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Ophey M, Koëter S, van Ooijen L, van Ark M, Boots F, Ilbrink S, Lankhorst NA, Piscaer T, Vestering M, den Ouden Vierwind M, van Linschoten R, van Berkel S. Dutch multidisciplinary guideline on anterior knee pain: Patellofemoral pain and patellar tendinopathy. Knee Surg Sports Traumatol Arthrosc 2025; 33:457-469. [PMID: 39045713 PMCID: PMC11792096 DOI: 10.1002/ksa.12367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 07/06/2024] [Accepted: 07/06/2024] [Indexed: 07/25/2024]
Abstract
PURPOSE The purpose of this study was to develop a multidisciplinary guideline for patellofemoral pain (PFP) and patellar tendinopathy (PT) to facilitate clinical decision-making in primary and secondary care. METHODS A multidisciplinary expert panel identified questions in clinical decision-making. Based on a systematic literature search, the strength of the scientific evidence was determined according to the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) method and the weight assigned to the considerations by the expert panel together determined the strength of the recommendations. RESULTS After confirming PFP or PT as a clinical diagnosis, patients should start with exercise therapy. Additional conservative treatments are indicated only when exercise therapy does not result in clinically relevant changes after six (PFP) or 12 (PT) weeks. Pain medications should be reserved for cases of severe pain. The additional value of imaging assessments for PT is limited. Open surgery is reserved for very specific cases of nonresponders to exercise therapy and those requiring additional conservative treatments. Although the certainty of evidence regarding exercise therapy for PFP and PT had to be downgraded ('very low GRADE' and 'low GRADE'), the expert panel advocates its use as the primary treatment strategy. The panel further formulated weaker recommendations regarding additional conservative treatments, pain medications, imaging assessments and open surgery ('very low GRADE' to 'low GRADE' assessment or absence of scientific evidence). CONCLUSION This guideline recommends starting with exercise therapy for PFP and PT. The recommendations facilitate clinical decision-making, and thereby optimizing treatment and preventing unnecessary burdens, risks and costs to patients and society. LEVEL OF EVIDENCE Level V, clinical practice guideline.
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Affiliation(s)
- Martin Ophey
- IJsveldFysio – Private Physiotherapy ClinicNijmegenThe Netherlands
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam UMC LocationUniversity of AmsterdamAmsterdamThe Netherlands
| | - Sander Koëter
- Orthopaedic SurgeryCanisius Wilhelmina HospitalNijmegenThe Netherlands
| | - Lianne van Ooijen
- Profysic – Private Clinic for Sport PodiatryEindhovenThe Netherlands
| | - Mathijs van Ark
- Physiotherapy DepartmentHanze University of Applied SciencesGroningenThe Netherlands
- Centre of Expertise Primary Care (ECEZG)GroningenThe Netherlands
| | - Fred Boots
- Boots Solide WerkenGorinchemThe Netherlands
| | - Shanna Ilbrink
- Jessica Gal Sportartsen, Amsterdam & Sport‐ en BeweegkliniekHaarlemThe Netherlands
| | | | - Tom Piscaer
- Department of Orthopaedics and Sports MedicineErasmus MCRotterdamThe Netherlands
| | - Myrthe Vestering
- Department of RadiologyGelderse Vallei HospitalEdeThe Netherlands
| | | | - Robbart van Linschoten
- Department of Orthopaedics and Sports MedicineErasmus MCRotterdamThe Netherlands
- Region NordjyllandSportsmedicinsk KlinikFrederikshavnDenmark
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Devran S, Gözübüyük ÖB, Dinçer Ş, Günver MG, Bayraktar B. Diagnostic value of shear-wave elastography for patellar tendinopathy in female volleyball and basketball athletes: a cross sectional case control study. PHYSICIAN SPORTSMED 2024; 52:470-477. [PMID: 38243396 DOI: 10.1080/00913847.2024.2308507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/18/2024] [Indexed: 01/21/2024]
Abstract
OBJECTIVES We aim to investigate the accuracy of shear-wave elastography (SWE) in diagnosing patellar tendinopathy in female volleyball and basketball players. In addition, we compared different parts of the patellar tendon and investigated the effects of different knee angles on elastography measurements. METHODS This cross-sectional case-control study evaluated 63 female athletes from professional basketball and volleyball teams (NCT06199583). Patellar tendinopathy diagnoses were made using clinical and ultrasonographic criteria. SWE measurements were taken at 30-degree knee flexion and extension. Rectangular regions of interest boxes were placed in three different parts of the tendon (proximal, middle, distal). The global SWE value was calculated by taking the mean of measurements in the three parts. Receiver operating characteristic (ROC) curves were used to identify significant cutoff points for SWE, and 2 × 2 tables were generated to determine sensitivity and specificity. RESULTS Thirteen (20.6%) of the 63 athletes were diagnosed with patellar tendinopathy. The ROC curves have identified different cutoff scores for SWE measurements. The SWE score of 130.75 from the proximal part showed the highest sensitivity of 89% and specificity of 80% (p < 0.001) with a 4.45 likelihood ratio at the 30-degree knee flexion. The likelihood ratio is 1.5 at a 30-degree angle and 1.65 at a 0-degree angle when measuring the entire tendon, whereas other portions indicate a ratio ranging from 1.12 to 1.73. CONCLUSIONS Shear-wave elastography is a reliable evaluation method for diagnosing patellar tendinopathy. It has more accuracy when applied to the proximal part and at 30-degree knee flexion compared to measurements taken at knee extension and other parts of the tendon.
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Affiliation(s)
- Sergen Devran
- Faculty of Medicine, Sports Medicine Department, Istanbul University, Istanbul, Turkey
| | | | - Şensu Dinçer
- Faculty of Medicine, Sports Medicine Department, Istanbul University, Istanbul, Turkey
| | - Mehmet Güven Günver
- Faculty of Medicine, Biostatistics Department, Istanbul University, Istanbul, Turkey
| | - Bülent Bayraktar
- Faculty of Medicine, Sports Medicine Department, Istanbul University, Istanbul, Turkey
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Kraszewski A, Argentieri E, Harris K, Toresdahl B, Drakos M, Hillstrom H, Allen A, Nwawka OK. Association Between Patellar Tendon Abnormality and Land-Jump Biomechanics in Male Collegiate Basketball Players During the Preseason. Orthop J Sports Med 2024; 12:23259671241242008. [PMID: 38686323 PMCID: PMC11057346 DOI: 10.1177/23259671241242008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 08/29/2023] [Indexed: 05/02/2024] Open
Abstract
Background Patellar tendinopathy is a degenerative condition that predominantly affects jumping athletes. Symptoms may be subtle or nonexistent at preseason, but structural abnormalities may be present. Assessing patellar tendon abnormality (PTA) through magnetic resonance imaging (MRI) and ultrasound (US) and classifying symptoms using the Victorian Institute for Sport Assessment-Patellar tendon (VISA-P) may provide useful insights if combined with biomechanics measurements. Purpose To (1) assess whether land-jump biomechanical patterns are associated with clinically pertinent PTA as seen on imaging and through VISA-P scores and (2) model the contributing risk and accuracy of biomechanics to classify PTA and symptomatic observations. Study Design Cross-sectional study; Level of evidence, 3. Methods A total of 26 National Collegiate Athletic Association Division I and II male basketball players (n = 52 limbs) were recruited during the preseason. We collected VISA-P scores, bilateral PTA through US and MRI morphology measurements, and bilateral 3-dimensional lower extremity kinematics and kinetics measurements from a land-jump test from an 18-inch-high (45.7-cm-high) box. Statistically, each limb was treated independently. The association of biomechanics with PTA and symptoms (VISA-P score <80) was tested with multivariate models and post hoc tests. Logistic regression modeled relative risk and accuracy of biomechanical variables to classify PTA and symptomatic limbs. Results There were 19 to 24 limbs with PTA depending on US and MRI measurements. Differences in hip and knee kinematic strategies and ground-reaction loads were associated with PTA and symptomatic limbs. Peak landing vertical ground-reaction force was significantly decreased (169 ± 26 vs 195 ± 29 %body weight; P = .001), and maximum hip flexion velocity was significantly increased (416 ± 74 vs 343 ± 94 deg/s; P = .005) in limbs with versus without PTA on imaging. Knee flexion at the initial contact was decreased in symptomatic versus healthy limbs (17°± 5° vs 21°± 5°, respectively; P = .045). Regression models classified PTA limbs and symptomatic limbs with 71.2% to 86.5% accuracy. Hip and knee maximum flexion velocity and vertical ground-reaction force variables were most common across models observing clinically pertinent PTA. Conclusion Our findings suggested that functional kinematic and kinetic biomechanical strategies at the hip and knee were associated with PTA, identified on imaging, and symptomatic limbs.
