Patellar Tendinopathy Research Articles

Patellar Tendon Debridement and Reconstruction With Hamstring Tendon Autografts in the Setting of Severe Patellar Tendinopathy

Background: Patellar tendinopathy is a multifactorial condition characterized by micro-degenerative changes in the patellar tendon. This results from repeated stress to the knee extensor mechanism from explosive movement, axial malalignment, and/or abnormal patellar height. Currently, there is no standard surgical procedure for the treatment of severe patellar tendinopathy. Indications: Patellar tendon reconstructions for patellar tendinopathy may be indicated when >50% of the tendon attachment is degenerative and detached from the distal patella and non-operative treatment, like physical therapy, bracing, and injections, have not relieved symptoms. Debridement may not offer long-term viability against augmentation of the patellar tendon with autografts, with a risk of recurrent breakdown of the patellar tendon attachment with resumption of previous activities that initially lead to overload. Technique Description: An anterior incision was made from the superior pole of the patella to the tibial tubercle. Then, dissection was performed medially to harvest the gracilis and semitendinosus tendons. Open harvesters were used, and the hamstring tendons were released proximally, keeping the tibial insertions attached. A horizontal pin was drilled across the tibial tubercle and reamed with a 4.5 mm reamer. A passing stitch was fed through the tunnel. The proximal and distal margins of the patella were localized with spinal needles and a pin was drilled across its midportion, 5 mm deep to the dorsal cortical margin, and then rearmed. Degenerative tissue at the patellar tendon was excised. The gracilis tendon was passed medial to lateral through the tibial tubercle, and a Q-Fix anchor anchored the grafts medially and laterally. The semitendinosus graft was passed medial to lateral through the patella followed by the gracilis tendon lateral to medial. Appropriate reconstruction graft tension was confirmed and grafts were whipstitched together. Results: Clinical outcomes for the debridement of severe patellar tendinopathy report 77% symptomatic relief. With many unable to return to activity, patellar tendon reconstruction can be indicated. Outcomes for reconstructions for severe patellar tendinopathy are not reported. Discussion: Patellar tendon reconstruction with hamstring autografts for the treatment of severe patellar tendinopathy can provide a strong reconstruction graft to allow for the resumption of high-level activities. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Effectiveness of Injection Strategies on Patients With Patellar Tendonitis (Jumpers' Knee): A Network Meta-analysis of Randomized Controlled Trials.

Patellar tendonitis (PT) is a common degenerative disease of the patellar tendon that seriously affects the sports careers of elite athletes and activities of daily living of sports enthusiasts. Injection therapy is a prevalent invasive treatment for PT. This work comprehensively analyzes various injection treatments for PT that consider agent type and characteristics, frequency, and assessment timepoints by meta-analysis. PubMed, Embase, and the Cochrane Library were sources of data. Randomized controlled trials (RCTs) analyzing the effect of various injection strategies on the treatment of patients with PT were considered. Systematic review and meta-analysis. Level 2. First author, year of publication, research location, registration information, patient type, sample size, age, sex, intervention, control treatment, and follow-up period in each study were extracted. Nineteen RCTs were included in the analysis. In the network meta-analysis of Victorian Institute of Sports Assessment-Patellar (VISA-P) outcomes, polidocanol (standardized mean difference (SMD), 6.52; 95% CI 4.75, 8.30; P < 0.01), tenocyte-like cells (SMD, 4.08; 95% CI 2.92, 5.25; P < 0.01), and leukocyte-poor platelet-rich plasma (LP-PRP) plus high-volume image-guided injection (HVIGI) (SMD, 1.56; 95% CI 0.62, 2.50; P < 0.01) were significantly superior to noninjection conservative treatment, mainly at the 6-month follow-up timepoint. For visual analog scale results, multiple dry needling (DN) (SMD, -1.78; 95% CI -2.56, -1.00; P < 0.01), LP-PRP (SMD, -0.71; 95% CI -1.31, -0.12; P = 0.02), and LP-PRP plus HVIGI (SMD, -1.31; 95% CI -2.22, -0.39; P < 0.01) were significantly superior to blank, which was also mainly at the 6-month timepoint. Injection-related treatments: polidocanol, tenocyte-like cells, LP-PRP, and multiple DN showed potential short (1-3 months) or medium (6 months)-term treatment benefits. There is still no evidence for injection interventions with long-term therapeutic benefit.

