Significant Knee Injury Research Articles

Patellar Sleeve Fracture: An Update of Literature

Patellar sleeve fractures, though relatively rare, present unique challenges in diagnosis and management. This review aims to provide a comprehensive overview of the current understanding of patellar sleeve fractures, focusing on their epidemiology, clinical presentation, imaging, and management strategies. Epidemiologically, these fractures are uncommon, representing approximately 1% of all fractures in pediatric patients, yet they account for 50% of all patella fractures in this population. They predominantly affect adolescents, with a peak incidence around 12.7 years of age, and are more common in boys, occurring at a ratio of 3 to 5:1. Understanding these demographic patterns is crucial for early recognition and appropriate management. Clinically, patellar sleeve fractures typically present with the sudden onset of severe pain, often associated with explosive activities such as jumping. However, diagnosis can be challenging, particularly in cases with minimal displacement or where alternative muscle groups compensate for the injury. Differential diagnosis is essential, and clinicians should be vigilant for signs such as palpable gaps at the lower pole of the patella and patella alta. Imaging modalities play a vital role in diagnosis, with plain X-rays often revealing no bony damage. Ultrasonography may offer a cost-effective alternative, especially in cases where radiographic findings are inconclusive. Advanced imaging techniques such as MRI can assist in characterizing the extent of the injury and assessing for associated complications. Management strategies encompass a spectrum of approaches, ranging from conservative measures such as immobilization and physical therapy to surgical interventions, including open reduction and internal fixation or arthroscopic surgery. The choice of treatment depends on various factors, including the fracture pattern, displacement, patient age, activity level, and associated injuries. Despite advancements in diagnosis and treatment, the optimal management of patellar sleeve fractures remains a clinical challenge. Further research is warranted to elucidate optimal algorithms for diagnosis and treatment, with the ultimate goal of improving outcomes and reducing the risk of long-term complications associated with this rare but clinically significant knee injury.

Suture anchor fixation of displaced tibial eminence avulsion fracture in children

Abstract Background Avulsion fractures of the tibial eminence during childhood are infrequent yet significant knee injuries. Given that the injury is equivalent to a rupture of the anterior cruciate ligament. The treatment strategy necessitates anatomic reduction to reestablish joint stability and reduce the risk of anterior impingement and flexion deformity. The aim of the study was to evaluate short-term results of arthroscopyassisted suture anchor fixation of tibial eminence avulsion in children. Methods This study included 11 injured children with type III avulsion tibial eminence. The average age was 8.55 years. The study included nine boys and two girls. The mechanism of trauma was bicycle accident in seven children, twisting injury in two children, falling downstairs in one child, and jumping from a height in one case. Results All patients were able to return to their everyday activities within 6 months following the injury. The range of motion at the end of follow up was full in 10 (90.9%) patients and functional range in one (9.1%) patient. The knee stability was excellent by clinical examination. Conclusion The successful application of this approach in preserving knee function following type III avulsion tibial eminence in pediatric patients has been demonstrated.

Lifetime risk and genetic predisposition to post-traumatic OA of the knee in the UK Biobank

