Tendinopathy In Athletes Research Articles

Ultrasound-Guided Percutaneous Ultrasonic Tenotomy for Refractory Patellar Tendinopathy in High-Level Athletes: A Case Series.

To elucidate the clinical outcomes and return-to-sport status of high-level athletes with refractory patellar tendinopathy treated with ultrasound-guided percutaneous ultrasonic tenotomy (PUT). Case series study. Single orthopaedic clinic. Five cases involving 8 knees from athletes (average age: 22 years, range: 17-30 years) who presented with refractory patellar tendinopathy and underwent PUT between 2022 and 2024. Conservative treatments had previously been attempted without sufficient pain relief or return to sports. All patients underwent ultrasound-guided PUT using the TX-2 device from Tenex Health. Jogging was resumed 1 month after surgery, and a return to competitive sports was permitted as early as 3 months postsurgery. Preoperative and postoperative Victorian Institute of Sport Assessment (VISA) scores and Numerical Rating Scale (NRS) scores for pain. Time to return to full training and competitive sports, and presence of postoperative infection signs. The VISA score significantly improved from a preoperative average of 43.1 to a postoperative average of 77.1 (P = 0.0004). The NRS significantly decreased from a preoperative average of 6.4 to a postoperative average of 2.8 (P = 0.0005). Four cases involving 6 knees fully returned to sports, with an average return time of 3 months and 19 days (range: 3 months to 4 months and 13 days). One case involving 2 knees did not show sufficient pain improvement and the patient could not return to sports. No signs of infection were observed in any case. PUT for refractory patellar tendinopathy in high-level athletes generally results in favorable treatment outcomes and successful return to sports. This study provides novel insights into the effectiveness of PUT for patellar tendinopathy in athletes, highlighting the need for future studies with larger sample sizes to validate these findings and explore factors associated with poor outcomes.

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...

EFFECTIVENESS OF ULTRASOUND GUIDED PLATELET RICH PLASMA INJECTION IN COMPARISON WITH EXTRACORPOREAL SHOCK WAVE THERAPY ON IMPROVING PAIN AND FUNCTION IN PATELLAR TENDINOPATHY: A RANDOMIZED CONTROLLED TRIAL

Background: Patellar Tendinopathy is an insertional tendinopathy of the extensor apparatus of the knee that affect athletes practicing several sports at every level of participation but is found mainly in elite athletes involved in jumping activities. The characteristic complaint is an anterior knee pain with insidious onset, localized in the involved area. Diagnosis is clinical and is typically based on medical history and clinical findings. Many methods to treat Patellar Tendinopathy have been evaluated, and there is no true consensus on the most efficacious treatment strategy. Objectives: To determine the effectiveness of ultrasound guided platelet rich plasma injection in comparison with extracorporeal shock wave therapy on improving pain and function among athletes with Patellar Tendinopathy. Study Design: Randomized controlled trial Methods: Forty-four athletes with patellar tendinopathy meeting the inclusion and exclusion criteria were selected for this study and randomized into 2 treatment groups: autologous PRP injections under ultrasound guidance (PRP group n = 22), and 3 sessions of focused extracorporeal shock wave therapy (ESWT group n = 22). The outcome measures were Victorian Institute of Sports Assessment–Patella (VISA-P) questionnaire and pain visual analog scale (VAS). For descriptive statistics mean, standard deviation and frequency were used. Continuous variables were analysed by students t-test. Categorical variables were analysed using Chi-square test. Within the group comparison (baseline and follow-up data of each group) was done by Repeated measures ANOVA. Between the groups comparison was analysed using students t-test. A p-value <0.05 was taken as significant. Results: The 2 groups were homogeneous in terms of their baseline characteristics like age, gender, duration of symptoms and side of affection. Within group comparison showed statistically significant improvement in VISA-P score and reduction in VAS from baseline at all follow ups (p=0.00) in the PRP group. While in the ESWT group, maximum improvement was seen from baseline to 1st follow up at 4 weeks (p = 0.01). However subsequent follow up showed reduction in VISA-P Scores and increased VAS but remained above the baseline values and it was statistically significant (p < 0.05) (Table III). Conclusion: Ultrasound guided injection of platelet rich plasma lead to significant improvement in pain and function over the long term in comparison with focused ESWT in the treatment of patellar tendinopathy in athletes and thereby enabling faster return to sports.