Location of Measurement Matters: Unveiling Regional Dynamics and Sex Differences in Patellar Tendon Strain InVivo.

Patellar tendinopathy is more prevalent in males versus female athletes and commonly presents in the medial region of the tendon. Separate measures of patellar tendon strain in the medial, central, and lateral regions of the tendon, however, have not been quantified. The purpose was to investigate the differences in tendon strain between the medial, lateral, and central regions of the patellar tendon in healthy men and women. Strain in the medial and lateral regions of the patellar tendon in healthy participants (10 males, 10 females) was evaluated using ultrasound during isometric quadriceps contractions at 20%, 40%, 60%, 80%, and 100% of maximum voluntary contraction (MVIC) in 60° and 90° of knee flexion. Central strain was also measured at 60% MVIC in 90° of knee flexion. Mixed models were used to determine strain between tendon regions and sex at 60% MVIC in 90° of knee flexion. Sequential modeling was used to fit region, sex, %MVIC, and angle to predict strain. The central region had less strain compared with both medial and lateral regions. The lateral region had higher strain compared with the medial region regardless of sex. Females had higher strain compared with males, regardless of region. Knee position did not influence tendon strain. Patellar tendon strain differs by region and sex. The varying prevalence between sex and in location of patellar tendinopathy may in part be explained by the unbalanced strains. Differential assessment of regional patellar tendon strain may be of importance for understanding injury risk and recovery with exercise.

Placebo Effect in the Treatment of Patellar Tendinopathy and Its Influencing Factors: Systematic Review With Meta-analysis and Meta Regression of Randomized Controlled Trials.

The effectiveness of nonsurgical treatment of patellar tendinopathy is questioned due to the conflicting results of placebo-controlled randomized controlled trials (RCTs) in which placebo arms often show impressive results. To quantify the magnitude of placebo effect of the different nonsurgical treatments of patellar tendinopathy. We also evaluated the influence of patients and treatments characteristics on the response to the placebo. Systematic review; Level of evidence, 1. We searched PubMed, Web of Science, Embase, Scopus, Cochrane Library, and gray literature databases on May 10, 2023, with no time limitation. RCTs on nonoperative treatment of patellar tendinopathy, including a placebo control arm reporting the evolution of symptoms after placebo administration, were included. A single-arm meta-analysis was performed with the Victorian Institute of Sport Assessment-Patella (VISA-P) at mid-term follow-up (3-6 months) as the primary outcome. The VISA-P score at short-term (1-3 months) and long-term (6-12 months) follow-ups, as well as visual analog scale (VAS) for pain at all 3 time points were also analyzed. A subanalysis based on the type of placebo and a meta-regression were conducted to look for potential determinants of the placebo effect. Risk of bias and level of evidence were also analyzed using the revised tool for risk of bias in randomized trials and Grading of Recommendations Assessment, Development and Evaluation. In total, 14 studies (251 patients) were included. VISA-P score at mid-term follow-up (3-6 months) showed statistically significant improvements of 13 of 100 points (P = .001). The change at short-term follow-up (1-3 months) was not statistically significant, whereas at long-term follow-up (6-12 months) it was 27 of 100 points (P < .001). Regarding VAS, results were statistically significant only at mid-term (MD = -1.5/10; P = .02) and long-term (MD = -3.2/10; P < .001) follow-ups. The meta-regression showed positive correlations between the response to placebo and the follow-up length (P < .001) and the effect size in the experimental group (P = .006). The level of evidence was moderate for mid- and long-term results and low for short-term results. The placebo effect for nonsurgical treatments of patellar tendinopathy is long-lasting (up to 12 months) and statistically and clinically significant. It has a perceived and true component and differs among treatments. The duration of follow-up and the effect size of experimental groups correlate with the magnitude of the placebo component, underlining the importance of RCTs to determine the effectiveness of new treatments of patellar tendinopathy.

Dutch multidisciplinary guideline on anterior knee pain: Patellofemoral pain and patellar tendinopathy.

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. 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. 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). 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 V, clinical practice guideline.

