Does the adolescent patellar tendon respond to 5 days of cumulative load during a volleyball tournament?

Abstract

Patellar tendinopathy (jumper's knee) has a high prevalence in jumping athletes. Excessive load on the patellar tendon through high volumes of training and competition is an important risk factor. Structural changes in the tendon are related to a higher risk of developing patellar tendinopathy. The critical tendon load that affects tendon structure is unknown. The aim of this study was to investigate patellar tendon structure on each day of a 5-day volleyball tournament in an adolescent population (16-18 years). The right patellar tendon of 41 players in the Australian Volleyball Schools Cup was scanned with ultrasound tissue characterization (UTC) on every day of the tournament (Monday to Friday). UTC can quantify structure of a tendon into four echo types based on the stability of the echo pattern. Generalized estimating equations (GEE) were used to test for change of echo type I and II over the tournament days. Participants played between eight and nine matches during the tournament. GEE analysis showed no significant change of echo type percentages of echo type I (Wald chi-square = 4.603, d.f. = 4, P = 0.331) and echo type II (Wald chi-square = 6.070, d.f. = 4, P = 0.194) over time. This study shows that patellar tendon structure of 16-18-year-old volleyball players is not affected during 5 days of cumulative loading during a volleyball tournament.

Can ultrasound imaging predict the development of Achilles and patellar tendinopathy? A systematic review and meta-analysis

“…In relation to the participant characteristics, all but 1 of the 17 included studies were carried out within sporting populations. Specifically, five involved volleyball,35 38 39 41 44 two involved basketball,16 36 three involved soccer players,14 42 45 one involved fencing,12 one involved badminton,46 one involved ballet dancers,10 two involved running15 43 and one involved various sporting populations 37. The remaining study16 was performed on participants from the general population referred to a sports medicine centre.…”

“…The length of the follow-up period ranged from five days to four years. The majority of studies used US as the modality of choice to investigate tendon structure, with only one study using Ultrasound Tissue Characterisation (UTC)41 In relation to the tendon structures investigated over the prospective period, nine studies investigated hypoechogenicity, thickness and vascularity,10 12 15 38–40 42–44 six investigated only hypoechogenicity and thickness,14 16 35–37 45 while the remaining two studies investigated only vascularity46 and hypoechogenicity,41 respectively. There was a large variation in the clinical measures of pain and/or function used among the included studies ranging from subjective reporting of pain, measures of function (eg, VISA scale), time absent from sport, performance measures (single leg squat and plyometric movements), as well as clinical measures such as tenderness on palpation.…”

“…Nine of these studies were included in the meta-analysis 12 14 16 35–39 41. Patellar tendon abnormalities at baseline were found to increase the risk of development of future patellar tendinopathy (RR=4.35, 95% CI 2.62 to 7.23).…”

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

“…Prospective studies are needed to validate whether the proximal patellar tendon attachment develops during puberty as is proposed and suggested by the current study. Limitations of this study include only one blind assessor and one blind reviewer evaluating the UTC scans where other studies have used three blind assessors, though reliability of the UTC has been established in previous studies 17 . The greyscale score needs to be validated in a prospective study.…”

“…The UTC scans were taken using a standardised protocol described below: this protocol was adapted from the protocol used for the Achilles tendon 16,17 . The UTC device has a standardised transducer tilt angle that provides a 3-dimensional image of the entire tendon.…”