectively. Injuries were reported in 3.3%, 1.6% and 0.7% of these structures with an adjusted relative risk of injury increased by 8.9 (95% CI 3.7, 21.4), 18.8 (95% CI 7.2, 48.8) and 21.0 (95% CI 6.4, 68.1) times in those with preseason ultrasound abnormalities (p<0.001). The presence of an ultrasound abnormality was more predictive of future injury than self-report of a prior injury or pain in the area at the time of the scan.

CONCLUSION

Preseason sonographic abnormalities of the patellar tendon, Achilles tendon or plantar fascia are associated with a higher risk of developing time-loss injuries in collegiate athletes.

Prevalence of Sonographic Achilles Tendon, Patellar Tendon, and Plantar Fascia Abnormalities in Division I Collegiate Athletes From a Variety of Sports

OBJECTIVE

This study aimed to determine the prevalence of ultrasound abnormalities in the Achilles tendon, patellar tendon, and plantar fascia among a large cohort of collegiate student-athletes.

DESIGN

Observational cross-sectional study.

SETTING

Three Division I institutions.

PARTICIPANTS

243 student-athletes participated in this study. Exclusion criteria included those younger than 18 years or who underwent prior surgery/amputation of structures, including anterior cruciate ligament (ACL) surgeries with patellar tendon grafts.

INTERVENTIONS

Ultrasound examination of the Achilles tendon, patellar tendon, and plantar fascia of each leg was performed. An experienced sonographer reviewed each tendon video in a blinded manner, with a separate experienced sonographer separately reviewing to establish inter-rater reliability.

MAIN OUTCOME MEASURES

The primary outcome measured was the presence of any sonographic abnormality including hypoechogenicity, thickening, or neovascularity.

RESULTS

Ultrasound abnormalities were identified in 10.1%, 37.2%, and 3.9% of all Achilles tendons, patellar tendons, and plantar fasciae, respectively. Abnormalities were significantly associated with the presence of concurrent pain for all structures ( P < 0.01). Specifically, athletes with sonographic abnormalities were approximately 4 times [relative risk (RR) = 4.25; 95% confidence interval (CI), 2.05-8.84], 6 times (RR = 5.69; 95% CI, 2.31-14.00), and 5 times (RR = 5.17; 95% CI, 1.76-15.25) more likely to self-report pain in the Achilles tendon, patellar tendon, and plantar fascia, respectively.

CONCLUSIONS

This multi-institutional study completed at 3 Division I institutions is the largest study of its kind to identify the prevalence of sonographic abnormalities in the Achilles tendon, patellar tendon, and plantar fascia among collegiate student-athletes of various sports.

The Best Current Research on Patellar Tendinopathy: A Review of Published Meta-Analyses

Patellar tendinopathy is a frequent overuse injury in sports that can cause significant pain and disability. It requires evidence-based guidelines on effective prevention and management. However, optimal treatments remain uncertain. We aimed to analyze available meta-analyses to summarize treatment recommendations, compare therapeutic modalities, examine included trials, and offer methodological suggestions to improve future systematic reviews. Meta-analyses were systematically searched for in PubMed (PROSPERO: CRD42023457963). A total of 21 meta-analyses were included. The AMSTAR-2 scale assessed study quality, which was low, with only 23.8% of the meta-analyses being of moderate quality, and none were considered to be of high quality. Heterogeneous outcomes are reported. Multiple platelet-rich plasma (PRP) injections appear superior to eccentric exercises and provide lasting improvements compared to eccentric exercises when conservative treatments fail. Extracorporeal shockwave therapy (ESWT) also seems superior to non-operative options and similar to surgery for patellar tendinopathy in the long term. However, evidence for eccentric exercise efficacy remains unclear due to inconclusive findings. Preliminary findings also emerged for genetic risk factors and diagnostic methods but require further confirmation. This review reveals a lack of high-quality evidence on optimal patellar tendinopathy treatments. While PRP and ESWT show promise, limitations persist. Further rigorous meta-analyses and trials are needed to strengthen the evidence base and guide clinical practice. Methodological enhancements are proposed to improve future meta-analyses.