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Affiliation(s)
| | - Erin Argentieri
- University of California–Berkeley, Berkeley, California, USA
| | - Kindred Harris
- University of Arizona College of Medicine, Tucson, Arizona, USA
| | | | - Mark Drakos
- Hospital for Special Surgery, New York, New York, USA
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Alfredson H, Roberts D, Spang C, Waldén M. Ultrasound- and Doppler-Guided WALANT Arthroscopic Surgery for Patellar Tendinopathy with Partial Rupture in Elite Athletes-A 2-Year Follow-Up of a Prospective Case Series. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:541. [PMID: 38674187 PMCID: PMC11051799 DOI: 10.3390/medicina60040541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 03/06/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024]
Abstract
Background and Objectives: Patellar tendinopathy is difficult to treat, and when combined with partial rupture, there are additional challenges. The aim of this study was to evaluate the subjective outcome and return-to-sport status after ultrasound (US)- and colour doppler (CD)-guided wide awake local anaesthetic no tourniquet (WALANT) arthroscopic shaving in elite athletes. Material and Methods: Thirty Swedish and international elite athletes (27 males) with a long duration (>1 year) of persistent painful patellar tendinopathy in 35 patellar tendons, not responding to non-surgical treatment, were included. All patients were treated with the same protocol of arthroscopic shaving, including bone removal and debridement of partial rupture, followed by at least 3 months of structured rehabilitation. The VISA-P score and a study-specific questionnaire evaluating physical activity level and subjective satisfaction with the treatment were used for evaluation. Results: At the 2-year follow-up (mean 23, range 8-38 months), 25/30 patients (29/35 tendons) were satisfied with the treatment result and had returned to their pre-injury sport. The mean VISA-P score increased from 37 (range 7-69) before surgery to 80 (range 44-100) after surgery (p < 0.05). There was one drop-out (one tendon). There were no complications. Conclusions: US- and CD-guided WALANT arthroscopic shaving for persistent painful patellar tendinopathy, including bone removal and debridement of partial rupture, followed by structured rehabilitation showed good clinical results in the majority of the elite-level athletes.
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Affiliation(s)
- Håkan Alfredson
- Sports Medicine Unit, Department of Community Medicine and Rehabilitation, Umeå University, 90187 Umeå, Sweden
- Alfredson Tendon Clinic, Capio Ortho Center Skåne, 21532 Malmö, Sweden
| | - David Roberts
- Capio Ortho Center Skåne, 21532 Malmö, Sweden; (D.R.); (M.W.)
| | - Christoph Spang
- Anatomy Section, Department of Integrative Medical Biology, Umeå University, 90187 Umeå, Sweden;
- Institute for Sports Science, Würzburg University, 97082 Würzburg, Germany
- Private Orthopaedic Spine Center, 97080 Würzburg, Germany
| | - Markus Waldén
- Capio Ortho Center Skåne, 21532 Malmö, Sweden; (D.R.); (M.W.)
- Department of Health, Medicine and Caring Sciences, Linköping University, 58183 Linköping, Sweden
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Ruffino D, Alfonso M, Campana V, Malliaras P. Sensitivity to change and responsiveness of provocative load tests among athletes with patellar tendinopathy. Braz J Phys Ther 2024; 28:101064. [PMID: 38696973 PMCID: PMC11070825 DOI: 10.1016/j.bjpt.2024.101064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/11/2024] [Accepted: 04/22/2024] [Indexed: 05/04/2024] Open
Abstract
BACKGROUND Pain provocation tests are recommended for assessing pain severity and as an outcome measure for individuals with patellar tendinopathy. OBJECTIVE To evaluate floor and ceiling effects, sensitivity to change, and responsiveness cut-offs of two provocative load tests among athletes with patellar tendinopathy. METHODS Athletes (N = 41) performed six repetitions for the single leg decline squat (SLDS) and resisted knee extension (KE) at baseline and 12 weeks. Participants rated their pain during each test on a visual analog scale (VAS). Sensitivity to change was assessed by calculating effect size (ES) and the standardized response mean (SRM). The responsiveness cut-offs were assessed using a combination of anchor and distribution- based methods to determine the minimal clinically important difference (MCID) for each test. RESULTS A floor or ceiling effect was observed in only a small number of participants for both tests except for KE, for which approximately one third of participants had a floor effect at week 12. There was higher sensitivity to change for SLDS (ES: 1.93/SRM: 1.43) compared with KE (ES:0.96/SRM: 1.09). The MCID corresponded to a decrease of 1.6 points for SLDS and 1.0 for KE, while the distribution-based method estimated 1.2 points for SLDS and 1.1 for KE. CONCLUSION This study found moderate to high sensitivity to change and established MCID values for the SLDS and KE test in athletes with patellar tendinopathy before and after rehabilitation. Both tests may be useful as pain on loading outcomes as athletes progress with their rehabilitation, but the KE test results in higher floor effects and has lower sensitivity to change.
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Affiliation(s)
- Diego Ruffino
- Escuela de Kinesiología y Fisioterapia, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina.
| | - Matías Alfonso
- Cátedra de Psicoestadística Descriptiva e Inferencial. Facultad de Psicología, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Vilma Campana
- Cátedra Física Biomédica, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Peter Malliaras
- Physical Therapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Sciences, Monash University, Frankston, Australia
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Agergaard AS, Comins JD, Siersma V, Malmgaard-Clausen NM, Couppe C, Hjortshoej MH, Olesen JL, Magnusson SP. Assessment of the Psychometric Properties of the Danish VISA-P. TRANSLATIONAL SPORTS MEDICINE 2023; 2023:5291949. [PMID: 38654908 PMCID: PMC11022774 DOI: 10.1155/2023/5291949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/15/2023] [Accepted: 04/06/2023] [Indexed: 04/26/2024]
Abstract
Purpose The objective of the current study was to conduct a rigorous assessment of the psychometric properties of the Victorian Institute of Sports Assessment-patellar tendinopathy (VISA-P). Methods Rasch analysis, confirmatory factor analysis (CFA), and multivariable linear regression were used to assess the psychometric properties of the VISA-P questionnaire in 184 Danish patients with patellar tendinopathy who had symptoms ranging from under 3 months to over 1 year. A group of 100 healthy Danish persons was included as a reference for known-group validation. Results The analyses revealed that the 8-item VISA-P did not fit a unidimensional model, yielded at best a 3-factor model, and exhibited differential item functioning (DIF) across healthy subjects versus people with patellar tendinopathy. Conclusion VISA-P in its present form does not satisfy a measurement model and is not a robust scale for measuring patellar tendinopathy. A new PROM for patellar tendinopathy should be developed and appropriately validated, and meanwhile, simple pain scoring (e.g., numeric rating scales) and functional tests are suggested as more appropriate outcome measures for studies of patellar tendinopathy.
