The Burden and Risk Factors of Patellar and Achilles Tendinopathy in Youth Basketball: A Cohort Study

Long-term Prognosis of Patellar Tendinopathy (Jumper's Knee) in Young, Elite Volleyball Players: Tendon Changes 11 Years After Baseline

BACKGROUND

The long-term prognosis of jumper's knee and whether structural changes in the patellar tendon persist is unknown.

PURPOSE

To investigate whether limitations in knee function and structural changes persisted beyond the athletic career of young elite volleyball players.

STUDY DESIGN

Cohort study; Level of evidence, 2.

METHODS

Volleyball players (mean ± SD age, 18 ± 0.8 years) enrolled in 2006-2011 in a prospective cohort study were invited in 2020-2022 to a follow-up study. Participants rated their knee function with the Victorian Institute of Sport Assessment-Patellar Tendon (VISA-P) score (baseline and follow-up) and the International Knee Documentation Committee (IKDC) score (follow-up) and reported if jumper's knee had influenced their decision to retire from sport. Tendon thickness and structural changes were assessed with ultrasound (baseline) and magnetic resonance imaging (MRI) (follow-up) of both patellar tendons.

RESULTS

We included 138 of 143 former athletes (97%) 11.4 ± 1.6 years after their baseline examination. At baseline, 37 persons (52 knees) had developed jumper's knee. At follow-up, participants reported lower knee function scores in knees diagnosed with jumper's knee at baseline than healthy knees (VISA-P scores: jumper's knee, 81 [95% CI, 70-92]; healthy, 90 [95% CI, 86-94]; P < .001; IKDC scores: jumper's knee, 82 [95% CI, 75-89]; healthy, 92 [95% CI, 91-95]; P < .001). Jumper's knee problems directly caused 7 of the 37 athletes (19%) with jumper's knee at baseline to retire from competitive volleyball. Of the 138 players included, 97 (70%) completed a bilateral MRI examination (194 knees). At follow-up, 38 of the 54 abnormal tendons (70%) had no structural changes (P < .001 vs baseline) while 22 of the 140 normal tendons (16%) had developed structural changes. Clinical symptoms were not correlated with tendon structure at follow-up (VISA-P scores for normal tendons: 85 [95% CI, 73-87]; abnormal: 89 [95% CI, 85-92]; P = .48).

CONCLUSION

Jumper's knee is not a self-limiting condition; volleyball players who had developed jumper's knee during adolescence reported persistent reductions in knee function 11 years later, leading one-fifth to retire from competitive volleyball. Although approximately 70% of tendons with structural changes at baseline were normal at follow-up, there was no clear relationship between structure and function.

Achilles tendinopathy research has a gender data gap: A systematic review and meta-analysis

PURPOSE

A persisting gender bias has been recently highlighted in orthopaedics and sports medicine. The aim of this study was to evaluate the volume of gender-specific data and gender-specific results in the treatment of a common tendon disease, Achilles tendinopathy.

METHODS

Pubmed, Cochrane, and Web of Science were searched to identify all clinical studies focusing on Achilles tendinopathy treatment. The Visual Analogue Scale (VAS) and Victorian Institute of Sport Assessment-Achilles (VISA-A) data of women and men of the studies that disaggregated results by gender were collected, and a meta-analysis was conducted. Treatment response within and in between gender categories was evaluated, focusing on overall gender-disaggregated data, as well as within each of the three treatment categories: conservative treatment, injective treatment and surgical treatment. A formal risk of bias analysis was conducted using Downs and Black's grading system.

RESULTS

Out of the 8796 papers screened, 178 were included after the screening. The number of female study participants grew from 20% up to 1990 to 48% in the years 2019-2022. Only 373 out of 3423 (11%) female patients and 685 of 4352 (16%) male patients were found in sex-disaggregated studies. A meta-analysis was conducted on the 14 papers that reported sex-disaggregated data for VAS and VISA-A. The meta-analysis revealed that there was no difference in the overall treatment response between women and men and that both genders showed an overall significant treatment benefit in terms of VAS and VISA-A values. However, significant differences were documented within the treatment categories. While no differences were found in surgical studies, in conservative treatment studies, men experienced lower posttreatment VAS values (p = 0.004). The largest difference was found in injective treatments, with men experiencing a larger change in VAS values (men = -3.0, women = -1.0, p = 0.016) and higher posttreatment VISA-A values (p = 0.032).