Acute knee injury is associated with post-traumatic OA (PTOA). Very little is known about the genome-wide associations of PTOA when compared with idiopathic OA (iOA). Our objective was to describe the development of knee OA after a knee injury and its genetic associations in UK Biobank (UKB). Clinically significant structural knee injuries in those ≤50 years were identified from electronic health records and self-reported data in 502,409 UKB participants. Time-to-first knee osteoarthritis (OA) code was compared in injured cases and age-/sex-matched non-injured controls using Cox Proportional Hazards models. A time-to-OA genome-wide association study (GWAS) sought evidence for PTOA risk variants 6 months to 20 years following injury. Evidence for associations of two iOA polygenic risk scores (PRS) was sought. Of 4233 knee injury cases, 1896 (44.8%) were female (mean age at injury 34.1 years [SD 10.4]). Over a median of 30.2 (IQR 19.5-45.4) years, 1096 (25.9%) of injured cases developed knee OA. The overall hazards ratio (HR) for knee OA after injury was 1.81 (1.70,1.93), P=8.9×10-74. Female sex and increasing age at injury were associated with knee OA following injury (HR 1.15 [1.02,1.30];1.07 [1,07,1.07] respectively). OA risk was highest in the first 5 years after injury (HR 3.26 [2.67,3.98]), persisting for 40 years. In 3074 knee injury cases included in the time-to-OA GWAS, no variants reached genome-wide significance. iOA PRS was not associated with time-to-OA (HR 0.43 [0.02,8.41]). Increasing age at injury and female sex appear to be associated with future development of PTOA in UKB, the risk of which was greatest in the 5 years after injury. Further international efforts towards a better-powered meta-analysis will definitively elucidate genetic similarities and differences of PTOA and iOA.

Value and imaging findings of the magnetic resonance in the posterolateral corner complex injuries of the knee

BackgroundMRI is considered the key tool for evaluation of knee injuries, notably the posterolateral corner, due to its complexity and multi-ligament involvement. This prospective study was conducted from September 2020 to September 2021 aiming to clarify the value and possible MRI findings in assessing the posterolateral corner (PLC) knee injuries which can subsequently result in an improvement in the management of these cases, preventing devastating consequences.ResultsThe current study was conducted on 30 patients (11 females and 19 males) whose mean age was 42 years. Imaging by a closed magnet (1.5 T) MRI was applied to 30 patients with traumatic history to the knee using: axial, sagittal, coronal T1WI, T2WI, and proton density fat sat sequences. The lateral collateral ligament (LCL) was the most commonly affected ligament. Grade I injuries were the most common form of injuries. Twenty-four (80%) patients suffered from LCL injury, popliteal complex injuries were in 21 (70%) patients, 10 (33.3%) patients had biceps femoris tendon injury, while injury to the popliteofibular ligament was seen in 8 (26%) patients. The arcuate ligament was poorly defined in 6 (20%) patients, indicating that it had torn, lateral head of gastrocnemius injury was seen in 5 (16.7%) patients and 4 (13.3%) patients showed injury to the iliotibial band. Correlation with arthroscopic findings was considered the gold standard of the results whenever available. That was applied to 16 cases who had clinically significant knee injuries and arthroscopy was requested.ConclusionsMRI is a key tool for determining a correct pre-surgical evaluation and diagnosis. It is critical to have a thorough understanding of the radiological PLC anatomy, as well as the presence of various pathologies on MRI. It allows the determination of whether the tendons and ligaments are partially or completely torn, besides any related injuries preventing possible poor consequences after the restoration of the cruciate ligaments.

Epidemiology With Video Analysis of Knee Injuries in the Women's National Basketball Association.

Background:Knee injuries are the most common type of injury seen in the Women’s National Basketball Association (WNBA). However, there are sparse epidemiologic data regarding these injuries over the past 20 years.Purpose/Hypothesis:The purpose of this study was to determine the prevalence, return to play (RTP) rate/length, and mechanism of knee injuries in the WNBA. We hypothesized that anterior cruciate ligament (ACL) tears would have the highest prevalence and longest RTP times.Study Design:Descriptive epidemiology study.Methods:Publicly available WNBA injury reports were used to find WNBA athletes who sustained knee injuries. The RTP length was determined by calculating the number of days between the date of the injury and the date of the first game they played after returning. The RTP rate was determined by calculating the number of players who returned to play from each injury compared with the total number of each injury. Incidence of knee injuries, frequency, and time to RTP were calculated for each injury. Available videos were analyzed to determine the mechanism and body position at the time of injury.Results:Overall, 99 WNBA players were identified as having sustained a knee injury during the study period resulting in loss of play. ACL tears (n = 37; 37%) were the most devastating injury, resulting in the longest time before RTP (n = 375 days; 70%). The position with the highest incidence of knee injuries was guard, accounting for 53% of knee injuries. Video analysis conducted on 12 knee injuries revealed that such injuries were most commonly noncontact (83%).The mechanisms of injury were most commonly planting (58%) and landing from a jump (33%) with the knee flexed in the valgus position (100%).Conclusion:Study findings indicated that ACL tears are the most common clinically significant knee injuries sustained in the WNBA, accounting for 37% of total knee injuries with a mean RTP rate of 375 days. The most common mechanism of injury was planting the foot or landing from a jump with a flexed knee in the valgus position. Knee injuries had a high RTP rate in WNBA players but resulted in them missing a significant amount of playing time.

