Landing Biomechanics, But Not Physical Activity, Differ in Young Male Athletes With and Without Patellar Tendinopathy

Pietrosimone, Brian; Blackburn, J. Troy; Wikstrom, Erik A.; Berkoff, David J.; Docking, Sean; Cook, Jill; Padua, Darin A.

doi:10.2519/jospt.2020.9065

Cited by 7 publications

(12 citation statements)

References 41 publications

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“…Figure 1 shows the search results and study selection process. A total of 16 studies (one prospective cohort [26], one cross-sectional [27], and 14 case-control [28][29][30][31][32][33][34][35][36][37][38][39][40][41] studies) were included in the qualitative analysis. Studies included 104 JPTs, 14 with previous PT, 45 with PTA, and 190 controls.…”

Section: Resultsmentioning

confidence: 99%

“…We were able to conduct only limited quantitative analysis because of methodological and outcome heterogeneity. After quality assessment, we identified four highquality [28][29][30][31], nine moderate-quality [26,27,[32][33][34][35][36][37][38], and three low-quality [39][40][41] studies. Quality assessment results and the characteristics of the included studies are shown in Tables 1 and 2, respectively.…”

Section: Resultsmentioning

confidence: 99%

“…In meta-analysis, moderate evidence indicated reduced knee joint power ( I 2 = 0%, effect size − 1.20 [95% CI − 2.00 to − 0.40]; p = 0.003) [ 30 , 32 ] and work ( I 2 = 0%, effect size − 1.13 [95% CI − 1.71 to − 0.56]; p < 0.001) [ 30 , 32 , 37 ] in JPTs with current symptoms only versus healthy controls (Fig. 4 ) during volleyball approaches [ 30 ] or drop landings [ 32 , 37 ].…”

Section: Resultsmentioning

confidence: 99%

“…JPTs had lower knee forces, resulting in reduced knee joint power [ 30 , 32 , 37 ] and work [ 30 , 32 ] (moderate evidence), sagittal plane knee moments [ 29 , 32 ], and patellar tendon loads [ 29 , 37 ] (limited or very limited evidence). JPTs may modify their landing patterns to avoid higher patellar tendon loads and reduce their pain by minimising those knee forces.…”

Section: Discussionmentioning

confidence: 99%

“…Five studies included a PTA group (two comparing with PT and controls [ 29 , 37 ], two comparing with controls [ 34 , 39 ], and one including only PTA [ 27 ]), whereas only two studies included previous PT (one comparing with PT and controls [ 32 ] and one comparing with controls [ 33 ]). Based on the available evidence, these groups presented different biomechanical features compared with PT or controls in ankle and knee angles at IC, ankle dorsiflexion angle, knee angular velocity, and knee joint power and work, whereas they presented similar features in trunk kinematics, leg stiffness, and ankle and hip joint power and work.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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Landing biomechanics are not immediately altered by a single-dose patellar tendon isometric exercise protocol in male athletes with patellar tendinopathy: A single-blinded randomized cross-over trial

Pietrosimone

Blackburn

Wikstrom

et al. 2020

Physical Therapy in Sport

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

Vermeulen

Bleecker

Spanhove

et al. 2023

Scandinavian Med Sci Sports

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Background and ObjectivePatellar tendinopathy (PT) is a highly prevalent overuse injury in volleyball and is often linked with overloading of the patellar tendon. Little is known, however, about whether and how patellar tendon loading is affected by fatigue during the most challenging jump activity in volleyball. Therefore, this study investigates the effect of a high‐intensity, intermittent fatigue protocol on movement alterations in terms of patellar tendon loading during a volleyball spike jump.MethodsForty‐three male volleyball players participated in this study. Three‐dimensional full‐body kinematics and kinetics were collected when performing a spike jump before and after the fatigue protocol. Sagittal plane joint angles, joint work and patellar tendon loading were calculated and analyzed with curve analyses using paired sample t‐tests to investigate fatigue effects (p < 0.05).ResultsFatigue induced a stiffer lower extremity landing strategy together with prolonged pelvis‐trunk flexion compared to baseline (p = 0.001–0.005). Decreased patellar tendon forces (p = 0.001–0.010) and less eccentric knee joint work (−5%, p < 0.001) were observed after the fatigue protocol compared to baseline.ConclusionProtective strategies seem to be utilized in a fatigued state to avoid additional tensile forces acting on the patellar tendon, including proximal compensations and stiff lower extremity landings. We hypothesize that players might be more prone for developing PT if eccentric patellar tendon loads are high in the non‐fatigued state and/or these loads are somehow not decreased after fatigue.

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Landing Biomechanics, But Not Physical Activity, Differ in Young Male Athletes With and Without Patellar Tendinopathy

Cited by 7 publications

References 41 publications

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

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

Landing biomechanics are not immediately altered by a single-dose patellar tendon isometric exercise protocol in male athletes with patellar tendinopathy: A single-blinded randomized cross-over trial

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

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