Patellar Tendon Pain Research Articles

Sonographic Assessment of Asymptomatic Patellar and Achilles Tendons to Predict Future Pain: A Systematic Review and Meta-analysis.

Patients with clinical tendinopathy often demonstrate significant abnormalities with ultrasound (US) imaging. Tendon abnormalities likely precede pain in these patients. The purpose of this review was to systematically evaluate the available literature regarding the utility of US imaging as a method to predict Achilles and patellar tendon pain. Systematic review and meta-analysis. Inclusion criteria were as follows: prospective studies of Achilles and patellar tendon pain development with baseline US measurements, follow-up clinical measurements, and English-language studies published after 2000. Exclusion criteria were prior rupture or surgery and presence of rheumatologic disorder. N/A. Athletes without Achilles or patellar tendon pain at baseline. N/A. Risk ratios (RRs) were identified for the development of pain in those with Achilles or patellar tendon sonographic abnormalities. This review of 16 studies included 810 Achilles and 1156 patellar tendons from a variety of sports and demonstrated that the RR for pain development from abnormal Patellar and Achilles tendons was 6.07 [95% confidence interval (CI), 2.88-12.81; P < 0.001] and 3.96 [95% CI, 2.21-7.09; P < 0.001], respectively. The positive and negative predictive values of an abnormal US finding were 27.2% and 92.0% for the Achilles tendon and 27.2% and 93.5% for the patellar tendon, respectively. This systematic review and meta-analysis identified that the use of asymptomatic US scanning of the Achilles or patellar tendon has a low positive predictive value but a high negative predictive value for the future development of pain.

Ultrasound-guided electrocoagulation of neovascularisation for persistent patellar tendinopathy in athletes: a cohort study of 25 patients with a mean follow-up of 5 years from the SANTI Study Group

BackgroundPatellar tendinopathy (PT) is a common condition characterised by persistent patellar tendon pain and dysfunction, particularly in athletes. Neovascularisation is frequently observed in the PT and is associated with increased...

Effect of Isometric and Eccentric Exercises on Pain and Jump Performance in Indian Male Volleyball Players with Patellar Tendinopathy

Aim: To find out which exercise, isometric or eccentric is the best intervention to reduce the patellar tendon pain and maximise the jump performance. Materials and Methods: The participants were screened and selected according to the inclusion and exclusion criteria. The demographic data, pain and Victorian Institute of Sport Assessment–Patella (VISA-P) scale were measured pre-intervention and post-intervention. A total of 25 players of mean age 17.00±16.54 years, mean weight 67.76±60.84 kg and 89.63±17.67 cm mean height were taken through the single-blinded randomised sampling and were allocated into two groups Group A (n=12) of isometric exercise intervention and Group B (n=13) of Eccentric (EC) exercise intervention for 12 weeks. Results: There was a statistically non significant difference seen for the demographic values between the groups (p&gt;0.05) for all the variables. There was a statistically highly significant difference seen for the values between the groups (p&lt;0.01) for post VISA-P with higher values in EC group. There was a statistically non significant difference seen for the values between the groups (p&gt;0.05) for pre VISA-P. Conclusion: In this trial, among volleyball players with chronic patellar tendinopathy, treatment with eccentric exercise is superior to isometric. Coaches, sport scientists and volleyball players may use the eccentric exercise as a training protocol to improve the game skills. This could aid coaches in planning and controlling training, making appropriate performance enhancement decisions, and avoiding hand injuries.

A Review of Patellar Tendinopathy in Athletes Involved in Jumping Sports.

This review article discusses the anatomy and histopathology of the patellar tendon, as well as the risk factors and common interventions for patellar tendinopathy (PT) with a view to guide clinicians in treating athletes with patellar tendon pain. PT, or jumper's knee, refers to a chronic injury to the patellar tendon that affects athletes who engage in jumping and explosive movements. The condition is characterized by degeneration and disorganization of the collagen fibers in the tendon, an increase in mucoid ground substance, and fibroblast proliferation. Risk factors for patellar tendinopathy include participation in jumping sports, a greater counter-movement jump height, and training on hard surfaces. Nonoperative treatments for patellar tendinopathy include relative rest, stretching and strengthening exercises, and correction of biomechanical abnormalities. Surgery and other procedures, such as extracorporeal shockwave therapy(ESWT) and injection therapies, may be considered for patients who do not respond to conservative measures.

