Characterising the proximal patellar tendon attachment and its relationship to skeletal maturity in adolescent ballet dancersCharacterising the proximal patellar  endon attachment and its relationship to skeletal maturity in adolescent ballet dancers

Rudavsky, Aliza; Cook, Jillianne Leigh; Magnusson, S. Peter; Kjær, Michael; Docking, Sean

doi:10.11138/mltj/2017.7.2.306

Cited by 15 publications

(4 citation statements)

References 35 publications

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“…Considering the age of the athletes participating in the present study, individual differences in biological maturity might have influenced the structural appearance of the tendon. Rudavsky et al (2017) reported a high variability of the echo patterns of the patellar tendons of young athletes before and around PHV and more consistent and continuous patterns similar to mature tendons after 1 year post-PHV. Such maturation-related structural changes would also affect the estimation of micromorphology as applied in the present study.…”

Section: Discussionmentioning

confidence: 81%

Patellar Tendon Strain Associates to Tendon Structural Abnormalities in Adolescent Athletes

et al. 2019

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High mechanical strain is thought to be one of the main factors for the risk of tendon injury, as it determines the mechanical demand placed upon the tendon by the working muscle. The present study investigates the association of tendon mechanical properties including force, stress and strain, and measures of tendon micromorphology and neovascularization, which are thought to be indicative of tendinopathy in an adolescent high-risk group for overuse injury. In 16 adolescent elite basketball athletes (14–15 years of age) we determined the mechanical properties of the patellar tendon by combining inverse dynamics with magnetic resonance and ultrasound imaging. Tendon micromorphology was determined based on a spatial frequency analysis of sagittal plane ultrasound images and neovascularization was quantified as color Doppler area. There was a significant inverse relationship between tendon strain and peak spatial frequency (PSF) in the proximal tendon region ( r = −0.652, p = 0.006), indicating locally disorganized collagen fascicles in tendons that are subjected to high strain. No such associations were present at the distal tendon site and no significant correlations were observed between tendon force or stress and tendon PSF as well as between tendon loading and vascularity. Our results suggest that high levels of tendon strain might associate to a micromorphological deterioration of the collagenous network in the proximal patellar tendon, which is also the most frequent site affected by tendinopathy. Neovascularization of the tendon on the other hand seems not to be directly related to the magnitude of tendon loading and might be a physiological response to a high frequency of training in this group. Those findings have important implications for our understanding of the etiology of tendinopathy and for the development of diagnostical tools for the assessment of injury risk.

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Section: Discussionmentioning

confidence: 81%

Patellar Tendon Strain Associates to Tendon Structural Abnormalities in Adolescent Athletes

et al. 2019

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“…In accordance with the previous study, Kubo et al (2014b) and Waugh et al (2012) reported that Achilles tendon Young’s modulus was lower in children (9–12 years) compared to adults, and junior high school students (13–15 years) had adult-like material properties. The mechanical changes observed from child- to adulthood may partly be mediated by an increase in the structural integrity of the collagenous network (Rudavsky et al, 2017, 2018). During pubertal growth, tendon length increases in a higher rate compared to the CSA, indicating that increments of tendon stiffness are mainly governed by a change of the material properties (Neugebauer and Hawkins, 2012; Waugh et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

Morphological and Mechanical Properties of the Quadriceps Femoris Muscle-Tendon Unit From Adolescence to Adulthood: Effects of Age and Athletic Training