Innovative Physiotherapy Approaches in Managing Patellar Tendinopathy (Jumper’s Knee): An Updated Literature Review

Introduction: Patellar tendinopathy (jumper's knee) is an overuse injury that usually has a gradual onset of pain. This condition is common in jumping athletes, characterized by local pain at the attachment of the proximal tendon to the bone and dysfunction of the patellar tendon during jumping and landing. Patellar tendinopathy clinically results from high loads on the tendon, such as jumping and changing direction. Patellar tendinopathy can affect health and quality of life by limiting participation in sports and activities for athletes. Objective: This study aims to summarize secondary data related to physiotherapy management of patellar tendinopathy. Methods: The research method used is a literature study using secondary data in the form of journals related to the topic of patellar tendinopathy (jumper's knee) obtained through Google Scholar, Science Direct, and PubMed. Results: From five recent journal articles obtained with various physiotherapy intervention protocols, the results were able to reduce symptoms in patients with patellar tendinopathy. Conclusion: Physiotherapeutic interventions such as progressive tendon-loading exercises (PTLE), Eccentric exercise programmes, Kinesio-tape® and isometric exercises are effective in reducing symptoms in patients with patellar tendinopathy. Keyword: patellar tendinopathy, jumper's knee, physiotherapy

Evaluation of Patellar Tendon Structural Changes following Biological Treatments: Secondary Analysis of Double-Blinded Clinical Trial of Bone Marrow Mesenchymal Stromal Cells and Leukocyte-Poor Platelet-Rich Plasma.

Objective quantification of tendon structural changes through imaging is only achieved by evaluating tendon structure using ultrasound tissue characterization (UTC) technology. This study compares the effects of bone marrow mesenchymal stromal cells (BM-MSC) and leukocyte-poor platelet-rich plasma (Lp-PRP) on tendon structure and clinical outcomes in male patients with patellar tendinopathy measured with UTC at 3, 6, and 12 months after treatment. This is a double-blinded clinical trial with a randomized active control study with 20 male patients diagnosed with patellar tendinopathy who underwent BM-MSC and Lp-PRP. Bilateral ultrasound tissue characterization scans of the patellar tendon were carried out after 3, 6, and 12 months, as well as tests for strength and pain. UTC patellar tendon was analyzed at the insertion, proximal, and mid-tendon. BM-MSC showed a greater capacity to promote further positive changes than Lp-PRP. Lp-PRP presented higher disorganized echo-type II in the mid-tendon (p = 0.04; ES = 1.06) and III (p = 0.02; ES = -1.47) after 3 months in the Lp-PRP group. Similar results were seen after 6 and 12 months. Pain and strength data show improvement in the treated tendon. BM-MSC treatment demonstrates a superior capacity to promote tendon regeneration and organization, restore strength, and reduce pain compared to Lp-PRP, after 3, 6, and 12 months in male patients with patellar tendinopathy.

Platelet-Rich Plasma for Patellar Tendinopathy: A randomized controlled trial correlating clinical outcomes and quantitative imaging

Abstract Background Patellar tendinopathy (PT) is a common overuse injury in active individuals, often with incomplete recovery. Recently, platelet-rich plasma (PRP) treatment has shown promising results. Traditional qualitative markers are not reliable indicators of treatment response. Advanced quantitative imaging, such as Ultrashort-TE (UTE) MRI and ultrasound (US) shear-wave elastography (SWE) may be valuable adjuncts. Purpose To investigate the clinical outcomes and quantitative imaging changes in adults with symptomatic patellar tendinopathy treated with PRP, needle tenotomy (NT) or sham injection (SH). Materials and Methods Single-blinded prospective randomized controlled trial from April 2017 until July 2022 with three parallel interventions in athletes with symptomatic PT: PRP, NT and SH. VAS pain, VISA-P function, conventional US, shear wave speed (SWS), UTE T2* relaxation time (T2*single) and T2* fraction of fast-relaxing macromolecular-bound water (FF) were acquired at 0, 16 and 52-weeks. Longitudinal analyses were used to compare intra- and inter-group differences over time. Correlations were assessed by Pearson’s correlation coefficient. Results 29 subjects (mean age, 26.1±5.3 years; 82.8% men) were randomized. At 52-weeks all groups demonstrated a significant improvement in pain, though most pronounced within the PRP group (ΔVAS=-5.9, 95% confidence interval (CI) [-7.8, -3.9], p&amp;lt;.001). SWS increased significantly only in the PRP group (Δ+2.3, [0.8, 3.9], p=.003). Change in SWS was moderately correlated with change in pain across all groups (r=-.52, [-.76, -.15], p=.009). FF significantly increased in all groups (Δ=0.10-0.11, p=.024-0.046); a significant decrease in T2*single was only seen in the PRP group (Δ=-8.07, [-14.6, -1.55], p=.014). Conclusion Clinical improvement was evident irrespective of treatment but was greatest with PRP. SWS correlated with improvement in pain and may represent an adjunctive measure to assess healing in patellar tendinopathy. Correlative changes in T2* UTE quantitative markers suggest their potential for response assessment, but further research is needed to clarify their clinical applicability.

