Tendon Adaptation to Sport-specific Loading in Adolescent Athletes

Cassel, Michael; Carlsohn, Anja; Fröhlich, Katja; John, Margaret; Riegels, N.; Mayer, Frank

doi:10.1055/s-0035-1559772

Cited by 18 publications

(24 citation statements)

References 31 publications

(41 reference statements)

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“…Waugh et al (2014) investigated the effects of a strength training intervention on the mechanical properties of the Achilles tendon in pre-pubertal children and reported a significant increase of tendon stiffness. More recently, a cross-sectional comparison of tendon thickness between 500 adolescent athletes from different sports provided an indication of tendon plasticity in response to increased loading for the patellar tendon as well (Cassel et al, 2016). Earlier work of our group already suggested that the patellar tendon is responsive to mechanical stimulation, but it was not possible to differentiate the effects of mechanical loading and maturation (Mersmann et al, 2017) or to directly compare the mechanical properties of the patellar tendon between athletes and controls due to inhomogeneous sample composition with regard to sex (Mersmann et al, 2016).…”

Section: Discussionmentioning

confidence: 99%

Muscle and Tendon Adaptation in Adolescence: Elite Volleyball Athletes Compared to Untrained Boys and Girls

et al. 2017

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Though the plasticity of human tendons is well explored in adults, it is still unknown how superimposed mechanical loading by means of athletic training affects the properties of tendons during maturation. Due to the increased responsiveness of muscle to mechanical loading, adolescence is an important phase to investigate the effects of training on the mechanical properties of tendons. Hence, in the present study we compared vastus lateralis (VL) architecture, muscle strength of the knee extensor muscles and patellar tendon mechanical properties of male and female adolescent elite athletes to untrained boys and girls. Twenty-one adolescent volleyball athletes (A; 16.7 ± 1 years; 12 boys, 9 girls) and 24 similar-aged controls (C; 16.7 ± 1 years; 12 boys and girls, respectively) performed maximum isometric contractions on a dynamometer for the assessment of muscle strength and, by integrating ultrasound imaging, patellar tendon mechanical properties. Respective joint moments were calculated using an inverse dynamics approach and an electromyography-based estimation of antagonistic contribution. Additionally, the VL pennation angle, fascicle length and muscle-thickness were determined in the inactive state by means of ultrasound. Adolescent athletes produced significantly greater knee extension moments (normalized to body mass) compared to controls (A: 4.23 ± 0.80 Nm/kg, C: 3.57 ± 0.67 Nm/kg; p = 0.004), and showed greater VL thickness and pennation angle (+38% and +27%; p < 0.001). Tendon stiffness (normalized to rest length) was also significantly higher in athletes (A: 86.0 ± 27.1 kN/strain, C: 70.2 ± 18.8 kN/strain; p = 0.04), yet less pronounced compared to tendon force (A: 5785 ± 1146 N, C: 4335 ± 1015 N; p < 0.001), which resulted in higher levels of tendon strain during maximum contractions in athletes (A: 8.0 ± 1.9%, C: 6.4 ± 1.8%; p = 0.008). We conclude that athletic volleyball training provides a more efficient stimulus for muscle compared to tendon adaptation, which results in an increased demand placed upon the tendon by the working muscle in adolescent volleyball athletes. Besides implications for sport performance, these findings might have important consequences for the risk of tendon overuse injury.

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Section: Discussionmentioning

confidence: 99%

Muscle and Tendon Adaptation in Adolescence: Elite Volleyball Athletes Compared to Untrained Boys and Girls

et al. 2017

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“…17 However, the effect of puberty is unclear as no significant difference in patellar tendon thickness was found in prepubertal vs postpubertal 13-year-old athletes. 18 Mechanically, Achilles tendon stiffness was greater for post-PHV adolescent males compared to a pre-PHV group. 19 In a cross-sectional study, the proximal tendon attachment in participants who were less than 1 year post-peak height velocity had variable appearance on grayscale ultrasound, while those who were more than 1 year post-PHV had a grayscale appearance similar to mature participants between 21 and 40 years of age.…”

Section: Introductionmentioning

confidence: 90%

“…Patellar tendon thickness has been positively correlated with age in 11‐ to 15‐year‐old volleyball players . However, the effect of puberty is unclear as no significant difference in patellar tendon thickness was found in prepubertal vs postpubertal 13‐year‐old athletes . Mechanically, Achilles tendon stiffness was greater for post‐PHV adolescent males compared to a pre‐PHV group .…”

Section: Introductionmentioning

confidence: 97%

Quantifying proximal patellar tendon changes during adolescence in elite ballet dancers, a 2‐year study

Rudavsky

Cook

Docking

2018

Scandinavian Med Sci Sports

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Patellar tendon pathology appears to develop in young athletes. It is not known how this tendon develops through adolescence. This longitudinal study investigated proximal patellar tendon development during the adolescent growth spurt in young ballet dancers and identified whether puberty (estimated by maturity offset) had an effect on tendon development. Fifty two dancers (32 female and 20 male dancers, ages 11‐18 at baseline) had ultrasound images of their tendons every 6 months for 2 years. Changes in tendon size (anterior‐posterior diameter) on grayscale images and echogenicity, as quantified using ultrasound tissue characterization, were recorded each time. Maturity offset was calculated used to estimate peak height velocity (adolescent growth spurt). Maturity offset did not affect effect tendon composition before peak height velocity; however, after participants passed peak height velocity, maturity offset increased the composition of stable echopattern (P < .05): a 4% differential increase in type I echopattern, indicative of normal tendon structure, and a decrease in type III echopattern (more disorganized echopattern) by 0.7% per year. Anterior‐posterior thickness increased by 0.2 mm/y (P < .05) measured 2 cm below the patella. Following peak height velocity, the proximal patellar tendon attachment increased in thickness and demonstrated a more stable echopattern representative of aligned fibrillar structure. Future research is required to further understand this normal maturation and the factors that support this process, with the aim of reducing the development of patellar tendon pathology in the adolescent jumping athlete.

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“…These differences most likely represent the wide variance of tendon load in different sport disciplines with a higher prevalence’s in explosive jumping sports. Therefore, volleyball and soccer can be considered high risk disciplines for tendon pathologies [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

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

Bode

Hammer

Karvouniaris

et al. 2017

BMC Musculoskelet Disord

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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.

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Tendon Adaptation to Sport-specific Loading in Adolescent Athletes

Cited by 18 publications

References 31 publications

Muscle and Tendon Adaptation in Adolescence: Elite Volleyball Athletes Compared to Untrained Boys and Girls

Muscle and Tendon Adaptation in Adolescence: Elite Volleyball Athletes Compared to Untrained Boys and Girls

Quantifying proximal patellar tendon changes during adolescence in elite ballet dancers, a 2‐year study

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

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