Prone Lachman with Ultrasound: A Literature Review and Description of the Technique.

Magnetic resonance imaging is the current gold standard imaging modality for diagnosing anterior cruciate ligament (ACL) tears. However, ultrasound has grown in popularity for detecting ACL injuries because of its low cost, portability, and dynamic assessment capabilities. Recent studies demonstrate high sensitivity and specificity for diagnosing isolated ACL tears via ultrasound, but tremendous heterogeneity remains for optimal technique including patient positioning, transducer placement, and dynamic versus static ultrasound usage. As ultrasound becomes ubiquitous in clinics, training rooms, and on the sidelines, identifying objective and sensitive measurements to appropriately screen athletes for significant knee injuries is imperative. This article aims to review the current role of diagnostic ultrasound in ACL injuries and propose a standardized version of the Prone Lachman with Ultrasound test, which is an objective, reliable, and easily reproducible technique to evaluate ACL competency. Developing a standardized protocol will expand the use of point-of-care ultrasound, which may reduce cost and improve efficiency in care.

Implementing an Injury Prevention and Performance Enhancement Program During a Softball Season for Young Female Athletes

Female athletes are up to 6 times more likely than males to sustain a significant noncontact knee injury. Although many reasons for this difference have been discussed, neuromuscular variances are trainable and strength programming can reduce the risk of injury and enhance performance for such athletes. Unfortunately, although such programming exists, injury rates remain largely unchanged over the past 2 decades, meaning there is a need for practical integration. This article describes a specific plan intended to be highly practical that can be used in softball practices and games to enhance the delivery of injury prevention and sport performance training.

Clinical and molecular associations with outcomes at 2 years after acute knee injury: a longitudinal study in the Knee Injury Cohort at the Kennedy (KICK).