Mechanisms, Efficacy, and Clinical Applications of Platelet-Rich Plasma in Tendinopathy: A Comprehensive Review.

Tendinopathy poses a significant clinical challenge characterized by chronic tendon pain, swelling, and impaired function, affecting athletes and the general population. Current treatments often provide limited success, necessitating exploration into regenerative therapies such as platelet-rich plasma (PRP). PRP harnesses the regenerative potential of autologous platelets and growth factors to promote tendon healing. This review aims to comprehensively examine the mechanisms, efficacy, and clinical applications of PRPin tendinopathy. We discuss the pathophysiology of tendinopathy, highlighting collagen disorganization, increased ground substance, and inflammatory changes. PRP's action mechanism involves releasing bioactive molecules that stimulate cellular proliferation, collagen synthesis, and tissue remodeling. Clinical studies and trials evaluating PRP in various tendinopathies, including Achilles, patellar, and rotator cuff tendinopathy, are reviewed to assess its efficacy and effectiveness compared to traditional therapies. Practical aspects, such as preparation methods, injection techniques, and safety considerations, are discussed to provide insights into optimal PRP administration. Challenges, including protocol variability and evidence gaps, are addressed, and future research and clinical practice directions are proposed. By synthesizing current knowledge, this review aims to guide clinicians in enhancing treatment strategies and advancing the field of tendon regenerative medicine.

Role of orthobiologics in managing patellar tendinopathy: A narrative review.

Not applicable (narrative review).

Prevalence of Jumpers Knee in Basketball Players

Jumpers knee is a painful condition caused due to small tears in the patellar tendon. it mainly occurs in sports requiring strenuous activities which results in localized pain and tenderness of patella .It is also known as patellar tendinopathy, which is an overuse injury caused due to extensor mechanism it complies of a complex structure formed by quadriceps muscle and tendon, the patella and patellar tendon and the ligaments that surround and stabilize the knee (the quadriceps muscles are connected to the inferior pole of the patella by the common quadriceps tendon through a sesamoid bone, the patella.. Key Words: Jumpers knee, Overuse Injury, Knee extensor mechanism, Quaadriceps.

Upregulation of FABP4 induced inflammation in the pathogenesis of chronic tendinopathy