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Affiliation(s)
- Anne-Sofie Agergaard
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark
- Center for Healthy Aging, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
| | - Jonathan D. Comins
- Section for Sports Traumatology M51, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
- Novo Nordisk A/S, Søborg, Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Nikolaj M. Malmgaard-Clausen
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark
- Center for Healthy Aging, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christian Couppe
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark
- Center for Healthy Aging, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
| | - Mikkel H. Hjortshoej
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark
- Center for Healthy Aging, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
| | - Jens L. Olesen
- Research Unit for General Practice in Aalborg, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - S. Peter Magnusson
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark
- Center for Healthy Aging, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
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Sharif F, Ahmad A, Gilani SA, Bacha R, Hanif A, Arif MA. Efficacy of ultrasound guided dry needling as an adjunct to conventional physical therapy for patients with jumper’s knee: A randomized controlled trial. Front Surg 2022; 9:1023902. [PMID: 36406368 PMCID: PMC9672502 DOI: 10.3389/fsurg.2022.1023902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022] Open
Abstract
Background Jumper’s knee is a degenerative condition among athletes, and it has been treated with conventional physical therapy (CPT). Ultrasound guided dry needling (USG-DN) is a relatively new technique to explore clinical outcomes in patients with tendinopathy. Methods This parallel group, single-blinded randomized controlled trial was carried out involving 94 athletes with clinically diagnosed jumper’s knee, divided into an intervention group (USG-DN + CPT, n = 47) and a control group (CPT, n = 47). Participants received a 4-week programme; the intervention group received ultrasound guided patellar tendon dry needling (DN) in conjunction with CPT. The control group received only CPT. The visual analog scale (VAS), Victorian institute of sports assessment-Patellar tendinopathy (VISA-P) questionnaire, Lysholm scale, Knee injury and osteoarthritis outcome score (KOOS) and ultrasonographic features of patellar tendinopathy were evaluated at baseline,1 week, 2 weeks, and 4 weeks. The data were analyzed through SPSS-26. Results The study found statistically significant differences (P < 0.05) regarding VAS, Lysholm, VISA-P, and KOOS scales at baseline, 1st, 2nd, and 4th week post-intervention. Within-group differences also showed statistically significant results after the intervention. There were significant results observed in ultrasonographic outcomes between both groups at 1 month post-intervention (all P < 0.05). Conclusion The results of the current study suggest, ultrasound guided DN of patellar tendon in combination with CPT reduced pain, improved function, and showed a tendency to decrease tendon thickness in patients with patellar tendinopathy. Clinical Trial Registration Number (IRCT20210409050913N1). Dated: 17.04.2021. https://www.irct.ir/user/trial/55607/view.
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Affiliation(s)
- Faiza Sharif
- University Institute of Physical Therapy, The University of Lahore, Lahore, Pakistan
- Correspondence: Faiza Sharif Ashfaq Ahmad
| | - Ashfaq Ahmad
- Faculty of Allied Health Sciences, The University of Lahore, Lahore, Pakistan
- Correspondence: Faiza Sharif Ashfaq Ahmad
| | - Syed Amir Gilani
- Faculty of Allied Health Sciences, The University of Lahore, Lahore, Pakistan
| | - Raham Bacha
- University Institute of Radiological Sciences and Medical Imaging Technology, University of Lahore, Lahore, Pakistan
| | - Asif Hanif
- University Institute of Public Health, Faculty of Allied Health Sciences, University of Lahore, Lahore, Pakistan
| | - Muhammad Asim Arif
- University Institute of Physical Therapy, The University of Lahore, Lahore, Pakistan
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Location of anterior knee pain affects load tolerance in isometric single leg knee extension. J Sci Med Sport 2022; 25:569-573. [DOI: 10.1016/j.jsams.2022.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 01/24/2022] [Accepted: 03/20/2022] [Indexed: 11/21/2022]
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Hannington M, Tait T, Docking S, Cook J, Owoeye O, Bonello C, Emery C, Pasanen K, Edwards S, Rio E. Prevalence and pain distribution of anterior knee pain in college basketball players. J Athl Train 2021; 57:319-324. [PMID: 34329433 DOI: 10.4085/1062-6050-0604.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Causes of anterior knee pain (AKP) in jumping athletes include patellofemoral pain and patellar tendinopathy. Differential diagnosis of AKP is challenging, with variation in clinical presentations. No previous research has used pain location to describe AKP in basketball athletes. OBJECTIVES To describe the prevalence and pain distribution of AKP in college basketball. To report the prevalence of focal inferior pole pain using two outcome measures. DESIGN Cross-sectional study Setting: University and college basketball facilities in Alberta, Canada. PATIENTS OR OTHER PARTICIPANTS 242 collegiate basketball athletes Main Outcome Measure(s): The single leg decline squat test (SLDS) was used to capture pain location using pain mapping (dichotomised into focal/diffuse) and pain severity (numerical rating scale). The Oslo Sports Trauma Research Centre Knee questionnaire (OSTRC-Knee) and adapted version for patellar tendinopathy (OSTRC-P) were used to report the prevalence of anterior knee pain (AKP) and patellar tendinopathy respectively. Focal inferior pole pain during the SLDS was used to classify patellar tendinopathy. RESULTS Of the 242 players (138 women, 104 men), 146 (60%) reported pain with the SLDS [unilateral n=64, (26%); bilateral n=82 (34%)]. 101 (43%) reported knee pain using the OSTRC-Knee. Pain mapping captured variability in pain location. Diffuse pain was more prevalent [left 70%; right 72%] than focal pain [left 30%; right 28%]. There was low prevalence of patellar tendinopathy with either outcome measure; OSTRC-P [n=21, 8.7%] and inferior pole pain during the SLDS [n=25, 10.3%] Conclusions: Diffuse AKP was common in Canadian basketball players, however pain mapped to the inferior pole of the patella was not. Few players reported tendinopathy using the OSTRC-P, suggesting that patellar tendinopathy was not a primary knee pain presentation in this jumping cohort. Pain location rather than presence or severity of pain alone may better describe the clinical presentations of AKP in jumping athletes.