SummaryBackgroundJoint injury is a major risk factor for osteoarthritis and provides an opportunity to prospectively examine early processes associated with osteoarthritis. We investigated whether predefined baseline demographic and clinical factors, and protein analytes in knee synovial fluid and in plasma or serum, were associated with clinically relevant outcomes at 2 years after knee injury.MethodsThis longitudinal cohort study recruited individuals aged 16–50 years between Nov 1, 2010, and Nov 28, 2014, across six hospitals and clinics in London, UK. Participants were recruited within 8 weeks of having a clinically significant acute knee injury (effusion and structural injury on MRI), which was typically treated surgically. We measured several predefined clinical variables at baseline (eg, time from injury to sampling, extent and type of joint injury, synovial fluid blood staining, presence of effusion, self-reported sex, age, and BMI), and measured 12 synovial fluid and four plasma or serum biomarkers by immunoassay at baseline and 3 months. The primary outcome was Knee Injury and Osteoarthritis Outcome Score (KOOS4) at 2 years, adjusted for baseline score, assessed in all patients. Linear and logistic regression models adjusting for predefined covariates were used to assess associations between baseline variables and 2-year KOOS4. This study is registered with ClinicalTrials.gov, number NCT02667756.FindingsWe enrolled 150 patients at a median of 17 days (range 1–59, IQR 9–26) after knee injury. 123 (82%) were male, with a median age of 25 years (range 16–50, IQR 21–30). 98 (65%) of 150 participants completed a KOOS4 at 2 (or 3) years after enrolment (50 participants were lost to follow-up and two were withdrawn due to adverse events unrelated to study participation); 77 (51%) participants had all necessary variables available and were included in the core variable adjusted analysis. In the 2-year dataset mean KOOS4 improved from 38 (SD 18) at baseline to 79 (18) at 2 years. Baseline KOOS4, medium-to-large knee effusion, and moderate-to-severe synovial blood staining and their interaction significantly predicted 2-year KOOS4 (n=77; coefficient −20·5, 95% CI −34·8 to −6·18; p=0·0060). The only predefined biomarkers that showed independent associations with 2-year KOOS4 were synovial fluid MCP-1 (n=77; −0·015, 0·027 to −0·004 per change in 1 pg/mL units; p=0·011) and IL-6 (n=77; −0·0005, −0·0009 to −0·0001 per change in 1 pg/mL units; p=0·017). These biomarkers, combined with the interaction of effusion and blood staining, accounted for 39% of outcome variability. Two adverse events occurred that were linked to study participation, both at the time of blood sampling (one presyncopal episode, one tenderness and pain at the site of venepuncture).InterpretationThe combination of effusion and haemarthrosis was significantly associated with symptomatic outcomes after acute knee injury. The synovial fluid molecular protein response to acute knee injury (best represented by MCP-1 and IL-6) was independently associated with symptomatic outcomes but not with structural outcomes, with the biomarkers overall playing a minor role relative to clinical predictors. The relationship between symptoms and structure after acute knee injury and their apparent dissociation early in this process need to be better understood to make clinical progress.FundingVersus Arthritis, Kennedy Trust for Rheumatology Research, and NIHR Oxford Biomedical Research Centre.

Dietary intake in youth with a sport-related knee injury - implications for secondary prevention of post-traumatic osteoarthritis

Purpose: Sport and recreation participation is the leading cause of injury requiring medical attention amongst school-aged children and adolescents, with approximately 40% of these injuries affecting the knee. Knee injuries increase the risk for post-traumatic osteoarthritis (OA), with 50% of youth who suffer a significant knee injury developing OA within 10-15 years. Given no OA disease-modifying treatment exists, preventative strategies are needed. Nutritional adequacy may be an important target for preventing OA following injury given the vital role of key nutrients in bone and joint health.

Intra-articular Injection Administration in UK Ex-professional Footballers During Their Playing Careers and the Association with Post-career Knee Osteoarthritis

BackgroundThe long-term risk from knee intra-articular (KIA) injections in professional athletes such as ex-footballers remains unknown. The use of KIA injections is controversial and remains anecdotally prolific as it is perceived as being safe/beneficial. The aim of this study was to determine the number, type and frequency KIA injections administered to retired professional footballers during their playing careers and the associations with post-career knee osteoarthritis (KOA).MethodsThis is a cross-sectional study involving a postal questionnaire (n = 1207) and subsequent knee radiographs in a random sample of questionnaire responders (n = 470). Footballers self-reported in the questionnaire whether they had received KIA injections and the estimated total number over the course of their playing career. Participant characteristics and football career-related details were also recorded. KOA was measured as self-reported knee pain (KP), total knee replacement (TKR) and radiographic KOA (RKOA).Results44.5% of footballers had received at least one KIA injection (mean: 7.5; SD ± 11.2) during their professional career. 71% of knee injections were cortisone/corticosteroid based. Multivariate logistic regression, adjusting for age, body mass index (BMI) and significant knee injury identified that footballers with injections were two times more likely to have KP (OR 1.81, 95% CI 1.40–2.34) and TKR (OR 2.21, 95% CI 1.43–3.42) than those without injections. However, there was no association with RKOA (OR 1.30, 95% CI 0.85–2.01). Given, the association with KP and TKR, we found a significant dose–response relationship as the more injections a player received (by dose–response groups), the greater the risk of KP and TKR outcomes after adjustment for knee injury and other confounders (p for trend < 0.01).ConclusionOn average, 8 KIA injections were given to the ex-footballers during their professional career. The most commonly administered injections were cortisone based. These injections associated with KP and TKR after they retired. The associations are independent of knee injuries and are dose dependent. The study suggests that there may have been excessive use of KIA injections to expedite return to play and this contributed to detrimental long-term outcomes such as KP and TKR post-retirement from professional football.