CONCLUSION

This systematic review and meta-analysis showed a lack of awareness of the importance of sex-specific data within Achilles tendinopathy treatment research. The proportion of female study subjects has grown over the years, but there is still a large data gap caused by the absence of sex-disaggregated data. The omission of sex-disaggregated data causes the loss of valuable knowledge on the true effectiveness of current Achilles tendinopathy treatment. The results of this study indicate that women profit less from available treatments, particularly injective approaches, which prompts further research for treatment adaptation by gender.

LEVEL OF EVIDENCE

Level IV.

Determination of differences in ultrasound parameters for patellar tendons in males with unilateral patellar tendinopathy-An ancillary analysis of data from two randomized controlled trials

PURPOSE

To investigate power Doppler (PD) activity and tendon structure (between the injured and contralateral limb) in patients with unilateral patellar tendinopathy (PT) using ultrasonography (US). Secondly, the aim was to determine the intra-rater reliability of the PD activity and tendon structure.

METHODS

This study analyzed US baseline data from 57 male participants with symptomatic unilateral PT who had been enrolled in one of two randomized clinical trials. Data were analyzed to examine if systematic differences existed between injured and contralateral limbs using Fiji ImageJ.

RESULTS

The PD activity of the symptomatic tendon was larger 25.6 (Q1 = 14.9; Q3 = 41.6) mm2 than the asymptomatic 0 (Q1 = 0.0; Q3 = 0.0) mm2 (p < 0.001). There was a significantly greater tendon thickness at the proximal (2.5 mm 95% CI [2.0; 3.0]), mid (0.8 mm 95% CI [0.5; 1.1]), and distal (0.2 mm 95% CI [0.1; 0.4]) part of the tendon for the symptomatic compared to the asymptomatic tendon. Intra-rater reliability for PD activity and tendon structure ranged from moderate-to-excellent (0.74; 0.99).

CONCLUSION

These results provide mean estimates for tendon thickness of symptomatic and asymptomatic tendons, that can be used for clinicians to reliably estimate pathological tendon thickness.

Normative Hamstrings and Quadriceps Isometric Strength Values and Hamstrings-Quadriceps Asymmetry in Healthy Collegiate Soccer and Basketball Players

The objectives of this study were to report weight-normalized, sex- and sport-stratified normative values for hamstrings and quadriceps isometric strength in collegiate soccer and basketball players using a low-cost hand-held dynamometer and assess the prevalence of "substantial" hamstrings-quadriceps (H/Q) ratio strength imbalance (<0.6) among players. Ninety-four healthy collegiate male and female soccer and basketball players (age range: 18-24 years) were examined for baseline isometric hamstrings and quadriceps strength using a handheld isometric dynamometer with standardized and valid protocols. For soccer, the mean (95%CI) weight-normalized peak isometric strength values (considering dominant limbs) were 3.29 (2.90 to 3.64) N/kg (hamstrings) and 5.48 (4.96 to 6.00) N/kg (quadriceps) in male players and 2.62 (2.39 to 2.85) N/kg (hamstrings) and 4.55 (4.14 to 4.96) N/kg (quadriceps) in female players. For basketball, the mean (95% CI) peak strength values were 2.97 (2.72 to 3.21) N/kg (hamstrings) and 4.89 (4.44 to 5.33) N/kg (quadriceps) in male players and 2.48 (2.15 to 2.80) N/kg (hamstrings) and 4.21 (3.54 to 4.87) N/kg (quadriceps) in female players. The prevalence of substantial H/Q strength imbalance was 37% (95%CI: 24% to 52%) in soccer and 44% (95%CI: 29% to 60%) in basketball players. This study is first to provide normative values for peak isometric hamstrings and quadriceps strength using a low-cost hand-held dynamometer. The normative database from this study is valuable to coaches, sports medicine professionals, exercise scientists and other stakeholders to inform injury prevention, rehabilitation progression, return to play decisions and performance goals in collegiate soccer and basketball players.

Bibliometric analysis of extracorporeal shock wave therapy for tendinopathy

BACKGROUND

Extracorporeal shock wave therapy (ESWT) is a mature, conservative treatment modality for tendinopathy. Although many relevant studies have been conducted, systematic bibliometric studies are lacking. This study aimed to identify trends and hotspots in the treatment of tendinopathy using ESWT.