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Affiliation(s)
- Madeline Hannington
- 1La Trobe Sport and Exercise Medicine Research Centre; College of Science, Health and Engineering; La Trobe University; Australia
| | - Tyler Tait
- 2Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Sean Docking
- 1La Trobe Sport and Exercise Medicine Research Centre; College of Science, Health and Engineering; La Trobe University; Australia
| | - Jill Cook
- 1La Trobe Sport and Exercise Medicine Research Centre; College of Science, Health and Engineering; La Trobe University; Australia
| | - Oluwatoyosi Owoeye
- 2Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,8Department of Physical Therapy and Athletic Training, Doisy College of Health Sciences, Saint Louis University, St. Louis, MO, United States
| | - Christian Bonello
- 1La Trobe Sport and Exercise Medicine Research Centre; College of Science, Health and Engineering; La Trobe University; Australia
| | - Carolyn Emery
- 2Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,4Departments of Pediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,5Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,6McCaig Research Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
| | - Kati Pasanen
- 2Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,5Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,6McCaig Research Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada.,7Tampere Research Center of Sport Medicine, UKK Institute, Tampere, Finland
| | - Suzi Edwards
- 2Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Ebonie Rio
- 1La Trobe Sport and Exercise Medicine Research Centre; College of Science, Health and Engineering; La Trobe University; Australia
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Pietrosimone LS, Blackburn JT, Wikstrom EA, Berkoff DJ, Docking SI, Cook J, Padua DA. Differences in Biomechanical Loading Magnitude During a Landing Task in Male Athletes with and without Patellar Tendinopathy. J Athl Train 2021; 57:464343. [PMID: 33887762 PMCID: PMC9875712 DOI: 10.4085/1062-6050-0548.20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
CONTEXT Prior research has not established if overloading or underloading movement profiles are present in symptomatic and asymptomatic athletes with patellar tendon structural abnormality (PTA) compared to healthy athletes. OBJECTIVE The purpose was to compare involved limb landing biomechanics between male athletes with and without patellar tendinopathy. DESIGN Cross-sectional study Setting: Laboratory Patients or Other Participants: 43 males were grouped based on patellar tendon pain & ultrasound imaging of the proximal patellar tendon: symptomatic with PTA (SYM-PTA; n=13; 20±2yrs; 1.8±0.1m; 84±5kg), asymptomatic with PTA (ASYM-PTA; n=15; 21±2yrs; 1.8±0.1m; 82±13kg), and healthy control (CON; n=15; 20±2yrs; 1.8±0.1m; 79±12kg). MAIN OUTCOME MEASURES 3D biomechanics were collected during double-limb jump-landing. Kinematic (knee flexion angle (KF)) and kinetic (vertical ground reaction force (VGRF); internal knee extension moment (KEM); patellar tendon force (FPT)) variables were analyzed as continuous waveforms during the stance phase for the involved limb. Mean values were calculated for each 1% of stance, normalized over 202 data points (0-100%), and plotted with 95% confidence intervals. Statistical significance was defined as a lack of 95% CI overlap for ≥ 6 consecutive data points. RESULTS SYM-PTA had lesser KF than CON throughout the stance phase. ASYM-PTA had lesser KF than CON in the early and late stance phase. SYM-PTA group had lesser KEM and FPT than CON in early stance, as well as ASYM-PTA in mid-stance. CONCLUSIONS Male athletes with SYM-PTA demonstrated a patellar tendon load-avoidance profile compared to ASYM-PTA and CON athletes. ASYM-PTA did not show evidence of overloading compared to CON. Our findings support the need for individualized treatments for athletes with tendinopathy to maximize load-capacity. TRIAL REGISTRY ClinicalTrials.gov (#XXX).
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Affiliation(s)
| | - J. Troy Blackburn
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Department of Orthopaedics, University of North Carolina at Chapel Hill
| | - Erik A. Wikstrom
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - David J. Berkoff
- Department of Orthopaedics, University of North Carolina at Chapel Hill
| | - Sean I. Docking
- La Trobe Sports and Exercise Research Centre, La Trobe University, Bundoora, Australia
| | - Jill Cook
- La Trobe Sports and Exercise Research Centre, La Trobe University, Bundoora, Australia
| | - Darin A. Padua
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Department of Orthopaedics, University of North Carolina at Chapel Hill
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Agergaard AS, Svensson RB, Malmgaard-Clausen NM, Couppé C, Hjortshoej MH, Doessing S, Kjaer M, Magnusson SP. Clinical Outcomes, Structure, and Function Improve With Both Heavy and Moderate Loads in the Treatment of Patellar Tendinopathy: A Randomized Clinical Trial. Am J Sports Med 2021; 49:982-993. [PMID: 33616456 DOI: 10.1177/0363546520988741] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Loading interventions have become a predominant treatment strategy for tendinopathy, and positive clinical outcomes and tendon tissue responses may depend on the exercise dose and load magnitude. PURPOSE/HYPOTHESIS The purpose was to investigate if the load magnitude influenced the effect of a 12-week loading intervention for patellar tendinopathy in the short term (12 weeks) and long term (52 weeks). We hypothesized that a greater load magnitude of 90% of 1 repetition maximum (RM) would yield a more positive clinical outcome, tendon structure, and tendon function compared with a lower load magnitude of 55% of 1 RM when the total exercise volume was kept equal in both groups. STUDY DESIGN Randomized clinical trial; Level of evidence, 1. METHODS A total of 44 adult participants with chronic patellar tendinopathy were included and randomized to undergo moderate slow resistance (MSR group; 55% of 1 RM) or heavy slow resistance (HSR group; 90% of 1 RM). Function and symptoms (Victorian Institute of Sport Assessment-Patella questionnaire [VISA-P]), tendon pain during activity (numeric rating scale [NRS]), and ultrasound findings (tendon vascularization and swelling) were assessed before the intervention, at 6 and 12 weeks during the intervention, and at 52 weeks from baseline. Tendon function (functional tests) and tendon structure (ultrasound and magnetic resonance imaging) were investigated before and after the intervention period. RESULTS The HSR and MSR interventions both yielded significant clinical improvements in the VISA-P score (mean ± SEM) (HSR: 0 weeks, 58.8 ± 4.3; 12 weeks, 70.5 ± 4.4; 52 weeks, 79.7 ± 4.6) (MSR: 0 weeks, 59.9 ± 2.5; 12 weeks, 72.5 ± 2.9; 52 weeks, 82.6 ± 2.5), NRS score for running, NRS score for squats, NRS score for preferred sport, single-leg decline squat, and patient satisfaction after 12 weeks, and these were maintained after 52 weeks. HSR loading was not superior to MSR loading for any of the measured clinical outcomes. Similarly, there were no differences in functional (strength and jumping ability) or structural (tendon thickness, power Doppler area, and cross-sectional area) improvements between the groups undergoing HSR and MSR loading. CONCLUSION There was no superior effect of exercising with a high load magnitude (HSR) compared with a moderate load magnitude (MSR) for the clinical outcome, tendon structure, or tendon function in the treatment of patellar tendinopathy in the short term. Both HSR and MSR showed equally good, continued improvements in outcomes in the long term but did not reach normal values for healthy tendons. REGISTRATION NCT03096067 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Anne-Sofie Agergaard
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Bispebjerg and Frederiksberg Hospital and Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Rene B Svensson
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Bispebjerg and Frederiksberg Hospital and Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Nikolaj M Malmgaard-Clausen
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Bispebjerg and Frederiksberg Hospital and Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christian Couppé
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Bispebjerg and Frederiksberg Hospital and Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel H Hjortshoej
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Bispebjerg and Frederiksberg Hospital and Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Simon Doessing
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Bispebjerg and Frederiksberg Hospital and Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Michael Kjaer
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Bispebjerg and Frederiksberg Hospital and Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - S Peter Magnusson
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Bispebjerg and Frederiksberg Hospital and Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
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12
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IN-SEASON REHABILITATION PROGRAM USING BLOOD FLOW RESTRICTION THERAPY FOR TWO DECATHLETES WITH PATELLAR TENDINOPATHY: A CASE REPORT. Int J Sports Phys Ther 2020; 15:1184-1195. [PMID: 33344034 DOI: 10.26603/ijspt20201184] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background and Purpose Patellar tendinopathy is an overuse injury experienced primarily by athletes; especially athletes who participate in sports that involve frequent jumping. Therapeutic exercise is the primary conservative treatment for patients with this condition. However, some patients with patellar tendinopathy may be unable to tolerate the loading that occurs during exercise. The use of blood flow restriction (BFR) therapy for patients with patellar tendinopathy may allow the athlete to exercise with a lower load while still experiencing the physiological benefits associated with training at a higher intensity. The purpose of this case report was to detail the outcomes from a rehabilitation program utilizing BFR for two collegiate decathletes with patellar tendinopathy. Study Design Case ReportCase Descriptions and Interventions: Two NCAA Division III freshmen collegiate decathletes with a history of left knee pain prior to college and who had been complaining of increasing pain during the initial month of track practices. Findings from the musculoskeletal examinations included left sided lower extremity weakness, pain during functional testing, pain when palpating the left patellar tendon, and VISA-P scores less than 80. Ultrasound imaging at baseline revealed thickened tendons on the left with hypoechoic regions. Both athletes participated in 20 therapy sessions consisting of therapeutic exercises performed with BFR. Outcomes Both athletes experienced improvements in pain scores, increases in lower extremity strength, improved functional test performance, higher VISA-P scores, and improvements in tendon size and appearance as measured by diagnostic ultrasound. Conclusion Both athletes experienced improvements with the BFR-based therapeutic exercise program and were able to compete throughout the track season. The use of BFR may allow patients who are unable to tolerate exercise due to pain an alternative approach during rehabilitation. Future research should compare therapeutic exercise programs for this condition with and without BFR. Level of Evidence Level V.