Longitudinal Evidence for High-Level Patellar Tendon Strain as a Risk Factor for Tendinopathy in Adolescent Athletes

BackgroundHigh tendon strain leads to sub-rupture fatigue damage and net-catabolic signaling upon repetitive loading. While high levels of tendon strain occur in adolescent athletes at risk for tendinopathy, a direct association has not yet been established. Therefore, in this prospective longitudinal study, we examined the hypothesis that adolescent athletes who develop patellar tendon pain have shown increased levels of strain in advance.MethodsIn 44 adolescent athletes (12–17 years old), patellar tendon mechanical properties were measured using ultrasonography and inverse dynamics at four time points during a season. Fourteen athletes developed clinically relevant tendon pain (SYM; i.e., reduction of the VISA-P score of at least 13 points), while 23 remained asymptomatic (ASYM; VISA-P score of > 87 points). Seven cases did not fall into one of these categories and were excluded. Tendon mechanical properties of SYM in the session before the development of symptoms were compared to a randomly selected session in ASYM.ResultsTendon strain was significantly higher in SYM compared to ASYM (p = 0.03). The risk ratio for developing symptoms was 2.3-fold higher in athletes with tendon strain ≥9% (p = 0.026). While there was no clear evidence for systematic differences of the force applied to the tendon or tendon stiffness between SYM and ASYM (p > 0.05), subgroup analysis indicated that tendon force increased prior to the development of symptoms only in SYM (p = 0.034).DiscussioThe study provides novel longitudinal evidence that high tendon strain could be an important risk factor for patellar tendinopathy in adolescent athletes. We suggest that inadequate adaptation of tendon stiffness to increases in muscle strength may occur if adolescent athletes are subject to mechanical loading which does not provide effective tendon stimulation.

Resection of Infrapatellar Fat Pad during Total Knee Arthroplasty Has No Impact on Postoperative Function, Pain and Sonographic Appearance of Patellar Tendon.

Routine resection of the infrapatellar fat pad (IFP) during total knee arthroplasty (TKA) is controversial, as it may result in shortening of the patellar tendon (PT) and anterior knee pain. This prospective study examined whether IFP excision during TKA affects joint function, anterior knee pain, PT dimensions and sonographic structure. A total of 65 consecutive patients undergoing TKA for osteoarthritis were randomized into two groups: IFP was resected in one and retained in the other. Patients were examined preoperatively, at 6 weeks and 6 months postoperatively: pain (Numerical Rating Scale-NRS), range of motion (ROM) and knee function (Knee Injury and Osteoarthritis Outcome Score-KOOS score) were evaluated; sonographic examination determined the length, structure and vascularity of the PTs. In both groups there were postoperative improvements in NRS and KOOS scores, although IFP resection did not influence clinical outcomes or sonographic parameters. At 6 weeks and 6 months postoperatively for both groups there were no differences between NRS scores (Mann-Whitney test, p = 0.511 and p = 0.579), ROM scores (Mann-Whitney test, p = 0.331, p = 0.180) or all KOOS subscores. IFP excision had no effect on sonographic parameters. This study suggests that IFP resection during TKA does not influence postoperative functional outcomes, pain scores, patellar tendon length and thickness, or sonographic structure.

Association between knee pain location and abnormal imaging or arthroscopic findings: A systematic review.