Consequences of Patellar Tendinopathy on Isokinetic Knee Strength and Jumps in Professional Volleyball Players

Patellar tendinopathy (PT) in professional volleyball players can have an impact on their careers. We evaluated the impact of this pathology in this specific population in terms of isokinetic strength and jumping performances. Thirty-six professional male volleyball players (mean age: 24.8 ± 5.2) performed isokinetic knee assessments, single-leg countermovement jumps and one leg hop test. They filled out the Victorian Institute of Sport Assessment-Patella (VISA-P) score. Two groups were assessed: “PT group” (n = 15) and “control group” (n = 21). The VISA-P score was lower in the PT group (p < 0.0001). No difference was found between the isokinetic strength limb symmetry index and the jump performance limb symmetry index. The healthy legs of the control group were compared with the affected (PT+) and the unaffected legs (PT−) of the PT group. Compared with the healthy legs, both PT+ and PT− legs showed decreased values of quadriceps and hamstring strengths. Only PT+ legs scored lower than healthy legs in countermovement jumps and hop tests. No differences were found between PT+ and PT− legs for muscle strengths and jumps. A low correlation existed between quadriceps strength and jumping performances (r > 0.3; p < 0.001). Volleyball players with PT showed a decrease in the isokinetic knee strength. This strength deficit was found both on the symptomatic legs and the asymptomatic ones. Jumps were only significantly altered on the pathological legs. Highlighting that the unaffected limbs were also impaired in addition to the affected limbs may help provide a better adaptation of the rehabilitation management.

Injury Epidemiology and Time Lost From Participation in Women's NCAA Division I Indoor Versus Beach Volleyball Players

Background:

Beach volleyball officially became a National Collegiate Athletic Association (NCAA) Division I sport in 2015-2016. Few studies have examined the epidemiology of injuries in indoor versus beach volleyball in NCAA Division I athletes.

Purpose:

To compare the epidemiology of injuries and time lost from participation between female NCAA Division I athletes who participate in indoor versus beach volleyball.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Injury surveillance data (2003-2020) were obtained using an institutional database for all NCAA Division I women’s beach or indoor volleyball athletes. The total injury rate was expressed per 1000 hours played. The injury rate per body site was calculated by dividing the number of injuries in each body region by the total number of injuries. The frequency of injury per body site was also expressed as number of injuries per 1000 hours of practice or number of injuries per 1000 hours of game. The injury rate (total and per body site) and time lost from participation were compared between indoor and beach volleyball athletes.

Results:

Participants were 161 female NCAA Division I volleyball athletes (53 beach volleyball and 108 indoor volleyball athletes). In total, 974 injuries were recorded: 170 in beach volleyball and 804 in indoor volleyball. The injury rates for beach versus indoor volleyball were 1.8 versus 5.3 injuries per 1000 hours played (P < .0001). Indoor volleyball athletes had significantly higher injury rates compared with beach volleyball players for concussion (7.5% vs 6.5%; P < .0001) and knee injury (16.7% vs 7.6%; P = .0004); however, the rate of abdominal muscle injury was significantly higher in beach versus indoor volleyball (11.8% vs 4.7%; P = .0008). Time lost from sport participation was significantly longer in beach versus indoor volleyball for knee (24 vs 11 days; P = .047), low back (25 vs 17 days; P = .0009), and shoulder (52 vs 28 days; P = .001) injuries.

Conclusion:

Based on this study, injury was more likely to occur in indoor compared with beach volleyball. Sport-related concussion and knee injuries were more common in indoor volleyball, but the rate of abdominal muscle injury was higher in beach volleyball. Beach volleyball players needed longer time to recover after injuries to the knee, low back, and shoulder.