Patellar tendinopathy in young elite soccer– clinical and sonographical analysis of a German elite soccer academy

Abstract

BackgroundThe prevalence of patellar tendinopathy is elevated in elite soccer compared to less explosive sports. While the burden of training hours and load is comparably high in youth elite players (age < 23 years), little is known about the prevalence of patellar tendinopathy at this age. There is only little data available on the influence of age, the amount of training, the position on the field, as well as muscular strength, range of motion, or sonographical findings in this age group. The purpose of the present study was to examine the above-mentioned parameters in all age groups of a German youth elite soccer academy.MethodsOne hundred nineteen male youth soccer players (age 15,97 ± 2,24 years, height 174, 60 ± 10,16 cm, BMI 21, 24 ± 2,65) of the U-13 to U-23 teams were part of the study. Data acquisition included sport specific parameters such as footwear, amount of training hours, leg dominance, history of tendon pathologies, and clinical examination for palpatory pain, indurations, muscular circumference, and range of motion.Subjective complaints were measured with the Victorian Institute of Sport Assessment Patellar (VISA-P) Score. Furthermore, sonographical examinations (Aplio SSA-770A/80; Toshiba, Tokyo, Japan) with 12-MHz multifrequency linear transducers (8–14 MHz) of both patellar tendons were performed with special emphasis on hyper- and hypo echogenic areas, diameter and neovascularization.ResultsThe prevalence of patellar tendinopathies was 13.4%. Seventy-five percent of the players complained of pain of their dominant leg with onset of pain at training in 87.5%. The injured players showed a medium amount of 10.34 ± 3.85 training hours and a medium duration of symptoms of 11.94 ± 18.75 weeks. Two thirds of players with patellar tendinopathy were at the age of 15–17 (Odds ratio 1.89) while no differences between players of the national or regional league were observed.In case of patellar tendinopathy, VISA-P was significantly lower in comparison to healthy players (mean ± SD 76.80 ± 28.56 points vs. 95.85 ± 10.37). The clinical examination revealed local pain at the distal patella, pain at stretching, and thickening of the patellar tendon (p = 0.02).The mean tendon diameter measured 2 cm distally to the patella was 4.10 ± 0.68 mm with a significantly increased diameter of 0.15 mm in case of an underlying tendinopathy (p = 0.00). The incidence of hypo-echogenic areas and neovascularizations was significantly elevated in players with patellar tendon syndrome (PTS) (p = 0.05).ConclusionThe prevalence of patellar tendinopathy in youth elite soccer is relatively high in comparison to available data of adult players. Especially players at the age of 15 to 17 are at considerable risk. Tendon thickening, hypo-echogenic areas, and neovascularization are more common in tendons affected by PTS.

Remarkably high prevalence of overuse-related knee complaints and MRI abnormalities in youth competitive alpine skiers: a descriptive investigation in 108 athletes aged 13–15 years

“…39 40 In elite volleyball players aged 15-19 years, the rate of jumper's knee was as high as 11%. 41 An ultrasound study of 119 young soccer players (mean age 15.97 years) showed high rates of structural abnormalities within the tendon, 42 and other studies demonstrated a high correlation between a clinical tendinopathy and structural intratendinous alterations in ultrasound. 43 44 In the current study with a cohort of youth skiers, even a higher proportion of the athletes had clinical complaints at the distal or proximal patellar tendon (overall: 31.5%; distal: 17.6%; proximal: 18.5%).…”

Patellar Tendon Strain Associates to Tendon Structural Abnormalities in Adolescent Athletes

“…A color Doppler examination to determine intratendinous blood flow was performed with the participants laying supine with the dominant knee flexed to 30° (0° = full extension). The joint angle was chosen based on former recommendations (Giombini et al, 2013; Bode et al, 2017) to reduce slack but avoid any passive forces that might induce vascular compression. The ultrasound system, probe model and orientation were as described above, yet the system settings were set as follows: CFM mode, 13 MHz frequency, 750 Hz peak repetition frequency, 1.1 by 1.6 cm color box size (spanning from the deep insertion at the patella or tibial tuberosity to the central portion of the tendon, respectively).…”

The Diagnosis and Therapy of Degenerative Knee Joint Disease: Expert Consensus from the Chinese Pain Medicine Panel

“…The knee joint pain aggravates with activity and alleviates after rest. With the patients condition worsened, the pain will be persistent and aggravated when squatting or going up and downstairs [32, 33].…”