Assessment of pain location is an essential component of the differential diagnosis of knee pain because pain location is thought to indicate pathology. Previous studies have questioned whether abnormal imaging findings are related to the presence of pain, but none has systematically reviewed the association between knee pain location and the location of abnormal imaging or arthroscopic findings. To systematically review the association between the location of knee pain and the location of abnormal imaging or arthroscopic findings. Databases were searched up to November 2021 for articles in English that investigated the association between pain location reported using pain mapping and the location of abnormal imaging or arthroscopic findings. Risk of bias was assessed with the modified Newcastle-Ottawa scale. Results were sub-grouped by pathology and data analysis was performed as appropriate. Among 7730 articles identified, 10 (n=2034 participants) met the inclusion criteria. Three sub-pathologies were evaluated: patellar tendinopathy (n=2), knee osteoarthritis (n=7), and degenerative meniscal tears (n=1). The primary analysis found poor sensitivity and specificity of patellar tendon hypoechogenic areas and local patellar tendon pain in adult (n=55) and adolescent athletes (n=114). The location of pain and the location of abnormal imaging findings was associated in 2 studies of knee osteoarthritis (n=166). Five articles reported no relationship (n=1563). No association was reported between the location of pain and the location of arthroscopic findings in degenerative meniscus tears (n=193). All articles included were rated at low risk of bias. Sensitivity and specificity of the presence of patellar tendon hypoechogenic areas and localised patellar tendon pain was poor. Pain location was not associated with the location of abnormal imaging findings in knee osteoarthritis or to abnormal arthroscopic findings in degenerative meniscus tears.

Risk factors for the occurrence and protraction of patellar and patellar tendon pain in children and adolescents: a prospective cohort study of 3\u2009years

BackgroundPatellar and patellar tendon pain is a common limitation to children’s participation in social and physical activities. Some factors have been implicated in the occurrence and protraction of knee pain, but the causal relationship is unknown. The purpose of this study was to investigate whether participants’ physical characteristics and activity level are risk factors for the occurrence and protraction of patellar and patellar tendon pain in children and adolescents.MethodsA three-year prospective cohort study was conducted with healthy students who were aged 8–14 years old, in Japan. Height, weight, heel-buttock distance, straight leg raising angle, and dorsiflexion angle of the ankle joint were collected as individual physical factors at the beginning of each year. The presence of self-reported patellar and patellar tendon pain and the Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS) was collected every month. Protraction was defined as either (1) pain lasting for more than three continuous months or (2) recurrent pain after more than three months of complete recovery. Participants who did not have any pain at the beginning of the observation period were included in the analysis. We analyzed the odds ratio (OR) of pain occurrence within a year of registration and protraction throughout the study period for all physical factors and HSS Pedi-FABS.ResultsWe included 1133 participants in the analysis and 252 participants developed knee pain within a year. 34.8% of participants with pain experienced protraction during the follow-up period. A high HSS Pedi-FABS significantly predicted knee pain occurrence (OR 1.03, 95% confidence interval [CI] 1.01–1.05) and protraction (OR 1.03, 95% CI 1.00–1.05). In addition, younger children and girls were at a significantly higher risk of patellar and patellar tendon pain protraction (age, OR 0.81, 95% CI, 0.73–0.90; sex, OR 1.69, 95% CI, 1.09–2.64). Other physical factors did not significantly predict the occurrence or protraction of knee pain.ConclusionsThis study showed that a greater physical activity level was a risk factor for the occurrence and protraction of patellar and patellar tendon pain in childhood. In addition, younger age and female sex predicted higher risk of protraction of pain.

Sonographic Screening of Distance Runners for the Development of Future Achilles and Patellar Tendon Pain.

The 2 primary aims of this study were to identify ultrasonographic tendon abnormalities in asymptomatic runners and to examine the likelihood of developing pain in runners with ultrasound abnormalities compared with those without abnormalities. Longitudinal, prospective cohort study. 2019 Salt Lake City Marathon. Recreational half-marathon and full-marathon runners. The Achilles and patellar tendons of asymptomatic runners were examined with ultrasound imaging before a running event. Runners were monitored for self-reported outcomes of pain in the examined tendons at 1, 3, 6, and 12 months after the event. Development of pain based on the presence of asymptomatic tendon abnormalities. One hundred thirty-eight runners (36.2 ± 12.0 years, 49.3% men, and 31.2% full-marathon runners) were included. Ultrasound abnormalities of the Achilles and patellar tendons were identified in 24.6% and 39.1% of the runners before the race, respectively. Ultrasound abnormalities were significantly associated with approximately a 3-fold increase [hazard ratio (HR) = 2.55, P = 0.004] in the hazard of developing pain in the Achilles tendon and patellar tendon (HR = 1.67, P = 0.042) over the year after the race. Positive and negative predictive values of developing pain over the year were 34.1% and 87.2%, respectively, for abnormal findings in the Achilles tendon, and 22.9% and 85.0%, respectively, for the patellar tendon. The presence of ultrasonographic abnormalities is associated with increased development of pain in the Achilles and patellar tendons within 1 year of a marathon or half marathon.