Do variants of the intercondylar notch predispose children to the injury of the anterior cruciate ligament?

Differences in knee development result in morphological variations observed among individuals. Some of them predispose to significant knee injuries. Although the anatomical risk factors are well established in adults, there is still a need for further research in this area in the group of children. This work aims to determine the morphological variations of the intercondylar notch of the femur predisposing to anterior cruciate ligament (ACL) injuries in the pediatric population. Magnetic resonance imaging (MRI) scans of the knee were retrospectively analyzed in 74 patients aged 4-18 years. Examinations were performed due to pain complaints after trauma. The completely torn ACL was found in 35 patients. The diagnosis was confirmed intraoperatively. The remaining patients, with no signs of injuries, were qualified as a reference group. The intercondylar notch width was evaluated by calculating the Notch Width Index. Additionally, the morphology of the intercondylar eminence was assessed. Finally, a statistical analysis of the obtained data was performed.Patients with a torn ACL had a narrower intercondylar notch (a lower Notch Width Index, P = 0.0007) as well as a broader and more sharply ended intercondylar eminence (P = 0.0267 and 0.0188, respectively). The narrowed intercondylar notch, expressed by the low Notch Width Index, and the increased size of the intercondylar eminence were identified as the risk factors for the ACL rupture in children. Clin. Anat. 32:706-709, 2019. © 2019 Wiley Periodicals, Inc.

Dietary intake in youth with a sport-related knee injury: implications for secondary prevention of post-traumatic osteoarthritis

Dietary intake in youth with a sport-related knee injury: implications for secondary prevention of post-traumatic osteoarthritis

“Dynamic knee valgus” – Are we measuring what we think we’re measuring? An evaluation of static and functional knee calibration methods for application in gait and clinical screening tests of the overhead squat and hurdle step

Background"Dynamic knee valgus” has been identified as a risk factor for significant knee injuries, however, the limits and sources of error associated with existing 3D motion analysis methods have not been well established. Research questionWhat effect does the use of differing static and functional knee axis orientation methods have on the observed knee angle outputs for the activities of gait, overhead squatting and a hurdle step? MethodsA pre-existing dataset collected from one season (September 2015–May 2016) as part of a prospective observational longitudinal study was used. A secondary analysis of data for 24 male footballers, from a single British University football team, was conducted in order to evaluate the effect of static (conventional gait model) and dynamic (constrained and unconstrained mDynaKAD) methods on knee joint kinematics for flexion-extension and valgus-varus angles. ResultsNo single calibration method consistently achieved both the highest flexion and lowest valgus angle for all tests. The constrained and unconstrained mDynaKAD methods achieved superior alignment of the knee medio-lateral axis compared to the conventional gait model, when the movement activity served as its own calibration. The largest mean difference between methods for sagittal and coronal plane kinematics was less than 4° and 14° respectively. Cross-talk could not account for all variation within the results, highlighting that soft tissue artefact, associated with larger muscle volumes and movements, can influence kinematics results. SignificanceWhen considering the trade-off between achieving maximum flexion and minimal valgus angle, the results indicate that the mDynaKAD methods performed best when the selected movement activity served as its own calibration method for all activities. Clinical decision making processes obtained through use of these methods should be considered in light of the model errors associated with cross-talk and effect of soft tissue artefact.