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Abián P, Martínez F, Jiménez F, Abián-Vicén J. Effects of Eccentric Single-Leg Decline Squat Exercise on the Morphological and Structural Properties of the Vastus Lateralis and Patellar Tendon. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249410. [PMID: 33333987 PMCID: PMC7765369 DOI: 10.3390/ijerph17249410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/13/2020] [Accepted: 12/14/2020] [Indexed: 12/23/2022]
Abstract
The purpose was to examine the effect of 6-week eccentric single-leg decline squat (SLDSe) training with two technical execution times (3 s or 6 s) on changes related to the structural properties of the vastus lateralis (VL) and patellar tendon (PT). Thirty-six physical active volunteers were randomly divided into three groups: control group (CG, n = 13, age = 20.8 ± 1.9 years, no intervention program), experimental group 1 (EG1, n = 11, age = 21.6 ± 2.5 years, execution time = 6 s) and experimental group 2 (EG2, n = 12, 21.1 ± 1.2 years, execution time = 3 s). Participants completed a 6-week SLDSe training program (80% of 1-RM) three days a week. The structural characteristics of the VL and the PT were measured with ultrasonography before and after 6-week SLDSe training and after 6 weeks of de-training. Our results indicate that EG1 increased ≈21.8% the thickness of the PT and EG2 increased ≈15.7% the thickness of the VL after the 6-week intervention program. EG1 and EG2 showed greater values (p < 0.05) of lean mass and lower values (p < 0.05) of fat percentage on the thigh after the intervention program. In conclusion, the SLDSe training carried out with the execution time of 6 s had greater effects on the structural and elastic properties of the PT, and the exercise with the execution time of 3 s caused greater structural adaptations in the VL musculature.
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Affiliation(s)
- Pablo Abián
- Faculty of Humanities and Social Sciences, Comillas Pontifical University, 28049 Madrid, Spain;
| | - Fernando Martínez
- Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, 45071 Toledo, Spain; (F.M.); (F.J.)
| | - Fernando Jiménez
- Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, 45071 Toledo, Spain; (F.M.); (F.J.)
| | - Javier Abián-Vicén
- Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, 45071 Toledo, Spain; (F.M.); (F.J.)
- Correspondence: ; Tel.: +34-925268800 (ext. 5522)
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14
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Coombes BK, Mendis MD, Hides JA. Evaluation of patellar tendinopathy using the single leg decline squat test: Is pain location important? Phys Ther Sport 2020; 46:254-259. [PMID: 33059234 DOI: 10.1016/j.ptsp.2020.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/28/2020] [Accepted: 10/02/2020] [Indexed: 12/23/2022]
Abstract
STUDY DESIGN A cross-sectional study of non-elite volleyball players aged 13-17years. OBJECTIVES To evaluate the presence and location of pain during the single leg decline squat (SLDS) and compare patellar tendon thickness, structure, neovascularisation and symptom severity between SLDS-derived groups. METHODS 32 male and 25 female participants attending a 5-day volleyball training camp underwent clinical evaluation by SLDS, describing the location of pain during this test using a pain map. The patellar tendon was examined using ultrasound imaging, performed by an assessor blinded to other assessments. Differences between participants experiencing local patellar tendon pain (PTP), other knee pain (OKP) or no-pain during the SLDS were evaluated. RESULTS Fifteen (26.3%) participants experienced pain during the SLDS. Local PTP was recorded for 12.3% and OKP for 10.5% of right legs. The PTP group was distinguished from the other groups by larger thickness and cross-sectional area of the mid-patellar tendon (p < 0.001), more frequent neovascularisation (p = 0.005) and greater pain and disability (p < 0.036). No differences between OKP and no-pain groups was observed. CONCLUSION Adolescent non-elite volleyball players reported symptoms indicative of patellar tendinopathy. In this cohort, the SLDS test combined with a pain map was associated with imaging and questionnaire-based outcomes. LEVEL OF EVIDENCE Diagnosis, Level 2; Cross-sectional study.
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Affiliation(s)
- Brooke K Coombes
- Griffith University, School of Allied Health Sciences, Nathan, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Queensland, Australia.
| | - M Dilani Mendis
- Griffith University, School of Allied Health Sciences, Nathan, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Julie A Hides
- Griffith University, School of Allied Health Sciences, Nathan, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Queensland, Australia
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15
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Masci L, Alfredson H, Neal B, Wynter Bee W. Ultrasound-guided tendon debridement improves pain, function and structure in persistent patellar tendinopathy: short term follow-up of a case series. BMJ Open Sport Exerc Med 2020; 6:e000803. [PMID: 32789022 PMCID: PMC7380954 DOI: 10.1136/bmjsem-2020-000803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2020] [Indexed: 01/17/2023] Open
Abstract
There is a need for effective therapeutic options for resistant patellar tendinopathy. Ultrasound (US)-guided arthroscopic debridement has demonstrated promising clinical results.