ObjectivesExcessive inflammation contributes to the pathogenesis of tendinopathy. Fatty acid binding protein 4 (FABP4) is a pro-inflammatory adipokine mediating various metabolic and inflammatory diseases. This study aimed to examine the expression of FABP4 and its association with the expressions of inflammatory cytokines in tendinopathy. The effects of a single injection of FABP4 on tendon pathology and inflammation were examined. The effect of FABP4 on the expressions of inflammatory cytokines and the effect of IL-1β on the expression of FABP4 in tendon-derived stem/progenitor cells (TDSCs) were also investigated. Methods1) Clinical patellar tendinopathy samples, healthy hamstring tendon samples, and healthy patellar tendon samples, 2) rotator cuff tendinopathy samples and healthy hamstring tendon samples; and 3) Achilles tendons of mice after saline or collagenase injection (CI) were stained for FABP4, IL-1β, IL-6, TNF-α and IL-10 by immunohistochemistry (IHC). For the rotator cuff tendinopathy samples, co-localization of FABP4 with IL-1β and TNF-α was done by immunofluorescent staining (IF). Mouse Achilles tendons injected with FABP4 or saline were collected for histology and IHC as well as microCT imaging post-injection. TDSCs were isolated from human and mouse tendons. The mRNA expressions of inflammatory cytokines in human and mouse TDSCs after the addition of FABP4 was quantified by qRT-PCR. The expression of FABP4 in TDSCs isolated from rotator cuff tendinopathy samples and healthy hamstring tendon samples was examined by IF. Mouse Achilles TDSCs were treated with IL-1β. The mRNA and protein expressions of FABP4 were examined by qRT-PCR and IF, respectively. ResultsThere was significant upregulation of FABP4 in the patellar tendinopathy samples and rotator cuff tendinopathy samples compared to their corresponding controls. FABP4 was mainly expressed in the pathological areas including blood vessels, hypercellular and calcified regions. The expressions of IL-1β and TNF-α increased in human rotator cuff tendinopathy samples and co-localized with the expression of FABP4. Collagenase induced tendinopathic-like histopathological changes and ectopic calcification in the mouse Achilles tendinopathy model. The expressions of inflammatory cytokines (IL-1β, IL-6, TNF-α, IL-10) and FABP4 increased in hypercellular region, round cells chondrocyte-like cells and calcified regions in the mouse Achilles tendons post-collagenase injection. A single injection of FABP4 in mouse Achilles tendons induced histopathological changes resembling tendinopathy, with increased cell rounding, loss of collagen fiber alignment, and additionally presence of chondrocyte-like cells and calcification post-injection. The expressions of IL1-β, IL-6, TNF-α and IL-10 increased in mouse Achilles tendons post-FABP4 injection. FABP4 increased the expressions of IL10, IL6, and TNFa in human TDSCs as well as the expressions of Il1b, Il6, and Il10 in mouse TDSCs. Human tendinopathy TDSCs expressed higher level of FABP4 compared to healthy hamstring TDSCs. Besides, IL-1β increased the expression of FABP4 in mouse TDSCs. ConclusionIn conclusion, an upregulation of FABP4 is involved in excessive inflammation and pathogenesis of tendinopathy. TDSCs is a potential source of FABP4 during tendon inflammation. Translation potential of this articleFABP4 can be a potential treatment target of tendinopathy.

Functionality and jump performance in patellar tendinopathy with the application of three different treatments

ObjectivesThe aim is to assess performance characteristics in jumps and functionality in participants with patellar tendinopathy and compare changes with various tendinopathy treatments in the short and medium term. As a secondary objective, the study aims to verify the relationship between changes in knee functionality assessed by the VISA-P and jump capacity in the different treatment groups. DesignA double-blinded randomized controlled trial. MethodsRecruitment was conducted at sport clubs, with 48 participants with patellar tendinopathy included in the study. Participants were randomized into groups: dry needling (DN), percutaneous electrolysis (PNE), and sham needling as the control group (CG), all combined with eccentric exercise (EE). Functionality and performance during jumps, including squat jump (SJ) and counter movement jump (CMJ), were assessed. ResultsSignificant differences were found in functionality between the pre-test and post-test evaluations, as well as between the pre-test and follow-up evaluations, in all three groups (p < 0.001). The DN group experienced an improvement in eccentric power (p = 0.021). A moderate correlation was found between the pre-test and post-test changes in functionality and SJ maximum concentric force (r = 0.63, p < 0.01, CI: 0.1; 0.8), CMJ maximum concentric force (r = 0.52, p = 0.05, CI: −0.01; 0.8), and CMJ eccentric power in the DN group (r = 0.63, p = 0.01, CI: 0.1; 0.8). ConclusionsEccentric exercise could be effective in improving functionality in patellar tendinopathy and DN could improve eccentric power in jumps performance. Moreover, the DN group experienced an increase in functionality that correlated with the improvements found in jump performance in eccentric power and concentric strength.

Ecologically dynamic flywheel ergometer squat performance characteristics between national Olympic athletes with and without patellar tendinopathy

Ecologically dynamic flywheel ergometer squat performance characteristics between national Olympic athletes with and without patellar tendinopathy

Placebo and nocebo effects of percutaneous needle electrolysis and dry-needling: an intra and inter-treatment sessions analysis of a three-arm randomized double-blinded controlled trial in patients with patellar tendinopathy.