Neuropathic-like knee pain and associated risk factors: a cross-sectional study in a UK community sample

BackgroundNeuropathic-like knee pain (NKP) is often reported in individuals with knee pain (KP), but the contribution of specific central and peripheral risk factors to NKP has not been studied previously. The aims of the present study were to determine the prevalence of NKP in a community-derived sample with KP and to identify risk factors associated with NKP.MethodsA cross-sectional study was undertaken (n = 9506) in the East Midlands community among responders (aged 40+ years) to a postal questionnaire. Questions included KP severity (numerical rating scale) and type (neuropathic versus nociceptive) using the modified painDETECT questionnaire, as well as age, body mass index (BMI), significant knee injury, widespread pain, pain catastrophising and fatigue. Multinomial regression analysis was used to determine ORs and 95% CIs. Risk factors were categorised into central and peripheral, and proportional risk contribution (PRC) and 95% CI were estimated using ROC.ResultsKP was reported in 28.2% of responders, of whom 13.65% had NKP (i.e., 3.9% of the total population). Women reported more NKP. After adjustment for age, gender, BMI and pain severity, definite NKP showed associations (aOR, 95% CI) with fibromyalgia (4.07, 2.49–6.66), widespread pain (1.93, 1.46–2.53), nodal osteoarthritis (1.80, 1.28–2.53), injury (1.50, 1.12–2.00), pain catastrophising (5.37, 2.93–9.84) and fatigue (5.37, 3.08–9.35) compared with non-NKP participants. Although only central risk factors contributed to NKP (PRC 8%, 95% CI 2.5–12.5 for central vs. PRC 3%, 95% CI −0.25 to 7.5 for peripheral), both central and peripheral risk factors contributed equally to non-NKP (PRC 10%, 95% CI 5–20 for both).ConclusionsNKP appears to be driven largely by central risk factors and may require different prevention/treatment strategies.Trial registrationClinicalTrials.gov, NCT02098070. Registered on 27 March 2014.

Prevalence of knee pain, radiographic osteoarthritis and arthroplasty in retired professional footballers compared with men in the general population: a cross-sectional study

ObjectivesTo determine the prevalence of knee pain, radiographic knee osteoarthritis (RKOA), total knee replacement (TKR) and associated risk factors in male ex-professional footballers compared with men in the general population...

Risk of Knee Osteoarthritis Over 24 Months in Individuals Who Decrease Walking Speed During a 12-Month Period: Data from the Osteoarthritis Initiative.

To assess the association between change in walking speed over a 12-month period and risk of developing radiographic knee osteoarthritis (rKOA) over a 24-month period. We included participants without rKOA from the Osteoarthritis Initiative. Change in walking speed was determined from a 20-m walk assessment, calculated using walking speed at 12-month followup minus baseline speed and/or 24-month followup walking speed minus 12-month speed. Incident rKOA was defined as progressing to Kellgren-Lawrence arthritis grading scale ≥ 2 within 24 months (i.e., incidence between 12 and 36 mos or 24 and 48 mos). Self-reported significant knee injury during the exposure period, age, body mass index (BMI), and Physical Activity Scale for the Elderly (PASE) score were adjusted for analytically. We included 2638 observations among 1460 unique participants (58% women; aged 59 ± 9 yrs, range 45-79). The mean change in walking speed over 12 months was 0.001 ± 0.13 m/s (range -0.6271 to 1.4968). About 5% of the sample (n = 122) developed rKOA over a 24-month period. After controlling for significant knee injury, age, BMI, and PASE score, we found an 8% relative increase in risk of developing rKOA for every 0.1 m/s decrease in walking speed over a 12-month period (risk ratio 1.08, 95% CI 1.00-1.15, p = 0.05). Evaluating change in speed over a 12-month period using a 20-m walk test may be useful in identifying individuals at increased risk of developing rKOA over the subsequent 24 months. Identification of patients at high risk for developing rKOA would allow medical providers to implement early interventions to maximize joint health.