Does the ultrasound imaging predict lower limb tendinopathy in athletes: a systematic review

BackgroundTo conduct a systematic review looking into the possibility of US imaging to anticipate and identify future patellar or Achilles tendinopathy symptoms.MethodsThe studies that were taken into consideration for this review were prospective studies that employed baseline US imaging of the patellar OR Achilles tendons in asymptomatic patients and follow-up measures of pain and/or function. Two impartial reviewers evaluated the study’s quality using the Critical Appraisal Skills Programme instrument.ResultsParticipants in the included studies in this review came from various sports. The systematic review revealed a link between baseline tendon abnormalities in the US and a higher chance of developing both patellar and Achilles tendinopathy as well as their future occurrence. Nine of the included studies examined the patellar tendon alone, eight the patellar and Achilles tendon together, and four the Achilles tendon exclusively. For both tendons, US administration is done in a largely consistent manner. The tendon abnormalities of tendon thickness, hypoechogenicity and vascularity at baseline were associated with an increased risk of both Achilles and patellar tendinopathy.ConclusionsThis systematic review shows that abnormal tendon structures seen by US in asymptomatic persons can predict the development of tendinopathy.

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.

The Effects of High-Load Slow-Velocity Resistance Exercise Training in Athletes With Tendinopathy: A Critically Appraised Topic.

Tendinopathy is a musculoskeletal pathological condition experienced by athletes that can result in pain, impaired muscle performance, and loss of physical function and can hinder return to sports. Various types of resistance exercise training are effective for treating tendinopathy, including isometric, concentric, eccentric, and high-load slow-velocity resistance exercise. What are the effects of high-load slow-velocity resistance exercise training, compared with other forms of resistance exercise, on tendon morphology and patient-reported outcomes in athletes with tendinopathy? The findings of 4 randomized clinical trials were included. One study compared high-load slow-velocity resistance exercise with moderate-load slow-velocity resistance exercise. Two studies investigated the effects of high-load slow-velocity resistance exercise versus eccentric resistance exercise. The fourth study compared high-load slow-velocity resistance exercise with inertia-based resistance exercise. In all of the studies, high-load slow-velocity resistance exercise was as effective as the other forms of resistance exercise for improving patient-reported outcomes and pain. Three studies found no significant differences in changes in tendon morphology between patients who received high-load slow-velocity resistance exercise versus those who received the other forms of resistance exercise. One study showed that high-load slow-velocity resistance exercise was more effective than eccentric exercise for improving tendon morphology outcomes. Current evidence supports the use of high-load slow-velocity resistance exercise as a treatment option for patellar and Achilles tendinopathy in athletes. Results from level 2 studies suggest grade B evidence in support of high-load slow-velocity resistance exercise for treating athletes with tendinopathy.

Poster 180: A prospective randomized comparative study between isolated eccentric versus conventional exercise therapy in athletes with rotator cuff tendinopathy