Differences in Biomechanical Loading Magnitude During a Landing Task in Male Athletes with and without Patellar Tendinopathy.

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. The purpose was to compare involved limb landing biomechanics between male athletes with and without patellar tendinopathy. 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). 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. 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. 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. ClinicalTrials.gov (#XXX).

A Functional High-Load Exercise Intervention for the Patellar Tendon Reduces Tendon Pain Prevalence During a Competitive Season in Adolescent Handball Players.

Imbalances of muscle strength and tendon stiffness may increase the risk for patellar tendinopathy in growing athletes. The present study investigated if a functional high-load exercise intervention, designed to facilitate tendon adaptation and reduce muscle-tendon imbalances, may prevent patellar tendon pain in adolescent male handball players (12–14 years). Tendon pain prevalence (using VISA-P scores), knee extensor strength, vastus lateralis (VL) architecture and patellar tendon mechanical properties were measured at four measurement time points (M1–M4) over a season. The control group (CON; n = 18; age 13.1 ± 0.7 yrs, height 170 ± 8 cm, mass 58 ± 10 kg) followed the usual strength training plan, including muscular endurance and explosive strength components. In the experimental group (EXP; n = 16; 13.1 ± 0.6 yrs, 169 ± 11 cm, 58 ± 16 kg), two sessions per week with functional high-load exercises for the patellar tendon were integrated in the strength training schedule, aiming to provide repetitive high-intensity loading of at least 3 s loading duration per repetition. While in the control group 30% of the athletes reported a clinically significant aggravation of symptoms, all players in the experimental group remained or became pain-free at M2 until the end of the season. There was a similar increase of strength (normalized to body mass; CON: 3.1%, d = 0.22; EXP: 6.8%, d = 0.47; p = 0.04) and VL thickness (CON: 4.8%, d = 0.28; EXP: 5.7%, d = 0.32; p < 0.001) in both groups, but no significant changes of tendon stiffness or maximum tendon strain. Further, both groups demonstrated similar fluctuations of tendon strain over time. We conclude that functional high-load exercises can reduce the prevalence of patellar tendon pain in adolescent athletes even without a reduction of tendon strain.

Pain-guided activity modification during treatment for patellar tendinopathy: a feasibility and pilot randomized clinical trial

BackgroundActivity modification is a key component of patellar tendinopathy treatment but there is a lack of evidence guiding activity modification prescription. Use of activity modification in treatment studies has varied widely and the impact of those recommendations has not been directly investigated or compared. The purpose of this study was to assess (1) the feasibility of using pain-guided activity modification during treatment for patellar tendinopathy and (2) if our outcome measures are responsive to changes in tendon health over the course of treatment.MethodsThis was an unblinded, randomized two-arm pilot and feasibility study randomized clinical trial with parallel assignment, conducted in Newark, DE. Individuals between the ages of 16 and 40 years old with patellar tendinopathy were included. Participants were randomly assigned to a pain-guided activity (PGA) or pain-free activity (PFA) group using a spreadsheet-based randomization scheme. All participants received standardized treatment using a modified version of the heavy-slow resistance protocol 3×/week for 12 weeks. For the first 6 weeks, the PGA group used the Pain-Monitoring Model to guide activity outside of treatment and the PFA group was restricted from running, jumping, or activities that provoked their patellar tendon pain. Feasibility outcomes included recruitment, enrollment, randomization, compliance, and retention percentages. Clinical evaluations were conducted at baseline, 6, and 12 weeks to assess symptom severity, psychological factors, tendon morphology and mechanical properties, lower extremity function, and quadriceps muscle performance.ResultsIn a ~ 13-month period, 108 individuals were screened, 47/108 (43.5%) were eligible for participation, and 15/47 (32.0%) of those were enrolled (9 PGA, 6 PFA). The recruitment rate was 1.15 participants/month. The mean ± SD compliance with treatment was PGA: 86.1 ± 13.0% and PFA: 67.1 ± 30.7%. There was one missed evaluation session and two adverse events, which were not due to study interventions. Changes exceeding the smallest detectable change were observed for at least one outcome in each domain of tendon health.ConclusionsUse of pain-guided activity modification during exercise therapy for patellar tendinopathy was found to be feasible, and the proposed outcome measures appropriate. Computer-based allocation concealment, blinding of evaluators, and greater recruitment of high-level athletes should be implemented in future trials.Trial registrationClinicalTrials.gov identifier: NCT03694730. Registered 3rd of October, 2018.