Injury Prevention at North Queensland Cowboys 2012 - 2015

Objectives:Review injury rates at North Queensland Cowboys and compare this to the league in general and finishing position.Methods:Injury statistics and surveillance body. Review shoulder and knee injury statistics from 2012 – 2016. Comparisons to rest of the competition and finishing position for the various seasons.Results:It has long been thought that to win premierships, injury rates are important. In 2012 North Queensland Cowboys finished in eight position. The injury rates at this time were high. 2011 signify high injury rates which led us to introduce prevention strategies for knee and shoulder injury based on FIFA 11+ format. There has been a significant decline in injury rates such that by 2015 we had the least injuries in the competition. This corresponds to finishing the season as premiers. During this period the only significant knee injuries occurred in players that were new to our system.Conclusion:The injury prevention strategies have worked well at our club. Significantly reducing our serious injury rates.

EXERCISE-BASED KNEE INJURY PREVENTION CLINICAL PRACTICE GUIDELINES

BackgroundKnee injuries are prevalent in cutting, pivoting, and jumping sports. Studies have investigated the effects of exercise-based knee injury prevention programs, however no clinical practice guidelines (CPG) exist.Objective1) Review the...

Patient-based decision for resuming activity after ACL reconstruction: a single-centre experience.

The purpose of the study was to report the functional outcome following anterior cruciate ligament (ACL) reconstruction in patients who decide when to resume work and normal sporting activity post-operatively. The hypothesis tested was that patient-based decision to return to work and sport was possible without compromising functional outcome and increased the rate of repeat rupture in comparison with the existing literature. This was a monocentric, retrospective study. Seventy-two patients requiring primary ACL reconstruction were included. All patients were followed up for a mean period of 4.3years. Return to work and to sporting activity was allowed based on patient's decision. No restriction was suggested by the physician. Delays to return to work and sports and occurrence of graft failure were documented. Sixty-six patients (92%) returned to any sporting activity. The mean delay was 4.1months for running, 6.1months for pivoting sports, and 6.6months for contact sports. Return to competitive sport was possible in 82% of patients after a mean delay of 7.1months. Return to work was possible for 96% of patients after a mean delay of 2.3months. Index Tegner score normalized in 71% of patients. Four repeat ruptures (6%) were observed, all of them following a significant knee injury. Patient-based decision to return to work and sport was possible without compromising functional outcome. The post-operative restrictions implemented by orthopaedic surgeons following ACL reconstructions may be relaxed and more patient based.

Factors associated with magnetic resonance imaging defined patellar tendinopathy in community-based middle-aged women: a prospective cohort study.

BackgroundPatellar tendinopathy identified by imaging modalities has been reported in asymptomatic athletes and associated with tendon-related symptoms. However there is little data in community-based populations. The aim of this cohort study was to examine the prevalence of magnetic resonance imaging (MRI) defined patellar tendinopathy, the factors associated with this condition, and whether it was associated with knee pain in community-based middle-aged women.MethodsOne hundred seventy six women, aged 40–67 years, with no significant knee pain or injury underwent knee MRI. Patellar tendinopathy was defined on both T1- and T2-weighted fat-saturated MRIs. The cross-sectional area of vastus medialis was measured from MRI. Height and weight were measured to calculate body mass index (BMI). Physical activity was assessed using a questionnaire. Knee pain was assessed using the Western Ontario and McMaster University Osteoarthritis Index.ResultsThe prevalence of MRI defined patellar tendinopathy was 30.1 %. Higher levels of physical activity (odds ratio 1.65, 95 % CI 1.09–2.51) and greater vastus medialis cross-sectional area (odds ratio 1.22, 95 % CI 1.04–1.43) were associated with increased prevalence of patellar tendinopathy, independent of age and BMI. The persistence of patellar tendinopathy was associated with the worsening of knee pain over 2 years (odds ratio 10.65, 95 % CI 1.14–99.77).ConclusionIn community-based middle-aged women MRI-diagnosed patellar tendinopathy is common, with higher levels of physical activity and greater vastus medialis size being risk factors suggesting a biomechanical effect. Persistent patellar tendinopathy is associated with worsening of knee pain. These findings suggest that further work is needed to determine the contribution of patellar tendinopathy on knee pain and function in older people.