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Affiliation(s)
- Lorenzo Masci
- Department of Sports and Execise Medicine, Queen Mary University of London, London, UK.,Department of Sports and Exercise Medicine, ISEH, London, UK
| | - Hakan Alfredson
- Department of Community Medicine and Rehabilitation, Sports Medicine, Umeå University, Umea, Sweden.,Clinical Research, Pure Sports Medicine, London, UK
| | - Brad Neal
- Department of Sports and Execise Medicine, Queen Mary University of London, London, UK.,Clinical Research, Pure Sports Medicine, London, UK
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Hannington M, Docking S, Cook J, Edwards S, Rio E. Self-reported jumpers’ knee is common in elite basketball athletes – But is it all patellar tendinopathy? Phys Ther Sport 2020; 43:58-64. [DOI: 10.1016/j.ptsp.2020.01.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 01/20/2020] [Accepted: 01/20/2020] [Indexed: 12/30/2022]
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17
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Landing Biomechanics, But Not Physical Activity, Differ in Young Male Athletes With and Without Patellar Tendinopathy. J Orthop Sports Phys Ther 2020; 50:158-166. [PMID: 31905096 DOI: 10.2519/jospt.2020.9065] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To examine differences in biomechanical and physical activity load in young male athletes with and without patellar tendinopathy. DESIGN Cross-sectional cohort study. METHODS Forty-one young male athletes (15-28 years of age) were categorized into 3 distinct groups: symptomatic athletes with patellar tendon abnormalities (PTA) (n = 13), asymptomatic athletes with PTA (n = 14), and a control group of asymptomatic athletes without PTA (n = 14). Participants underwent a laboratory biomechanical jump-landing assessment and wore an accelerometer for 1 week of physical activity monitoring. RESULTS The symptomatic group demonstrated significantly less patellar tendon force loading impulse in the involved limb compared with both the control and asymptomatic groups (P<.05), with large effects (d = 0.91-1.40). There were no differences in physical activity between the 3 groups (P>.05). CONCLUSION Young male athletes with symptomatic patellar tendinopathy demonstrated smaller magnitudes of patellar tendon force loading impulse during landing compared to both asymptomatic athletes with patellar tendinopathy and healthy control participants. However, these 3 distinct groups did not differ in general measures of physical activity. Future investigations should examine whether comprehensively monitoring various loading metrics may be valuable to avoid both underloading and overloading patterns in athletes with patellar tendinopathy. J Orthop Sports Phys Ther 2020;50(3):158-166. Epub 6 Jan 2020. doi:10.2519/jospt.2020.9065.
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18
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Meir R, Chapman N, Whitting JW, Crowley-McHattan ZJ. A Strategy for Assessing Acute (Transient) Pain or Discomfort in the Strength and Conditioning Environment. Strength Cond J 2019. [DOI: 10.1519/ssc.0000000000000491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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19
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Ho KY, Harty M, Kellogg J, Teter K, Lee SP, Chang YJ, Bashford G. Patellar tendon morphology in trans-tibial amputees utilizing a prosthesis with a patellar-tendon-bearing feature. Sci Rep 2019; 9:16392. [PMID: 31704989 PMCID: PMC6841932 DOI: 10.1038/s41598-019-52747-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 10/22/2019] [Indexed: 11/09/2022] Open
Abstract
A patellar-tendon-bearing (PTB) bar is a common design feature used in the socket of trans-tibial prostheses to place load on the pressure-tolerant tissue. As the patellar tendon in the residual limb is subjected to the perpendicular compressive force not commonly experienced in normal tendons, it is possible for tendon degeneration to occur over time. The purpose of this study was to compare patellar tendon morphology and neovascularity between the residual and intact limbs in trans-tibial amputees and healthy controls. Fifteen unilateral trans-tibial amputees who utilized a prosthesis with a PTB feature and 15 age- and sex- matched controls participated. Sonography was performed at the proximal, mid-, and distal portions of each patellar tendon. One-way ANOVAs were conducted to compare thickness and collagen fiber organization and a chi-square analysis was used to compare the presence of neovascularity between the three tendon groups. Compared to healthy controls, both tendons in the amputees exhibited increased thickness at the mid- and distal portions and a higher degree of collagen fiber disorganization. Furthermore, neovascularity was more common in the tendon of the residual limb. Our results suggest that the use of a prosthesis with a PTB feature contributes to morphological changes in bilateral patellar tendons.
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Affiliation(s)
- Kai-Yu Ho
- Department of Physical Therapy, University of Nevada, Las Vegas, 4505 S. Maryland Pkwy, Las Vegas, NV, 89154, USA.
| | - Michelle Harty
- Department of Physical Therapy, University of Nevada, Las Vegas, 4505 S. Maryland Pkwy, Las Vegas, NV, 89154, USA
| | - Jessica Kellogg
- Department of Physical Therapy, University of Nevada, Las Vegas, 4505 S. Maryland Pkwy, Las Vegas, NV, 89154, USA
| | - Kelly Teter
- Department of Physical Therapy, University of Nevada, Las Vegas, 4505 S. Maryland Pkwy, Las Vegas, NV, 89154, USA
| | - Szu-Ping Lee
- Department of Physical Therapy, University of Nevada, Las Vegas, 4505 S. Maryland Pkwy, Las Vegas, NV, 89154, USA
| | - Yu-Jen Chang
- Division of Physical Therapy, West Virginia University, 64 Medical Center Drive, P.O. Box 9226, Morgantown, WV, 26506, USA
| | - Gregory Bashford
- Department of Biological Systems Engineering, University of Nebraska-Lincoln, 230 L. W. Chase Hall, P. O. Box 830726, Lincoln, NE, 68583, USA
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20
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Keefer Hutchison M, Patterson C, Cuddeford T, Dudley R, Sorenson E, Brumitt J. Low prevalence of patellar tendon abnormality and low incidence of patellar tendinopathy in female collegiate volleyball players. Res Sports Med 2019; 28:155-167. [PMID: 31663370 DOI: 10.1080/15438627.2019.1683559] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The prevalence of patellar tendinopathy has been reported to be as high as 50% in elite male volleyball (VB) players; however, the rate of injury in female collegiate VB athletes is unknown. The purpose of this study was to 1) identify the prevalence of ultrasonographic evidence of patellar tendon abnormality at the start of the preseason in female collegiate VB players; 2) report the incidence of tendinopathy during the season; and 3) determine if the preseason presence of tendon abnormality is associated with onset of disease. One hundred and six female collegiate VB players had both patellar tendons imaged. Incidence of patellar tendinopathy was tracked during the course of the 4-month season. Twenty-two athletes presented with ultrasonographic evidence of patellar tendon abnormality in at least one knee at the start of the preseason. The incidence of time-loss patellar tendinopathy was 0.26 (95% CI: 0.04, 0.85) per 1000 athletic exposures. This study was unable to determine if preseason presence of tendon abnormality was associated with a greater risk of tendinopathy due to power. The prevalence of tendon abnormality in the preseason and the incidence of patellar tendinopathy in female collegiate VB players are lower than that observed in other populations.