Ultrasound evaluation of the patellar tendon and Achilles tendon and its association with future pain in distance runners

ABSTRACT Objectives: To examine whether asymptomatic ultrasonographic abnormalities in the Achilles and patellar tendons in runners are associated with an increased risk of pain development. Methods: This is a longitudinal, prospective cohort study with 139 runners recruited at a half and full marathon race. Ultrasound examination of the Achilles and patellar tendons was performed bilaterally the day prior to the race. Self-reported injury data were collected at 1, 3, 6 and 12 months. 104 (74.8%) runners were included in the data analysis. Results: Ultrasonographic tendon abnormalities were found in 24.1% of the Achilles and in 23.1% of the patellar tendons prior to the race. Runners with tendon abnormality were 2–3 times more likely to develop pain within 12 months than those without (relative risk = 3.14, p = 0.010 for Achilles; relative risk = 2.52, p = 0.008 for patellar tendon). After adjusting for gender, age, years of running, average miles per week of running over a year, and pre-race pain, runners with ultrasound abnormality were about 3 times (hazard ratio = 2.89, p = 0.039 for Achilles; hazard ratio = 2.73, p = 0.030 for patellar tendon) more likely to develop pain after the race. Tendon delamination was most strongly associated with pain in both the Achilles (relative risk = 6.00; p = 0.001) and patellar tendons (relative risk = 3.81; p = 0.001). Conclusions: Structural changes in asymptomatic tendons were found in almost 25% of runners. Presence of structural changes was associated with increased development of Achilles and patellar tendon pain within one year.

Evaluation of patellar tendinopathy using the single leg decline squat test: Is pain location important?

Study designA cross-sectional study of non-elite volleyball players aged 13–17years. ObjectivesTo 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. Methods32 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. ResultsFifteen (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. ConclusionAdolescent 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 evidenceDiagnosis, Level 2; Cross-sectional study.

Immediate and Short-Term Effects of Short- and Long-Duration Isometric Contractions in Patellar Tendinopathy.

Isometric muscle contractions are used in the management of patellar tendinopathy to manage pain and improve function. Little is known about whether long- or short-duration contractions are optimal to improve pain. This study examined the immediate and short-term (4 weeks) effects of long- and short-duration isometric contraction on patellar tendon pain, and tendon adaptation. Repeated measures within groups. Clinical primary care. Participants (n = 16, males) with patellar tendinopathy. Short-duration (24 sets of 10 seconds) or long-duration (6 sets of 40 seconds) isometric knee extension loading (85% maximal voluntary contraction), for 4 weeks. Immediate change in pain with single-leg decline squat (SLDS) and hop, as well as change in pain and tendon adaptation [within-session anterior-posterior (AP) strain] were assessed over 4 weeks. Pain was significantly reduced after isometric loading on both SLDS (P < 0.01) and hop tests (P < 0.01). Pain and quadriceps function improved over the 4 weeks (P < 0.05). There was significant AP strain at each measurement occasion (P < 0.01). Although transverse strain increased across the training period from ∼14% to 22%, this was not significant (P = 0.08). This is the first study to show that short-duration isometric contractions are as effective as longer duration contractions for relieving patellar tendon pain when total time under tension is equalized. This finding provides clinicians with greater options in prescription of isometric loading and may be particularly useful among patients who do not tolerate longer duration contractions. The trend for tendon adaptation over the short 4-week study period warrants further investigation.