et al. 2019

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The combined effects of mechanical loading and maturation during adolescence are still not well understood. The purpose of the study was to investigate the development of the quadriceps femoris muscle-tendon unit from early adolescence (EA), late adolescence (LA) to young adulthood (YA), and examine how it is influenced by athletic training in a cross-sectional design. Forty-one male athletes and forty male non-athletes from three different age groups (EA: 12–14 years, n = 29; LA: 16–18 years, n = 27; and YA: 20–35 years, n = 25) participated in the present study. Maximum strength of the knee extensor muscles, architecture of the vastus lateralis (VL) muscle and patellar tendon stiffness were examined using dynamometry, motion capture, electromyography, and ultrasonography. Muscle strength and tendon stiffness significantly increased ( p < 0.001) from EA to LA without any further alterations ( p > 0.05) from LA to YA. Athletes compared to non-athletes showed significantly greater ( p < 0.001) absolute muscle strength (EA: 3.52 ± 0.75 vs. 3.20 ± 0.42 Nm/kg; LA: 4.47 ± 0.61 vs. 3.83 ± 0.56 Nm/kg; and YA: 4.61 ± 0.55 vs. 3.60 ± 0.53), tendon stiffness (EA: 990 ± 317 vs. 814 ± 299 N/mm; LA: 1266 ± 275 vs. 1110 ± 255 N/mm; and YA: 1487 ± 354 vs. 1257 ± 328), and VL thickness (EA: 19.7 ± 3.2 vs. 16.2 ± 3.4 mm; LA: 23.0 ± 4.2 vs. 20.1 ± 3.3 mm; and YA: 25.5 ± 4.2 vs. 23.9 ± 3.9 mm). Athletes were more likely to reach strain magnitudes higher than 9% strain compared to non-athlete controls (EA: 28 vs. 15%; LA: 46 vs. 16%; and YA: 66 vs. 33%) indicating an increased mechanical demand for the tendon. Although the properties of the quadriceps femoris muscle-tendon unit are enhanced by athletic training, their development from early-adolescence to adulthood remain similar in athletes and non-athletes with the major alterations between early and LA. However, both age and athletic training was associated with a higher prevalence of imbalances within the muscle-tendon unit and a resultant increased mechanical demand for the patellar tendon.

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“…This is particularly as adolescence is proposed to be a critical time for the formation of normal tendon attachment. 23 24 …”

Section: Discussionmentioning

confidence: 99%

“…Adolescence is a key developmental period, with a mature proximal patellar tendon enthesis occurring after peak height velocity. 25 Given that patellar tendon structure is a predictor for pain, 26 it is reasonable to argue that caution should be exercised when treating patients with an immature enthesis. Training beyond pain in order to satisfy short-term sporting objectives could have negative long term implications for the individual.…”

Section: Discussionmentioning

confidence: 99%

Therapeutic interventions in children and adolescents with patellar tendon related pain: a systematic review

Cairns

Owen

Kluzek

et al. 2018

BMJ Open Sport Exerc Med

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ObjectiveEvaluate effectiveness and harms of interventions for patellar tendon related pain in children and adolescents.DesignSystematic review and meta-analysis.Data sourcesMedline via Pubmed, Embase via OVID, CINAHL via Ebsco, SportDiscus up until 24 November 2017 were searched.Eligibility criteria for selecting studiesInclusion criteria were (1) controlled or randomised controlled clinical trials (RCTs), (2) participants with diagnosis of patellar tendon related disorder, (3) participants≤18 years of age at enrolment and (4) published in a peer-reviewed English or Scandinavian language journal.ResultsOf 530 studies identified, eight were included after screening, with three included in data synthesis. To be included in data synthesis, we required studies to have included (and have data available for) a minimum of 10 participants under 18 years. All studies were rated as being at high risk of bias. For adolescents with patellar tendinopathy, one RCT compared eccentric exercises to usual care and found no difference between groups. In adolescents with Osgood-Schlatter disease (OSD), injection of local anaesthetic with dextrose proved superior to either usual care or local anaesthetic alone (three armed RCTs). In a retrospective case controlled study in adolescents with OSD, surgery provided no benefit over conservative management in terms of persistent symptoms and had a higher complication rate.ConclusionThere is weak evidence to support the use of dextrose injection with local anaesthetic and no evidence to support the use of specific types of exercises to treat children/adolescents with OSD/patellar tendinopathy. Until further evidence arises, clinicians should include load modification and advise on a return to sport based on symptoms.

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Characterising the proximal patellar tendon attachment and its relationship to skeletal maturity in adolescent ballet dancersCharacterising the proximal patellar endon attachment and its relationship to skeletal maturity in adolescent ballet dancers

Cited by 15 publications

References 35 publications

Patellar Tendon Strain Associates to Tendon Structural Abnormalities in Adolescent Athletes

Patellar Tendon Strain Associates to Tendon Structural Abnormalities in Adolescent Athletes

Morphological and Mechanical Properties of the Quadriceps Femoris Muscle-Tendon Unit From Adolescence to Adulthood: Effects of Age and Athletic Training

Therapeutic interventions in children and adolescents with patellar tendon related pain: a systematic review

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