Patellar tendinopathy is often treated surgically after failure of conservative treatment but clinical experience suggests that results are not uniformly excellent. The aim of this review was to (i) identify the different surgical techniques that have been reported and compare their success rates, and (ii) critically assess the methodology of studies that have reported surgical outcomes. Twenty-three papers and two abstracts were included in the review. Surgical procedures were categorized and outcomes summarized. Using ten criteria, an overall methodology score was derived for each paper. Criteria for which scores were generally low (indicating methodological deficiency) concerned the type of study, subject selection process and outcome measures. We found a negative correlation between papers' reported success rates and overall methodology scores (r= -0.57, P<0.01). There was a positive correlation between year of publication and overall methodology score (r=0.68, P<0.001). We conclude that study methodology may influence reported surgical outcome. We suggest practical guidelines for improving study design in this area of clinical research, as improved study design would provide clinicians with a more rigorous evidence-base for treating patients who have recalcitrant patellar tendinopathy.

The BstUI RFLP is associated with chronic Achilles tendinopathy in a second population and a region within the COL5A1 3' untranslated region may predispose individuals to an increased risk of developing chronic Achilles tendinopathy.

Background-Palpation is an important clinical test for jumper's knee.Objectives-To (a) test the reproducibility of palpation tenderness, (b) evaluate the sensitivity and specificity of palpation in subjects with clinical symptoms of jumper's knee, and (c) determine whether tenderness to palpation may serve as a useful screening test for patellar tendinopathy. The yardstick for diagnosis of patellar tendinopathy was ultrasonographic abnormality. Methods-In 326 junior symptomatic and asymptomatic athletes' tendons, palpation was performed by a single examiner before ultrasonographic examination by a certified ultrasound radiologist. In 58 tendons, palpation was performed twice to test reliability. Tenderness to palpation was scored on a scale from 0 to 3 where 0 represented no pain, and 1, 2, and 3 represented mild, moderate, and severe tenderness respectively. Results-Patellar tendon palpation was a reliable examination for a single examiner (Pearson r = 0.82). In symptomatic tendons, the positive predictive value of palpation was 68%. As a screening examination in asymptomatic subjects, the positive predictive value of tendon palpation was 36-38%. Moderate and severe palpation tenderness were better predictors of ultrasonographic tendon pathology than absent or mild tenderness (p<0.001). Tender and symptomatic tendons were more likely to have ultrasound abnormality than tenderness alone (p<0.01). Conclusions-In this age group, palpation is a reliable test but it is not cost eVective in detecting patellar tendinopathy in a preparticipation examination. In symptomatic tendons, palpation is a moderately sensitive but not specific test. Mild tenderness in the patellar tendons in asymptomatic jumping athletes should be considered normal. (Br J Sports Med 2001;35:65-69)

The transitions identified between normal, diffusely thickened tendons and those containing a hypoechoic region suggests that these greyscale US changes may represent different phases of tendon pathology. Tendons containing a hypoechoic region are more likely to be painful and contain Doppler flow than diffusely thickened tendons.

A direct and specific enzymatic method is described for the determination of 1,3:1,4-p-glucans in barley grain and other cereals.In the procedure, purified, amylase-free, bacterial 1,3:1,4-p-glucan hydrolase is used to depolymerize the 1,3:1,4-p-glucan in autoclaved and ethanol-extracted flour prepared from whole grain. The liberated oligoglucosides are extracted with 80% (vol/vol) ethanol and, following acid hydrolysis, measured by the glucose oxidase method. The method can be used to measure total p-glucan and p-glucan in 65°C water-soluble and water-insoluble fractions of cereal grains. The procedure has been applied to barley grains allowed to develop under controlled environmental conditions and to a series of barleys of different geographical origins. The results for Canadian cultivars are compared with estimates based on viscometric data for the same samples. The 1,3:1,4-p-glucan content of a number of other cereals has also been measured.Key words: barley, glucan, P-glucanase. IntroductionWhen present in elevated levels, the l,3:l,4-/3-glucans of barley produce highly viscous solutions which can lead to problems during post-malting operations in the brewing process.3-13'30'31'*"'*0 High glucan levels in barley also lower the feeding quality of the grain." In view of these fac tors, methods for the quantification of the glucan are of practical significance in predicting the malting or feeding quality of grain samples, in monitoring changes in glucan level during malting and subsequent brewing processes and in assessing breeding programmes aimed at lowering the barley /S-glucan content. Since l,3:l,4-/3-glucans arc also found in the leaves, stems, husks, coleoptilcs and roots of cereals and other monocotyledonous plants,3 a method for their quantification has a more general significance.Preece & Mackenzie41 showed that not all barley 0-glucan is extractable with water and that subsequent extractions with alkali released more glucan. Chaotropic agents such as urea solutions also extract additional glucan.20'*8 Most of the previously documented methods, summarized in Table I, determine only glucan cxtractable in water at 40°C or 65°C. It is clear however that the originally insoluble glucan fraction which is released during malting and in mashing should be considered when assessing grain quality. It is this glucan fraction which is likely to be incompletely degraded and form viscous solutions and precipitates during the subsequent brewing operations. This paper reports a direct and specific enzymatic method for the determination of total, water-soluble and waterinsoluble p-glucan in cereal grains and other plant materials. The enzyme used is the /3-glucan endo-hydrolase (E.C. 3.2.1.73)"'" from Bacillus subtilis which specifically hydrolyses 1,4-linkagcs in /3-glucans containing both 1,3-and 1,4-linkages such as barley and oat /3-glucans, lichenin and the reduced Pneumococcal Type III polysaccharide.3 It has no action on either l,4-|3-glucans (cellulose) or 1,3-0-glucans of the callose type which are known to...