Objectives: To compare the effectiveness of an isolated Eccentric exercise program versus Conventional exercise program in athletes with rotator cuff tendinopathy. Methods: The study included 80 athletes with rotator cuff (RC) tendinopathy (diagnosed on Magnetic resonance imaging) presenting to author’s tertiary level institute. Patients were randomized into two groups of 40 each. The eccentric exercise group (n = 40, mean age = 26.4years ) received an isolated eccentric training combined with stretching, while the conventional exercise group received scapular stabilization exercises, concentric RC strengthening exercises and stretching. (n = 40, mean age = 25.2years). Patients in both groups fulfilled 12 week daily home based exercise program and received treatments twice a week for 3 months. Primary outcome measures were shoulder pain (a 0–100mm Visual Analog Scale; VAS) and function measured with the Constant Murley score and Disabilities of the Arm, Shoulder and Hand (DASH) score. Secondary outcome measures were isometric abduction strength in 45° in the scapular plane (Hand held dynamometer) and shoulder range of motion (forward elevation, abduction and external rotation). All measurements were taken at baseline, at 12, and 24weeks. There was no statistically significant difference in pre-intervention scores between two groups. The study was approved by Institutional Review Board. Results: After 24 weeks, both groups showed a significant decrease in VAS scores and DASH score and a significant increase in the Constant Murley score. No statistically significant differences were found between the groups for any of the evaluated outcome measures. In the EE group, there was a slight deterioration in both CM and VAS scores between 12 and 24 weeks, but this did not reach statistical significance. Both groups also had a significant increase in isometric muscle strength between baseline and 24 weeks. Conclusions: A 12 week isolated eccentric training program of the rotator cuff is as effective (but not superior to) as conventional exercise program for the rotator cuff tendinopathy in athletes.

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

Patellar tendinopathy (PT) mainly affects athletes who use the tendon for repeated energy storage and release activities. It can have a striking impact on athletes' careers, although data on its real prevalence and incidence are sparse. Research efforts should start from the results of reliable and updated epidemiological research to help better understand the impact of PT and underpin preventative measures. To determine the prevalence and incidence of PT in athletes and the general population. Systematic review; Level of evidence, 3. A systematic review of the literature was performed on January 17, 2022, and conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed, Web of Science, and Wiley Cochrane Library databases were searched for epidemiological reports of any evidence level and clinical studies reporting data on the incidence or prevalence of PT for the 11,488 retrieved records. The primary endpoint was the prevalence and incidence of PT in sport-active patients. The secondary endpoints were PT prevalence and incidence in subgroups of athletes based on sex, age, sport type, and sport level played, as well as the same epidemiological measures in the general population. A total of 28 studies, with 28,171 participants, were selected and used for the qualitative and quantitative analysis. The general and athletes' populations reported an overall PT prevalence of 0.1% and 18.3%, respectively. In athletes, the prevalence of PT was 11.2% in women and 17% in men (P = .070). The prevalence of PT in athletes <18 years was 10.1%, while it was 21.3% in athletes ≥18 years (P = .004). The prevalence of PT was 6.1% in soccer players, 20.8% in basketball players, and 24.8% in volleyball players. Heterogeneous PT diagnostic approaches were observed. Higher prevalence values were found when PT diagnoses were made using patient-reported outcomes versus clinical evaluations (P = .004). This review demonstrated that PT is a common problem in the male and female sport-active populations. There are twice as many athletes aged ≥18 years than there are <18 years. Volleyball and basketball players are most affected by PT.

Application of visual methods in the diagnosis of tendinopathy of athletes

This article presents an analysis of the problem of diagnosis of tendinopathy in athletes according to scientific research of domestic and foreign scientists. The advantages and disadvantages of visual diagnostic methods (ultrasound, MRI) are considered. The article clarifies the advantages and disadvantages of adequate diagnostic methods of tendinopathy of the lower extremities based on the analysis of domestic and foreign scientific sources, as well as a plan for treatment and physical rehabilitation of tendon pain based on evidence: clinical doctor's opinion, patient complaints and data regarding motor dysfunctions. It is concluded that the possibility of diagnosing tendinopathy by functional tests presented in a review published in January 2012, which proposed three functional tests to detect tendinopathy of the upper tendon of the biceps femoris. It should be noted that severe tendinopathy may be asymptomatic (without pain and manifestations of motor dysfunction) for a long period before the onset of clinical signs. Studies have shown ultrasound anomalies of the patellar tendon among asymptomatic athletes of game sports, as well as athletes. There is an assumption that by means of ultrasonic inspection of sinews of athletes who did not have a pain syndrome - it is possible to predict group of risk of development of a tendinopathy. These diagnostic methods can be useful to confirm the diagnosis where it is doubtful. Diagnosis of tendinopathy in athletes by visual methods should be carried out in case of difficulty in diagnosis. If there are clinical signs of tendinopathy, it is sufficient to perform a series of functional tests to confirm (histological changes in the tendons will be present) or to refute the diagnosis.