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Affiliation(s)
| | | | - Tyler Cuddeford
- School of Physical Therapy, George Fox University, Newberg, OR, USA
| | | | | | - Jason Brumitt
- School of Physical Therapy, George Fox University, Newberg, OR, USA
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21
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Hutchison MK, Houck J, Cuddeford T, Dorociak R, Brumitt J. Prevalence of Patellar Tendinopathy and Patellar Tendon Abnormality in Male Collegiate Basketball Players: A Cross-Sectional Study. J Athl Train 2019; 54:953-958. [PMID: 31424974 DOI: 10.4085/1062-6050-70-18] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Patellar tendinopathy (PT) is a degenerative condition known to affect athletes who participate in sports such as basketball and volleyball. Patellar tendinopathy is a challenging condition to treat and may cause an athlete to prematurely retire from sport. The prevalence of PT in male collegiate basketball players is unknown. OBJECTIVE To determine the prevalence of PT and patellar tendon abnormality (PTA) in a population of male collegiate basketball players. DESIGN Cross-sectional study. SETTING National Collegiate Athletic Association Divisions II and III, National Association of Intercollegiate Athletics, and Northwest Athletic Conference male collegiate basketball teams were assessed in a university laboratory setting. PATIENTS OR OTHER PARTICIPANTS Ninety-five male collegiate basketball players (age = 20.0 ± 1.7 years). MAIN OUTCOME MEASURE(S) A diagnostic ultrasound image of an athlete's patellar tendon was obtained from each knee. Patellar tendinopathy was identified based on a player's symptoms (pain with palpation) and the presence of a hypoechoic region on an ultrasonographic image. RESULTS A majority of participants, 53 of 95 (55.8%), did not present with pain during palpation or ultrasonographic evidence of PTA. Thirty-two basketball players (33.7%) displayed ultrasonographic evidence of PTA in at least 1 knee; 20 of those athletes (21.1%) had PT (pain and tendon abnormality). Nonstarters were 3.5 times more likely to present with PTA (odds ratio = 3.5, 95% confidence interval = 1.3, 9.6; P = .017) and 4 times more likely to present with PT (odds ratio = 4.0, 95% confidence interval = 1.1, 14.8; P = .038) at the start of the season. CONCLUSIONS One in 3 male collegiate basketball players presented with either PT or PTA. Sports medicine professionals should evaluate basketball athletes for PT and PTA as part of a preseason screening protocol.
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Affiliation(s)
| | - Jeff Houck
- School of Physical Therapy, George Fox University, Newberg, OR
| | - Tyler Cuddeford
- School of Physical Therapy, George Fox University, Newberg, OR
| | - Robin Dorociak
- School of Physical Therapy, George Fox University, Newberg, OR.,Northwest Biomechanics, LLC, Portland, OR
| | - Jason Brumitt
- School of Physical Therapy, George Fox University, Newberg, OR
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Mendonça LDM, Bittencourt NFN, Alves LEM, Resende RA, Serrão FV. Interventions used for Rehabilitation and Prevention of Patellar Tendinopathy in athletes: a survey of Brazilian Sports Physical Therapists. Braz J Phys Ther 2018; 24:46-53. [PMID: 30581095 DOI: 10.1016/j.bjpt.2018.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 10/30/2018] [Accepted: 12/06/2018] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES (1) To identify the type and frequency of interventions used by Brazilian physical therapists to treat and prevent the occurrence of patellar tendinopathy in athletes and the criteria used to return to sport; (2) to compare the interventions used to the grade of recommendation of current evidence. METHODS Design: cross-sectional study. SETTING online survey throughout sports physical therapy association. PARTICIPANTS Physical therapists who were invited to complete a structured questionnaire. MAIN OUTCOME MEASURES Interventions more frequently used for treating and preventing PT in athletes and the criteria used to define return to sport. RESULTS One-hundred and twenty-one physical therapists participated in this study. Quadriceps eccentric strengthening (75.2%), education (61.2%) and lower limb joint/lumbo-pelvic stabilization/hamstrings stretching (59.5%) were more frequently cited for prevention purposes, while lower limb joint stabilization (81.8%), education (80.2%) and myofascial release (78.5%) were more frequently reported for treatment. The majority of the physical therapists based their decision of athlete discharge on a combination of pain intensity, function and functional test results (44.6%). CONCLUSION There was inconsistency between interventions used in clinical practice and interventions recommended by the best available evidence.
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Affiliation(s)
- Luciana De Michelis Mendonça
- Physical Therapy Department, School of Biological and Health Sciences (FCBS), Universidade Federal dos Vales do Jequitinhonha e do Mucuri (UFVJM), Diamantina, MG, Brazil; Postgraduate Program of Rehabilitation and Functional Performance (PPGReab), Universidade Federal dos Vales do Jequitinhonha e do Mucuri (UFVJM), Diamantina, MG, Brazil.
| | | | - Laís Emanuelle Meira Alves
- Physical Therapy Department, School of Biological and Health Sciences (FCBS), Universidade Federal dos Vales do Jequitinhonha e do Mucuri (UFVJM), Diamantina, MG, Brazil
| | - Renan Alves Resende
- Postgraduate Program of Rehabilitation and Functional Performance (PPGReab), Universidade Federal dos Vales do Jequitinhonha e do Mucuri (UFVJM), Diamantina, MG, Brazil; Physical Therapy Department, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Fábio Viadanna Serrão
- Physical Therapy Department, Universidade Federal de São Carlos (UFSCar), São Carlos, SP, Brazil; Postgraduate Program of Physical Therapy, Universidade Federal de São Carlos (UFSCar), São Carlos, SP, Brazil
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Abstract
BACKGROUND To engage clinicians in diagnosing patellar tendinopathy in large surveillance studies is often impracticable. The Oslo Sports Trauma Research Centre-patellar tendinopathy (OSTRC-P) questionnaire, a self-report measure adapted from the OSTRC questionnaire, may provide a viable alternative. OBJECTIVES To evaluate the diagnostic accuracy of the OSTRC-P questionnaire in detecting patellar tendinopathy in youth basketball players when compared to clinical evaluation. METHODS Following the STAndards for Reporting of Diagnostic accuracy studies guidelines, the researchers recruited 208 youth basketball players (13-18 years of age) for this prospective diagnostic accuracy validation study. Participants completed the OSTRC-P questionnaire (index test) prior to a clinical evaluation (reference standard) by a physical therapist blinded to OSTRC-P questionnaire results. Sensitivity, specificity, predictive value, likelihood ratio, and posttest probability were calculated. Linear regression was used to examine the association between the OSTRC-P questionnaire severity score and the patellar tendinopathy severity rating during a single-leg decline squat. RESULTS The final analysis included 169 players. The OSTRC-P questionnaire had a sensitivity of 79% (95% confidence interval [CI]: 65%, 90%), specificity of 98% (95% CI: 94%, 100%), positive predictive value of 95% (95% CI: 83%, 99%), negative predictive value of 92% (95% CI: 86%, 96%), positive likelihood ratio of 48 (95% CI: 12, 191), and negative likelihood ratio of 0.21 (95% CI: 0.12, 0.37). The posttest probabilities were 95% and 8%, given positive and negative results, respectively. A positive association was found between OSTRC-P questionnaire severity score and single-leg decline squat rating (β = 0.08; 95% CI: 0.03, 0.12; P = .001). CONCLUSION The OSTRC-P questionnaire is an acceptable alternative to clinical evaluation for self-reporting patellar tendinopathy and grading its severity in settings involving youth basketball players. LEVEL OF EVIDENCE Diagnosis, level 1b. J Orthop Sports Phys Ther 2018;48(10):758-766. Epub 27 Apr 2018. doi:10.2519/jospt.2018.8088.