무릎 스트랩과 테이핑 적용이 배구선수의 외발 착지에서 슬개건 통증과 하지 동역학 및 운동학에 미치는 영향

The primary purpose of this study was to compare patellar tendon pain and low extremity kinetics and kinematics of male high school volleyball players on one-leg landing after applying a strap, C-tape, and E-tape, respectively. A total of 16 male high school volleyball players who had no history of lower extremity injury at least for 3 months were recruited(age: 16.37±1.08years, height: 185.56±5.52cm, weight: 76.81±8.52kg). Each participant were alternately equipped with a strap, C-tape, or E-tape on each patellar tendon, and visual analogue scale(VAS) was measures during one leg landing. Maximal knee flexion angle, range of motion, angular velocity, moment, and maximal ground reaction force at the hip, knee, and ankle joint were assessed after each application using 3 dimensional motion analyses. Statistical analyses were done with one-way repeated measure ANOVA and post-hoc analysis. The VAS of strap(2.56±1.45) and C-tape(2.87±1.31) were lower than that of E-tape(3.50±1.31; each p.001 and p=.007). The mean angular velocity of the knee flexion (285.77±88.60deg/s) was significantly higher in strap than in E-tape(242.68±61.64deg/s; p=.026). In summary, it appeared that the application of strap or C-tape was related to effectively reducing patellar tendon pain. Additionally, it could be postulated that the application of a strap attributed to the increase of knee flexion angular velocity during one-leg landing.

Partial resection of the infrapatellar fat pad during anterior cruciate ligament reconstruction has no effect on clinical outcomes including anterior knee pain.

Anterior knee pain (AKP) is a major complication that occurs after anterior cruciate ligament reconstruction (ACLR), even when hamstring tendon (HT) grafts are used. Damage to the infrapatellar fat pad (IPFP) during arthroscopy can cause AKP. The purpose of this study was to evaluate the influence of IPFP preservation on clinical outcomes, including AKP, in patients who underwent ACLR with HT autografts using the inside-out technique. Forty-two patients who underwent primary ACLR with HT autografts were prospectively assessed for 2years after surgery. They were randomly selected to undergo treatment with as much intercondylar IPFP preservation as possible or with intercondylar IPFP resection to confirm the ACL origin on the femoral and tibial sides, especially the femoral footprint in deep flexion of the knee joint. The total IPFP volume was calculated using sagittal MR images before and 6months after surgery. The patients completed a subjective knee score questionnaire and were assessed for patellar tendon tenderness and pain with the half-squat test or single-leg hop test at 6months and 2years postoperatively. There were no differences in the patient characteristics, including age, sex, BMI, time from injury to surgery, and meniscus tear. The difference in the total size of the IPFP preserved was significant (P = 0.004). However, there were no significant differences in the subjective knee scores. Moreover, there were no differences in the clinical assessment parameters between the IPFP preservation and resection groups. The size of the IPFP decreased more in the resection group than in the preservation group at 6months after surgery. However, partial IPFP resection, which was used to better visualize the origin of the ACL, had no effect on the clinical outcomes, including AKP. Level II.

Quadriceps Inhibition After Naturally Occurring Patellar Tendon Damage and Pain.

After knee-joint injury, pain, effusion, and mechanoreceptor damage alter afferent signaling, which can result in quadriceps inhibition and subsequent weakness. The individual contributions of each factor to inhibition remain unclear due to confounding knee-joint injuries and indirect experimental models. To characterize the influence of naturally occurring knee damage and pain on quadriceps neuromuscular function in individuals with patellar tendinopathy. Cross-sectional study. Research laboratory. Twenty participants who self-reported patellar tendinopathy (PT) and 10 healthy control individuals underwent ultrasonic tendon assessment. Injured participants were dichotomized by an orthopaedic surgeon into groups with (1) pain and structural tendon abnormality and (2) regional pain alone. Quadriceps inhibition was assessed with the Hoffman reflex and the central activation ratio via the superimposed-burst technique. Normally distributed measures were analyzed using a 1-way analysis of variance and post hoc independent t tests. Kruskal-Wallis tests with post hoc Mann-Whitney U tests were used to analyze nonnormally distributed data. An a priori α level of P ≤ .05 was set. Control participants presented with more spinal-reflex excitability (0.37 ± 0.23) than the PT (0.10 ± 0.06; P = .03) and regional-pain (0.18 ± 0.05; P = .02) groups. Knee-extension strength was greater in the control (3.37 ± 0.59 Nm/kg) than in the PT (2.41 ± 0.67 Nm/kg; P = .01) group but not the regional-pain group (3.05 ± 0.66 Nm/kg; P = .24). Control individuals presented with more quadriceps activation (97.93% ± 3.12) than the PT (84.44% ± 16.98; P < .01) and regional-pain (91.17% ± 10.56; P = .01) groups. No differences were present for any measures between the PT and regional-pain groups (P values > .05). Deficits in spinal-reflex excitability, quadriceps activation, and strength were present in both the PT and regional-pain groups. A combination of pain and structural damage appeared to have the greatest negative effect on quadriceps function, as only the PT group presented with neuromuscular outcomes that failed to meet clinical thresholds.