Association of TNF-\u03b1 -308G\u2009>\u2009A polymorphism with susceptibility to tendinopathy in athletes: a case\u2013control study

BackgroundHigh levels of the tumor necrosis factor alpha (TNF-α) induce apoptosis and pro-inflammatory effects for primary degeneration of tendon and development of tendinopathy. The aim of this study was to investigate the association between the TNF-α polymorphisms and tendinopathy in athletes.MethodsTwo hundred and seventy athletes (135 tendinopathy cases and 135 controls) were included and genotyped (TNF-α -1031T > C; -857 C > T; -308G > A) using TaqMan validated assays. The association of the polymorphisms with tendinopathy was evaluated by a multivariate logistic regression model, using odds ratios (OR) and 95 % confidence intervals (CI).ResultsThe variant allele − 308 A was significantly associated with patellar (OR: 1.9; 95 % CI: 1.01–3.6) or Achilles tendinopathies (OR: 2.7; 95 % CI: 1.1–6.7). No significant differences were found in allele or genotype distributions of the − 1031T > C and − 857 C > T polymorphisms between cases and controls. TNF-α TCA haplotype was associated with increased tendinopathies risk, either considering all cases (OR: 2.6, 95 % CI: 1.3–5.3), patellar (OR: 3.3, 95 % CI: 1.5–7.3), rotator cuff (OR: 3.1, 95 % CI: 1.4–7.2) or Achilles tendinopathies (OR: 3.8, 95 % CI: 1.1–12.7).ConclusionsThese results suggest that the TNF-α polymorphisms could influence the susceptibility to developing tendinopathy among athletes. Knowledge of the TNF-α polymorphisms associated to tendinopathy in athletes can further understanding of the inflammatory role in the early stages of the disease and contribute for sports injury surveillance programmes, in which athletes with TNF-α TCA haplotype could be early subjected to cryotherapy after training and competition to avoid tendinopathy development.

Failed Surgery for Patellar Tendinopathy in Athletes: Midterm Results of Further Surgical Management.

Background:Tendon injuries are commonly seen in sports medicine practice. Many elite players involved in high-impact activities develop patellar tendinopathy (PT) symptoms. Of them, a small percentage will develop refractory PT and need to undergo surgery. In some of these patients, surgery does not resolve these symptoms.Purpose:To report the clinical results in a cohort of athletes who underwent further surgery after failure of primary surgery for PT.Study Design:Case series; Level of evidence, 4.Methods:A total of 22 athletes who had undergone revision surgery for failed surgical management of PT were enrolled in the present study. Symptom severity was assessed through the Victorian Institute of Sport Assessment Scale for Patellar Tendinopathy (VISA-P) upon admission and at the final follow-up. Time to return to training, time to return to competition, and complications were also recorded.Results:The mean age of the athletes was 25.4 years, and the mean symptom duration from the index intervention was 15.3 months. At a mean follow-up of 30.0 ± 4.9 months, the VISA-P score improved 27.8 points (P < .0001). The patients returned to training within a mean of 9.2 months. Fifteen patients (68.2%) returned to competition within a mean of 11.6 months. Of these 15 patients, a further 2 had decreased their performance, and 2 more had abandoned sports participation by the final follow-up. The overall rate of complications was 18.2%. One patient (4.5%) had a further revision procedure.Conclusion:Revision surgery was feasible and effective in patients in whom PT symptoms persisted after previous surgery for PT, achieving a statistically significant and clinically relevant improvement of the VISA-P score as well as an acceptable rate of return to sport at a follow-up of 30 months.