This study aimed to investigate the influence of potential placebo and nocebo effects on pain perception of percutaneous needle electrolysis (PNE) in individuals with patellar tendinopathy. In this secondary analysis of a three-arm randomized double-blinded controlled trial, intra and inter-session pain perception data from 48 sporting participants with patellar tendinopathy between 18 and 45 years were investigated. Participants were divided into 3 parallel groups: "no-sham group" [PNE intervention], "single-sham group" [sham PNE by using dry needling], and "double-sham group" [sham PNE by using sham needles]. Every group received 4 sessions of the needling therapies targeting the patellar tendon over 8 weeks and was instructed to perform a unilateral eccentric exercise program of the quadriceps muscle on the affected side. Clinical and needle-related pain was assessed before, during, and after each treatment session using a visual analog scale. No differences were found between groups intra- or inter-session in terms of pain reduction (P = 0.424) despite clinical pain decreased in all groups since the first treatment session (P < 0.001). Furthermore, although the double-sham group showed a lower percentage of participants reporting needle-related pain during needle intervention (P = 0.005), the needle-related pain intensity after needle intervention was similar between groups (P = 0.682). Moreover, there were no group differences for the duration of pain sensation after any needle intervention (P = 0.184), extending in many cases beyond 24 h. Needling therapies for individuals with patellar tendinopathy are prone to elicit placebo effects regarding clinical pain and nocebo effects regarding needling-related pain. Clinicians and physical therapists treating musculoskeletal pain conditions should consider the added value and potential mechanisms of action before routinely using needle techniques.

Review of the Literature on Patellar Tendinopathy: Current State of Knowledge

Review of the Literature on Patellar Tendinopathy: Current State of Knowledge

Impact of Centrifugation Parameters on Platelet-Rich Plasma Injection for Patella Tendinopathy: A Systematic Review and Meta-Analysis.

Patellar tendinopathy (PT) is a chronic, degenerative form of tendinitis commonly affecting young, active individuals. Numerous nonsurgical treatments exist, of which platelet-rich plasma (PRP) is a frontrunner. However, heterogeneity among various PRP preparation techniques results in a large variation in treatment efficacy. This review and meta-analysis aims to investigate the effect of PRP centrifugation factors, specifically centrifuge speed and duration, on functional outcomes in patients with PT. A systematic search of the literature was performed in April 2024 on Medline and Embase. Articles involving the use of PRP in the treatment of PT were included. The risk of bias was assessed using the Risk of Bias 2 (RoB 2; the Cochrane Collaboration, England, UK) and Risk of Bias in Non-randomised Studies of Intervention (ROBINS-I; the Cochrane Collaboration, England, UK) tools. Comparative meta-analysis between the different centrifugation speeds and the different centrifugation durations was performed on articles reporting Victorian Institute of Sports Assessment - Patellar tendon (VISA-P) and visual analogue scale (VAS) scores for PT. Seventeen studies consisting of 360 participants were included in the analysis. The mean follow-up duration was 13.2 months (95% CI: 8.81 to 17.7). The mean VAS reduction was 3.85 (95% CI: -4.63 to -3.08; P < 0.01). VISA-P scores improved by 32.03 (95% CI: 24.29 to 39.78; P < 0.01). There were no significant differences between centrifuge speeds for VAS (P = 0.17) and VISA-P (P = 0.18) and between centrifuge durations for VAS (P = 0.25) and VISA-P (P = 0.27). Centrifuge speed and duration and number of centrifuge cycles did not show any significant differences in patient outcomes. There were no significant differences observed in outcomes for the different preparations of PRP. There remains a need for further high-quality RCTs using standardized PRP preparations with long-term follow-up for the development of a consensus method of PRP preparation for the treatment of PT.