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Abstract
Background Investigations on the causes of patellar tendinopathy should consider impairments at the hip and foot/ankle because they are known to influence movement patterns and affect patellar tendon loading. Objectives To investigate hip and foot/ankle impairments associated with patellar tendinopathy in volleyball and basketball athletes using classification and regression tree analysis. Methods In this clinical measurement, cross-sectional study, 192 athletes were assessed for impairments of the hip and foot/ankle, including shank-forefoot alignment, dorsiflexion range of motion (ROM), iliotibial band flexibility, passive hip internal rotation ROM, and hip external rotator and hip abductor isometric strength. Athletes with tenderness and/or pain at the inferior pole of the patella were considered to have patellar tendinopathy. Athletes with scores higher than 95 points on the Victorian Institute of Sport Assessment-patella (VISA-P), no pain during the single-leg decline squat, and no history of patellar tendon pain were considered not to have patellar tendinopathy. Classification and regression tree analyses were performed to identify interacting factors associated with patellar tendinopathy. Results Interactions among passive hip internal rotation ROM, shank-forefoot alignment, and hip external rotator and abductor strength identified athletes with and without patellar tendinopathy. The model achieved 71.2% sensitivity and 74.4% specificity. The area under the receiver operating characteristic curve was 0.77 (95% confidence interval: 0.70, 0.84; P<.001). Conclusion Impairments of the hip and foot/ankle are associated with the presence of patellar tendinopathy in volleyball and basketball athletes. Future studies should evaluate the role of these impairments in the etiology of patellar tendinopathy. J Orthop Sports Phys Ther 2018;48(9):676-684. Epub 23 May 2018. doi:10.2519/jospt.2018.7426.
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Liao CD, Xie GM, Tsauo JY, Chen HC, Liou TH. Efficacy of extracorporeal shock wave therapy for knee tendinopathies and other soft tissue disorders: a meta-analysis of randomized controlled trials. BMC Musculoskelet Disord 2018; 19:278. [PMID: 30068324 PMCID: PMC6090995 DOI: 10.1186/s12891-018-2204-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 07/20/2018] [Indexed: 12/26/2022] Open
Abstract
Background Extracorporeal shock-wave therapy (ESWT), which can be divided into radial shock-wave therapy (RaSWT) and focused shock-wave therapy (FoSWT), has been widely used in clinical practice for managing orthopedic conditions. The aim of this study was to determine the clinical efficacy of ESWT for knee soft tissue disorders (KSTDs) and compare the efficacy of different shock-wave types, energy levels, and intervention durations. Methods We performed a comprehensive search of online databases and search engines without restrictions on the publication year or language. We selected randomized controlled trials (RCTs) reporting the efficacy of ESWT for KSTDs and included them in a meta-analysis and risk of bias assessment. The pooled effect sizes of ESWT were estimated by computing odds ratios (ORs) with 95% confidence intervals (CIs) for the treatment success rate (TSR) and standardized mean differences (SMDs) with 95% CIs for pain reduction (i.e., the difference in pain relief, which was the change in pain from baseline to the end of RCTs between treatment and control groups) and for restoration of knee range of motion (ROM). Results We included 19 RCTs, all of which were of high or medium methodological quality and had a Physiotherapy Evidence Database score of ≥5/10. In general, ESWT had overall significant effects on the TSR (OR: 3.36, 95% CI: 1.84–6.12, P < 0.0001), pain reduction (SMD: − 1.49, 95% CI: − 2.11 to − 0.87, P < 0.00001), and ROM restoration (SMD: 1.76, 95% CI: 1.43–2.09, P < 0.00001). Subgroup analyses revealed that FoSWT and RaSWT applied for a long period (≥1 month) had significant effects on pain reduction, with the corresponding SMDs being − 3.13 (95% CI: − 5.70 to − 0.56; P = 0.02) and − 1.80 (95% CI: − 2.52 to − 1.08; P < 0.00001), respectively. Low-energy FoSWT may have greater efficacy for the TSR than high-energy FoSWT, whereas the inverse result was observed for RaSWT. Conclusions The ESWT exerts an overall effect on the TSR, pain reduction, and ROM restoration in patients with KSTDs. Shock-wave types and application levels have different contributions to treatment efficacy for KSTDs, which must be investigated further for optimizing these treatments in clinical practice. Electronic supplementary material The online version of this article (10.1186/s12891-018-2204-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chun-De Liao
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Guo-Min Xie
- Department of Neurology, Ningbo Medical Center Lihuili Eastern Hospital, Taipei Medical University, Zhejiang, China
| | - Jau-Yih Tsauo
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hung-Chou Chen
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.,Center for Evidence-Based Health Care, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, No. 250 Wu-Hsing Street, Taipei, Taiwan
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan. .,Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan. .,Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, No. 250 Wu-Hsing Street, Taipei, Taiwan.
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Rio E, Girdwood M, Thomas J, Garofalo C, Fortington LV, Docking S. Pain mapping of the anterior knee: injured athletes know best. Scand J Pain 2018; 18:409-416. [DOI: 10.1515/sjpain-2018-0046] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 04/14/2018] [Indexed: 12/17/2022]
Abstract
Abstract
Background and aims
Research investigating differences in pain location and distribution across conditions is lacking. Mapping a patient’s pain may be a useful way of understanding differences in presentations, however the use of pain mapping during a pain provocation task has not been investigated. The aim of this study was to assess the reliability of patient and clinician rated pain maps during a pain provocation task for the anterior knee.
Methods
Participants were recruited from a larger study of professional Australian rules football players (n=17). Players were invited to participate if they reported a current or past history of patellar tendon pain. No clinical diagnosis was performed for this reliability study. Participants were asked to point on their own knee where they usually experienced pain, which was recorded by a clinician on a piloted photograph of the knee using an iPad. Participants then completed a single leg decline squat (SLDS), after which participants indicated where they experienced pain during the task with their finger, which was recorded by a clinician. Participants then recorded their own self-rated pain map. This process was repeated 10 min later. Pain maps were subjectively classified into categories of pain location and spread by two raters. Pain area was quantified by the number of pixels shaded. Intra- and inter-rater reliability (between participants and clinicians) were analysed for pain area, similarity of location as well as subjective classification.
Results
Test-retest reliability was good for participants (intraclass correlation coefficients [ICC]=0.81) but only fair for clinicians (ICC=0.47) for pain area. There was poor agreement between participants and clinicians for pain area (ICC=0.16) and similarity of location (Jaccard index=0.19). Clinicians had good inter- and intra-rater reliability of classification of pain spread (k=0.75 and 0.67).
Conclusions
Participant completed pain maps were more reliable than clinician pain maps. Clinicians were reliable at classifying pain based on location and type of spread.
Implications
Clinicians should ask patients to complete their own pain maps following a pain provocation test, to elicit the most reliable and consistent understanding of their pain perception.
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Affiliation(s)
- Ebonie Rio
- La Trobe Sport and Exercise Medicine Centre (LASEM) , La Trobe University , Bundoora VIC , Australia
| | - Michael Girdwood
- La Trobe Sport and Exercise Medicine Centre (LASEM) , La Trobe University , Bundoora VIC , Australia
| | - Jake Thomas
- La Trobe Sport and Exercise Medicine Centre (LASEM) , La Trobe University , Bundoora VIC , Australia
| | - Christopher Garofalo
- La Trobe Sport and Exercise Medicine Centre (LASEM) , La Trobe University , Bundoora VIC , Australia
| | | | - Sean Docking
- La Trobe Sport and Exercise Medicine Centre (LASEM) , La Trobe University , Bundoora VIC , Australia
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November 2016 Letter to the Editor-in-Chief. J Orthop Sports Phys Ther 2016; 46:1012-1014. [PMID: 27802798 DOI: 10.2519/jospt.2016.0203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Letter to the Editor-in-Chief of JOSPT as follows: "Use of the VISA-P as a Clinical Measure in Research" with Authors' Response J Orthop Sports Phys Ther 2016;46(11):1012-1014. doi:10.2519/jospt.2016.0203.
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