Extracorporeal shockwave therapy versus musculoskeletal mesotherapy for Achilles tendinopathy in athlete

BackgroundAchilles tendinopathy (AT) is considered the commonest tendon pathology, occurring mainly in athletes. Different conservative treatment options have been introduced but with short-term effects; however, extracorporeal shockwave therapy (ESWT) and mesotherapy (MT) injections were claimed to provide longer effects and could be used in cases failure of response to conservative treatments.The objective of our prospective 12-week study was to compare the effect of ESWT and MT on chronic Achilles tendinopathy in athletes by both clinical and ultrasonographical assessment.ResultsForty patients with chronic AT diagnosed clinically and with high-resolution ultrasound (US) randomly allocated in two groups first received weekly ESWT session, and the other group underwent weekly MT sessions for 4 consecutive weeks. Both groups improved during the treatment and follow-up period. The mean visual analogue score (VAS) decreased in both the ESWT group and the MT group. Mean American Orthopedic Foot and Ankle Society (AOFAS) hindfoot score and VAS scores were not significantly different between ESWT and MT groups at the 4th and the 12th week of follow-up. However, US assessment significantly improved after 12 weeks in the ESWT group (as regards tendon thickness, calcifications, and Doppler signal), and for the mesotherapy group, there was the only improvement of tendon thickness.ConclusionESWT showed improvement of pain and inflammation and calcifications of AT than MT injections, which was documented by US improved findings at week 12 follow up.

Deep Friction Massage in the Management of Patellar Tendinopathy in Athletes: Short-Term Clinical Outcomes.

Deep friction massage (DFM) is often used in the treatment of tendinopathies; however, the pressure applied may vary and interfere with the obtained results. To assess whether the immediate effects of DFM on pain (pain intensity and time to onset of analgesia) and muscle strength are dependent on the pressure applied during the DFM application in athletes with patellar tendinopathy. Randomized, controlled, cross-over trial. University research laboratory (institutional). Ten athletes with diagnosis of unilateral patellar tendinopathy (age 27.90 [5.24]y). All participants attended 4 sessions, 3 treatment sessions with DFM applied with different pressures (the mean pressure-previously determined for each participant-and the mean pressure ± 25%) and a control session, each of which was separated by 48hours. Pain (intensity upon palpation and time to onset of analgesia), and muscle strength of knee extensors were assessed before and immediately after each session. Pain intensity changed significantly over time (F1,9 = 52.364; P < .001; ηp2=.853) and among sessions (F3,27 = 82.588; P < .001; ηp2=.902), with a significant interaction for group × time (F3,27 = 19.841; P < .001; ηp2=.688). The knee extensors strength did not change significantly over time (F1,9 = 2.240; P = .17; ηp2=.199), nor a significant interaction for session × time was observed (F3,27 = 3.276; P = .07; ηp2=.267). Regardless of the pressure applied, the time to onset of analgesia was not significantly different (F2,18 = 1.026; P > .05; ηp2=.102). It was shown that DFM induces an immediate reduction in pain intensity upon palpation, regardless of the pressure performed. Notwithstanding, the reader should take into account the small sample size and the caution needed in the results' interpretation.

Patellar Tendinopathy in Athletes

This review discusses the current practice of evaluation and treatment of patellar tendinopathy with emphasis on rehabilitation. The latest studies revolve primarily around implementation of isometric and heavy slow resistance (HSR) exercises in the rehabilitation of patellar tendinopathy rather than the traditional rehabilitation method of eccentric exercise. Patellar tendinopathy is a common injury of the inferior anterior knee seen in athletes but predominantly in jumping athletes. Onset is insidious and frequently noted in a loaded position with knee flexion. Physical exam finds tenderness along the patellar tendon with pain recreated while squatting. Treatment initially includes conservative measures such as guided physical therapy, medical therapy, and modalities. If recalcitrant, injections may be warranted, or rarely surgery may be considered.