METHODS

A literature search was conducted on ESWT for tendinopathy using the Web of Science Core Collection with a search period of 2002 to 2022. Of 559 identified studies, 276 met the inclusion criteria and were analyzed using CiteSpace software.

RESULTS

The results showed that from 2002 to 2022, the publication rate of literature on ESWT for tendinopathy was generally increasing. Research hotspots, such as tendinopathy and calcific rotator cuff deposits, began earlier but continued to receive scholarly attention. Research on animal models and molecular mechanisms has progressed slowly in this field. The combined or comparative effectiveness of injectable and supplement-based treatments with ESWT is a popular research topic.

CONCLUSION

Pain management in patients with tendinopathy has received considerable attention. Simultaneously, more clinical indicators of energy levels and pulse parameters during ESWT are needed to provide more scientific and accurate treatment for patients.

Current Concepts in Patellar Tendinopathy: An Overview of Imaging, Pathogenesis, and Nonoperative and Operative Management

» Approximately 1 in 3 high-impact athletes develops patellar tendinopathy (PT), with the proximal insertion of the patellar tendon being the most commonly affected anatomical site.» Nonoperative treatment options are effective in reducing pain and restoring functionality in most patients with PT. However, operative intervention should be considered when conservative management fails.» A comprehensive review of the literature on surgical procedures, including both open and arthroscopic approaches, was conducted with a specific focus on clinical outcomes and return to sports.» Both open surgery and arthroscopic surgery for PT have demonstrated favorable success rates and return-to-sport outcomes, with arthroscopic treatment potentially expediting the recovery process.

Epidemiology of Patellar Tendinopathy in Athletes and the General Population: A Systematic Review and Meta-analysis

Background

Patellar tendinopathy (PT) mainly affects athletes who use the tendon for repeated energy storage and release activities. It can have a striking impact on athletes' careers, although data on its real prevalence and incidence are sparse. Research efforts should start from the results of reliable and updated epidemiological research to help better understand the impact of PT and underpin preventative measures.

Purpose

To determine the prevalence and incidence of PT in athletes and the general population.

Design

Systematic review; Level of evidence, 3.

Methods

A systematic review of the literature was performed on January 17, 2022, and conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed, Web of Science, and Wiley Cochrane Library databases were searched for epidemiological reports of any evidence level and clinical studies reporting data on the incidence or prevalence of PT for the 11,488 retrieved records. The primary endpoint was the prevalence and incidence of PT in sport-active patients. The secondary endpoints were PT prevalence and incidence in subgroups of athletes based on sex, age, sport type, and sport level played, as well as the same epidemiological measures in the general population.

Results

A total of 28 studies, with 28,171 participants, were selected and used for the qualitative and quantitative analysis. The general and athletes' populations reported an overall PT prevalence of 0.1% and 18.3%, respectively. In athletes, the prevalence of PT was 11.2% in women and 17% in men (P = .070). The prevalence of PT in athletes <18 years was 10.1%, while it was 21.3% in athletes ≥18 years (P = .004). The prevalence of PT was 6.1% in soccer players, 20.8% in basketball players, and 24.8% in volleyball players. Heterogeneous PT diagnostic approaches were observed. Higher prevalence values were found when PT diagnoses were made using patient-reported outcomes versus clinical evaluations (P = .004).

Conclusion

This review demonstrated that PT is a common problem in the male and female sport-active populations. There are twice as many athletes aged ≥18 years than there are <18 years. Volleyball and basketball players are most affected by PT.

On-site Ultrasound Screens out Asymptomatic Knee Lesions in Elite Adolescent Male Basketball Players

Basketball is a popular sport worldwide with a high injury risk. In this study, we conducted survey composed of clinical symptom reporting scale, physical examination and meticulous portable musculoskeletal ultrasound to 19 elite male high school basketball players and 15 regular male high school students. Our study showed the incidence of ultrasonographic findings of any lesion, suprapatellar effusion and proximal patellar tendinopathy is significantly higher in player group, and the incidence of asymptomatic ultrasonographic lesion is also higher in player group. Screening for asymptomatic lesions bares clinical relevance and plays a role in prevention of symptom development. With the concise and easy-to-perform ultrasonography protocol we performed and being interpreted by sports team physician, the protocol can offer precise diagnosis of common injury and screening for asymptomatic lesion potentially progressive.