Are Landing Patterns in Jumping Athletes Associated with Patellar Tendinopathy? A Systematic Review with Evidence Gap Map and Meta-analysis

Abstract

Background Patellar tendinopathy (PT) is common and debilitating for jumping athletes. Intriguingly, despite its high prevalence and many research studies, a causal explanation for PT presence remains elusive. Objective Our objective was to investigate whether landing biomechanics among jumping athletes are associated with PT and can predict onset. Methods We conducted a systematic review with evidence gap map and meta-analysis. We searched three databases from inception to May 2021 for observational studies or trials evaluating landing biomechanics in jumping athletes with PT (JPTs). We assessed quality with a modified Downs and Black checklist, risk of bias with the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool, and evidence levels with van Tulder’s criteria and provided an evidence gap map. Results One prospective cohort (moderate quality), one cross-sectional cohort (moderate quality), and 14 case–control (four high-, seven moderate-, and three low-quality) studies, including 104 JPTs, 14 with previous PT, 45 with asymptomatic patellar tendon abnormality (PTA), and 190 controls were retained. All studies had a high risk of bias. Meta-analysis showed an association between lower ankle dorsiflexion and the presence of tendinopathy during drop and spike landings, and JPTs had reduced knee joint power and work during volleyball approach or drop landings (moderate evidence). Limited evidence suggested that JPTs had lower patellar tendon loads during drop landings. Strong or moderate evidence showed no relation between PT and sagittal plane peak knee and hip angles or range of motion; hip, knee, or ankle angles at initial contact (IC); knee angular velocities, peak trunk kinematics, or trunk angles at IC; sagittal plane hip, knee, or ankle moments; and peak vertical ground reaction force (vGRF) and vGRF impulse. Identified gaps were that no study simultaneously investigated athletes with previous PT, current PT, and PTA, and studies of joint angular velocities at IC, ankle and hip angular velocities after touchdown, leg stiffness, loading rate of forces, and muscle activation are lacking. Conclusion Despite the voluminous literature, large number of participants, multitude of investigated parameters, and consistent research focus on landing biomechanics, only a few associations can be identified, such as reduced ankle dorsiflexion–plantarflexion range. Further, the quality of the existing literature is inadequate to draw strong conclusions, with only four high-quality papers being found. We were unable to determine biomechanical factors that predicted PT onset, as longitudinal/prospective studies enabling causal inference are absent. The identified gaps indicate useful areas in which to explore causal relationships to inform intervention development. Therefore, high-quality prospective studies are essential to definitively determine whether landing biomechanics play a part in the development, recurrence, or management of PT and represent a potential therapeutic or preventive target alongside non-biomechanical factors.

Trunk Biomechanics in Individuals with Knee Disorders: A Systematic Review with Evidence Gap Map and Meta-analysis

“…An evidence gap map was created to provide an overview of the evidence available investigating trunk biomechanics in individuals with knee disorders. The evidence gap map allows the identification of outcomes with sufficient or insufficient evidence due to the number of similar studies [ 41 ]. For the presentation of the evidence, all data were grouped according to measurement method, planes of motion, outcome, and task categories as previously mentioned.…”

The effect of fatigue on spike jump biomechanics in view of patellar tendon loading in volleyball

“…11 Jump-landing biomechanics have the potential to detect risky movement patterns in terms of suboptimal patellar tendon loading. 9,12,13 Only three studies explicitly investigated patellar tendon loading during jump-landing tasks and found protective strategies including reduced peak patellar tendon forces and/or loading rate in subjects with current symptoms of PT. 8,14,15 On the other hand, fatigue is considered to be a major extrinsic risk factor for knee injuries, primarily by modulating other intrinsic risk factors for lower extremity injuries such as jump-landing biomechanics.…”

“…Therefore, suboptimal tendon loading should be monitored carefully, certainly in case of non‐uniform muscle‐tendon adaptations (e.g., adolescent athletes) 11 . Jump‐landing biomechanics have the potential to detect risky movement patterns in terms of suboptimal patellar tendon loading 9,12,13 . Only three studies explicitly investigated patellar tendon loading during jump‐landing tasks and found protective strategies including reduced peak patellar tendon forces and/or loading rate in subjects with current symptoms of PT 8,14,15 …”

Knee Movement Characteristics of Basketball Players in Landing Tasks Before Onset of Patellar Tendinopathy: A Prospective Study

“…The second study only recorded vertical jump height and concluded that great jumping ability was a risk factor for developing patellar tendinopathy, which is not meaningful to the injury prevention (Visnes et al, 2013 ). High-quality prospective studies with larger sample sizes and more rigorous study designs are essential to definitively determine whether landing biomechanics play a role in the development of patellar tendinopathy (Tayfur et al, 2021 ).…”