Significance of Asymptomatic Tendon Pathology in Athletes.

Symptomatic tendinopathy can be a disabling condition for athletes. Common sites of tendinopathy in athletes include the rotator cuff (RTC), Achilles, and patellar tendons. Advanced imaging modalities, such as magnetic resonance imaging and ultrasound occasionally identify tendinopathic changes in asymptomatic individuals. Such asymptomatic changes have been documented in the RTC, Achilles, and patellar tendons of athletes. In the RTC, tendinopathy, partial-, and full-thickness tears have been demonstrated in asymptomatic athletes, though only small numbers of these athletes may develop symptoms despite prolonged periods of ongoing, competitive play. In the Achilles and patellar tendons, neovascularization, hypoechogenicity, and tendon thickening are commonly noted findings in asymptomatic athletes, and though all have been associated with tendon pain in the literature, there is some inconsistency as to which are the strongest predictors of future tendon pain. Evidence on how best to address or intervene upon such asymptomatic changes is limited.

Interventions used for Rehabilitation and Prevention of Patellar Tendinopathy in athletes: a survey of Brazilian Sports Physical Therapists

Objectives(1) To identify the type and frequency of interventions used by Brazilian physical therapists to treat and prevent the occurrence of patellar tendinopathy in athletes and the criteria used to return to sport; (2) to compare the interventions used to the grade of recommendation of current evidence. MethodsDesign: cross-sectional study. Setting: online survey throughout sports physical therapy association. Participants: Physical therapists who were invited to complete a structured questionnaire. Main Outcome Measures: Interventions more frequently used for treating and preventing PT in athletes and the criteria used to define return to sport. ResultsOne-hundred and twenty-one physical therapists participated in this study. Quadriceps eccentric strengthening (75.2%), education (61.2%) and lower limb joint/lumbo-pelvic stabilization/hamstrings stretching (59.5%) were more frequently cited for prevention purposes, while lower limb joint stabilization (81.8%), education (80.2%) and myofascial release (78.5%) were more frequently reported for treatment. The majority of the physical therapists based their decision of athlete discharge on a combination of pain intensity, function and functional test results (44.6%). ConclusionThere was inconsistency between interventions used in clinical practice and interventions recommended by the best available evidence.

Extracorporeal shock wave therapy for isokinetic muscle strength around the knee joint in athletes with patellar tendinopathy.

The aim of this study was to explore the efficacy of 16 weeks of extracorporeal shockwave therapy in athletes with patellar tendinopathy. Athletes with patellar tendinopathy were matched for age, height and body weight and assigned to the experimental group (N.=26) or control group (N.=25). Subjects in the experimental group received 16 rounds (once per week) of extracorporeal shockwave therapy (2000 single shocks; strength, 1.5 to 3.0 bar; shock frequency, 9 to 12 Hz). Subjects in the control group received physical treatments, such as acupuncture, ultrasonic wave, and microwave therapy. After 16 weeks, Visual Analog Scale (VAS) Score in the experimental group was reduced by 69.4% (P<0.01) compared with that at 0 weeks. Knee joint 60°/s and 240°/s peak torques were increased by 17.2% (P<0.01) and 7.2% (P<0.05), respectively, and extensor endurance by 17.4% (P<0.05). VAS Score in the control group was reduced by 16.9% (P<0.01) at 16 weeks compared with 0 weeks, and the knee joint 60°/s peak torque was increased by 8.2% (P<0.05). For between-groups comparisons, the VAS Score in the experimental group was reduced by 62.7% (P<0.01); whereas knee joint 60°/s and 240°/s peak torques increased by 8.8% and 5.8%, respectively, and extensor endurance by 12.5% (P<0.05). There were no significant differences between male and female subjects (P>0.05). Extracorporeal shock wave therapy has a positive effect on patellar tendinopathy in athletes, with no gender differences in therapeutic effect. Extracorporeal shock wave therapy may be used to alleviate pain and improve knee joint extensor strength and endurance.