Different Profiles of Jumper's Knee Indications in Basketball, Volleyball, and Football Athletes

PURPOSE: The present study aimed to compare the incidence of “jumper’s knee” injuries among athletes in basketball, volleyball, and football; to understand the causality and effect of the participation period and the incidence of jumper’s knee; to ascertain the link between history of injury and the incidence of jumper’s knee; and to determine the relationship between the type of tournament and the probability of jumper’s knee injury occurring.METHODS: This analytic, observational, cross-sectional study included subjects from high schools and clubs in Bandung, Solo, and Jogja, with a sample of approximately 30 participants representing each sport selected using a purposive sampling method (N = 93). Analytic observational using a cross sectional study approach in high schools and clubs in Bandung, Solo, and Jogja with a total sample of 30 for each sport selected by the purposive sampling method and obtained a total of 93 respondents. Dependent variable in this study is the jumper’s knee diagnosis. Statistical test data analysis used is different profiles using chi-square test effect of type of injury using binary regression relationship between participation period with jumper’s knee using Kendall's tau_b, the effect of playing time using binary regression and the relationship between the type of tournament and jumper’s knee using Kendall's tau_b. Statistical analysis of the dependent variable risk/indication for jumper’s knee used different methods. The chi-squared test was used to analyze the effect of type of injury using a binary regression method (Kendall's tau_b) to determine the relationship between participation period and jumper’s knee; and binary regression was used to assess the effect of playing time and the relationship between the type of tournament and jumper’s knee.RESULTS: Chi-squared analysis yielded an asymptotic significance value of p = .079, indicating no significant difference in the incidence of knee injuries among basketball, volleyball, and football athletes. Jumper's knee had positive percentage values of 38%, 34.6%, and 26.9% in basketball, volleyball, and football, respectively. Statistical tests examining the association between injury history and the incidence of jumper’s knee yielded a value of p = .00 with exp (b) = 0.075, which suggests an influence between ankle injury and jumper’s knee among the highest-risk athletes.CONCLUSIONS: Basketball, volleyball, and football players sustained jumper’s knee injuries at similar rates.

Surgical and Biological Treatment with a Platelet-Rich Fibrin Matrix for Patellar Tendinopathy: Clinical Outcomes and Return to Sport at 2-Year Follow-Up.

Patellar tendinopathy (PT) involves anterior knee pain and functional. Platelet-rich fibrin matrix (PRFM) is a promising biological therapy for tendinopathies. We examined a cohort of PT patients treated with tendon debridement and autologous PRFM at the 24-month follow-up to assess whether the combined treatment facilitated return to sports and yielded satisfactory clinical and functional scores. Baseline and 24-month visual analogue scale (VAS), Victorian Institute of Sport Assessment Scale for Patellar Tendinopathy (VISA-P), Tegner Activity Scale (TAS), and Blazina scores were compared to evaluate treatment effectiveness. The Friedman test was used to compare repeated observations of VAS, VISA-P, TAS, and Blazina Score values. Return to sport rate, Tampa Scale of Kinesiophobia (TKS) score and patient satisfaction were collected at 24 months. The postoperative clinical scores demonstrated significant improvement compared with their preoperative values (all p < 0.001). Specifically, the VISA-P score was 80.32 (±20.58), 92.10% of patients had resumed sports activities and patient satisfaction was 9.21 (±1.21) at 24 months. Surgical debridement and autologous PRFM application in patients with chronic PT resulted in a higher rate of return to sports when compared to solely surgical treatment, significantly improved clinical outcomes and excellent patient satisfaction at 24 months.

Relative Energy Deficiency in Sport (REDs) and knee injuries: current concepts for female athletes

In athletes, a mismatch between caloric intake and energy expended in exercise can eventually lead to Relative Energy Deficiency in Sport (REDs), where the athlete suffers from physiological derangements and decreased sport performance. The prevalence of REDs is higher in females than males. Females are already at a higher risk of knee injuries, which has been attributed to a multitude of factors such as hormonal influences, differences in musculoskeletal anatomy and neuromuscular control compared to males. The literature demonstrates an even higher risk of knee injuries in female athletes with symptoms of REDs. We propose the various factors that influence this risk. A reduction in anabolic hormones can affect muscle development and tendon repair. A relationship between poor neuromuscular control and knee injury has been established, and this can be further worsened in patients with menstrual dysfunction. Chronic deficiency in nutrients such as collagen and vitamin D can result in poorer recovery from microtrauma in tendons and ligaments. All these factors may contribute to increasing the risk of knee injuries, which may include anterior cruciate ligament tears, patella tendinopathy and patellofemoral pain syndrome. This review aims to educate sports clinicians to have a high index of suspicion when treating knee injuries in females; to screen and then manage for REDs if present, for holistic patient care.