Activity Modification and Knee Strengthening for Osgood-Schlatter Disease: A Prospective Cohort Study.

Background:Osgood-Schlatter disease (OSD) affects 1 in 10 adolescents. There is a lack of evidence-based interventions, and passive approaches (eg, rest and avoidance of painful activities) are often prescribed.Purpose:To investigate an intervention consisting of education on activity modification and knee-strengthening exercises designed for adolescents with OSD.Study Design:Case series; Level of evidence, 4.Methods:This study included 51 adolescents (51% female; age range, 10-14 years) with OSD. The 12-week intervention consisted of an activity ladder designed to manage patellar tendon loading and pain, knee-strengthening exercises, and a gradual return to sport. The primary outcome was the global reporting of change at 12 weeks, evaluated with a 7-point Likert scale (successful outcome was considered “much improved” or “improved”). Additional endpoints were at 4, 8, 26, and 52 weeks. Secondary outcomes included the Knee injury and Osteoarthritis Outcome Score (KOOS), objective strength, and jump performance.Results:Adolescents reported a mean pain duration of 21 months at enrollment. After 12 weeks, 80% reported a successful outcome, which increased to 90% at 12 months. At 12 weeks, 16% returned to playing sport, which increased to 69% at 12 months. The KOOS subscores of Pain, Activities of Daily Living, Sport and Recreation, and Quality of Life improved significantly (7-20 points), and there were improvements in knee extension strength (32%; P < .001), hip abduction strength (24%; P < .001), and jumping for distance (14%; P < .001) and height (19%; P < .001) at 12 weeks.Conclusion:An intervention consisting of activity modification, pain monitoring, progressive strengthening, and a return-to-sport paradigm was associated with improved self-reported outcomes, hip and knee muscle strength, and jumping performance. This approach may offer an alternative to passive approaches such as rest or wait-and-see, often prescribed for adolescents with OSD.Registration:NCT02799394 (ClinicalTrials.gov identifier)

Multimodal management of patellar tendinopathy in basketball players: A retrospective chart review pilot study

BackgroundThe aim of this observational study was to document changes in pain, dysfunction, and fear of movement in basketball players using a multimodal rehabilitation approach for managing patellar tendinopathy. MethodsA multimodal treatment approach was utilized with basketball athletes during a competitive season. Numeric pain rating scale (NPRS), Victorian Institute of Sport Assessment Patellar (VISA-P) questionnaire, and a Tampa Scale of Kinesiophobia were used as outcome measures to assess for patellar tendon pain and knee function. A single group, pre-test/post-test, de-identified, retrospective chart review was performed at the end of the season. ResultsNine basketball players were diagnosed and treated for patellar tendinopathy during the course of a single season. VISA-P questionnaire scores were significantly higher at the end of the season, with a mean increase of 30 points (95% CI 22–38 p < 0.05). This magnitude of improvement exceeds the minimum clinically important difference of the VISA-P of 13 points. The NPRS during training over the previous week was significantly improved by 4.6 points (95% CI 2.6–6.6) from the start of treatment to the end of the season. ConclusionDry needling, Extracorporeal Shockwave Therapy (ESWT), hands on manual therapy, and corrective exercise may be safe and effective strategies to reduce patellar tendon pain and improve knee function. Future research involving a larger sample size, control group, and randomization is indicated.