Association between limited dorsiflexion of the first metatarsophalangeal joint and Achilles tendinopathy in athletes: a case control study

Association between limited dorsiflexion of the first metatarsophalangeal joint and Achilles tendinopathy in athletes: a case control study

Incidence of Achilles and Patellar Tendinopathy in Adolescent Elite Athletes

The study investigated the incidence of Achilles and patellar tendinopathy in adolescent elite athletes and non-athletic controls. Furthermore, predictive and associated factors for tendinopathy development were analyzed. The prospective study consisted of two measurement days (M1/M2) with an interval of 3.2±0.9 years. 157 athletes (12.1±0.7 years) and 25 controls (13.3±0.6 years) without Achilles/patellar tendinopathy were included at M1. Clinical and ultrasound examinations of both Achilles (AT) and patellar tendons (PT) were performed. Main outcome measures were incidence tendinopathy and structural intratendinous alterations (hypo-/hyperechogenicity, vascularization) at M2 [%]. Incidence of Achilles tendinopathy was 1% in athletes and 0% in controls. Patellar tendinopathy was more frequent in athletes (13%) than in controls (4%). Incidence of intratendinous alterations in ATs was 1-2% in athletes and 0% in controls, whereas in PTs it was 4-6% in both groups (p>0.05). Intratendinous alterations at M2 were associated with patellar tendinopathy in athletes (p≤0.01). Intratendinous alterations at M1, anthropometric data, training amount, sports or sex did not predict tendinopathy development (p>0.05). Incidence of tendinopathy and intratendinous alterations in adolescent athletes is low in ATs and more common in PTs. Development of intratendinous alterations in PT is associated with tendinopathy. However, predictive factors could not be identified.

Arthroscopic patellar release for treatment of chronic symptomatic patellar tendinopathy: long-term outcome and influential factors in an athletic population

BackgroundArthroscopic patellar release (APR) is utilized for minimally invasive surgical treatment of patellar tendinopathy. Evidence regarding long-term success following the procedure is limited. Also, the influence of age and preoperative performance level, are incompletely understood. The aim of this study was to investigate whether APR translates into sustained pain relief over a long-term follow-up in athletes undergoing APR. Furthermore, we analyzed if age influences clinical and functional outcome measures in APR.MethodsBetween 1998 and 2010, 30 competitive and recreational athletes were treated with APR due to chronic refractory patellar tendinopathy. All data were analyzed retrospectively. Demographic data, such as age or level of performance prior to injury were extracted. Clinical as well as functional outcome measures (Swedish Victorian Institute of sport assessment for patella (VISA-P), the modified Blazina score, pain level following exercise, return to sports, and subjective knee function were assessed pre- and postoperatively.ResultsIn total, 30 athletes were included in this study. At follow-up (8.8 ± 2.82 years), clinical and functional outcome measures such as the mean Blazina score, VISA-P, VAS, and subjective knee function revealed significant improvement compared to before surgery (P < 0.001). The mean time required for return to sports was 4.03 ± 3.18 months. After stratification by age, patients younger than 30 years of age yielded superior outcome in the mean Blazina score and pain level when compared to patients ≥30 years (P = 0.0448). At 8 years of follow-up, patients yielded equivalent clinical and functional outcome scores compared to our previous investigation after four years following APR.ConclusionIn summary, APR can be regarded a successful, minimally invasive, and sustained surgical technique for the treatment of patella tendinopathy in athletes. Younger age at surgery may be associated with improved clinical and functional outcome following APR.