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Background: As inter-limb asymmetries can be associated with higher injury risk, we aimed to investigate their role in Achilles tendinopathy patients. Methods: In Achilles tendinopathy patients (n = 41), we assessed inter-limb asymmetries of mechanical, material, and morphological musculoskeletal properties and function and how those were affected by 12 weeks of exercise intervention (high-load protocol, n = 13; Alfredson protocol, n = 11). Moreover, we assessed whether asymmetry reductions correlated with improved Patient-Reported Outcomes (VISA-A score). Results: At baseline, tendinopathic tendons demonstrated lower tendon force (p = 0.017), lower tendon stress (p < 0.0001), larger tendon cross-sectional area (CSA) (p < 0.001), and increased intratendinous (p = 0.042) and tendon overall (p = 0.021) vascularization. For the high-load group, PRE-to-POST asymmetry comparisons revealed an asymmetry increase for the counter-movement jump (CMJ) (p = 0.034) and PRE-to-POST VISA-A score improvements correlated with CSA asymmetry reductions (p = 0.024). Within the Alfredson group, PRE-to-POST VISA-A score improvements correlated with CMJ asymmetry reductions (p = 0.044) and tendon stiffness asymmetry increases (p = 0.037). POST-to-POST in-between group comparisons revealed lower asymmetry in the high-load group for tendon elongation (p = 0.021) and tendon strain (p = 0.026). Conclusions: The tendinopathic limb differs from the asymptomatic limb while therapeutic exercise interventions have little effect on asymmetries. Asymmetry reductions are not necessarily associated with tendon health improvements. [ABSTRACT FROM AUTHOR]

The objective of the current study was to assess sodium (23Na) and quantitative proton (1H) parameter changes in muscle tissue with magnetic resonance imaging (MRI) after eccentric exercise and in delayed-onset muscle soreness (DOMS). Fourteen participants (mean age: 25 ± 4 years) underwent 23Na/1H MRI of the calf muscle on a 3-T MRI system before exercise (t0), directly after eccentric exercise (t1), and 48 h postintervention (t2). In addition to tissue sodium concentration (TSC), intracellular-weighted sodium (ICwS) signal was acquired using a three-dimensional density-adapted radial projection readout with an additional inversion recovery preparation module. Phantoms containing saline solution served as references to quantify sodium concentrations. The ¹H MRI protocol consisted of a T1-weighted turbo spin echo sequence, a T2-weighted turbo inversion recovery, as well as water T2 mapping and water T1 mapping. Additionally, blood serum creatine kinase (CK) levels were assessed at baseline and 48 h after exercise. The TSC and ICwS of exercised muscles increased significantly from t0 to t1 and decreased significantly from t1 to t2. In the soleus muscle (SM), ICwS decreased below baseline values at t2. In the tibialis anterior muscle (TA), TSC and ICwS remained at baseline levels at each measurement point. However, high-CK participants (i.e., participants with a more than 10-fold CK increase, n = 3) displayed different behavior, with 2- to 4-fold increases in TSC values in the medial gastrocnemius muscle (MGM) at t2. ¹H water T1 relaxation times increased significantly after 48 h in the MGM and SM. ¹H water T2 relaxation times and muscle volume increased in the MGM at t2. Sodium MRI parameters and water relaxation times peaked at different points. Whereas water relaxation times were highest at t2, sodium MRI parameters had already returned to baseline values (or even below baseline values, for low-CK participants) by this point. The observed changes in ion concentrations and water relaxation time parameters could enable a better understanding of the physiological processes during DOMS and muscle regeneration. In the future, this might help to optimize training and to reduce associated sports injuries. [ABSTRACT FROM AUTHOR]

Background: This study aimed to translate, adapt, and test the psychometric properties of the Japanese version of the Victorian Institute of sports assessment for patellar tendinopathy (VISA-P-J). Methods: This prospective cohort study registered 43 participants ≥ 18 years old with a history of painful symptoms in the inferior pole of the patella to the proximal patellar tendon lasting ≥ 1 month for patellar tendinopathy. Pain in daily life and during sports activities, symptom classification, and patient global impression of change were assessed at the baseline, 1 week, and 12 weeks. The psychometric properties, test–retest reliability, standard error of measurement, internal consistency criterion validity, construct validity, responsiveness, and interpretability, of the VISA-P-J were calculated according to the COSMIN. Results: The two-way random-effects, absolute agreement intraclass correlation coefficient for test–retest reliability of VISA-P-J was 0.87 (95% confidence interval: 0.78, 0.93), and the standard error of measurement of VISA-P-J was 0.89. The Cronbach's alpha for internal consistency of VISA-P-J was 0.81. A correlation between VISA-P-J and Roel's classification, Visual Analog Scale for pain (VAS)-Active Daily Living, and VAS-Sports (r = − 0.52, r = − 0.66, r = − 0.86, p < 0.01, respectively) was observed for criterion validity. All hypotheses of the hypothesis-testing method to evaluate construct validity and responsiveness of VISA-P-J were substantiated. The minimal clinically important difference of VISA-P-J was 7 points. Conclusion: We demonstrated that the VISA-P-J was a reliable, valid, and responsive assessment method for individuals with chronic pain in the patellar tendon. [ABSTRACT FROM AUTHOR]

The aversive aspect of pain constitutes a major burden faced by pain patients. This has been recognized by the pain research community, leading to the development of novel methods focusing on affective-motivational behaviour in pain model animals. The most common tests used to assess pain aversion in animals require cognitive processes, such as associative learning, complicating the interpretation of results. To overcome this issue, studies in recent years have utilized unconditioned escape as a measure of aversion. However, the vast majority of these studies quantify jumping - a common escape behaviour in mice, but not in adult rats, thus limiting its use. Here, we present the "Heat Escape Threshold" (HET) paradigm for assessing heat aversion in rats. We demonstrate that this method can robustly and reproducibly detect the localized effects of an inflammatory pain model (intraplantar carrageenan) in male and female Sprague-Dawley rats. In males, a temperature that evoked unconditioned escape following carrageenan treatment also induced real-time place avoidance (RTPA). Systemic morphine more potently alleviated carrageenan-induced heat aversion (as measured by the HET and RTPA methods), as compared to reflexive responses to heat (as measured by the Hargreaves test), supporting previous findings. Next, we examined how blocking of excitatory transmission to the lateral parabrachial nucleus (LPBN), a key node in the ascending pain system, affects pain behaviour. Using the HET and Hargreaves tests, we show that intra-LPBN application of glutamate antagonists reverses the effects of carrageenan on both affective and reflexive pain behaviour, respectively. Finally, we employed the HET paradigm in a generalized opioidwithdrawal pain model. Withdrawal from a brief systemic administration of remifentanil resulted in a long-lasting and robust increase in heat aversion, but no change in reflexive responses to heat. Taken together, these data demonstrate the utility of the HET paradigm as a novel tool in preclinical pain research. [ABSTRACT FROM AUTHOR]

Purpose: Comminuted inferior patellar pole fractures are challenging injuries and require effective treatment due to the extension mechanism of the knee. This study aims to evaluate the outcome of above fractures treated with a modified technique of cerclage-wire-augmented separate vertical wiring (SVW) with cerclage wiring passed through the proximal patella. Methods: Retrospective analysis (1/2017–1/2020) were performed for patients that were treated with three SVWs through the posterior margin of proximal fragment and directly to the anterosuperior border of patella, combined with a cerclage wiring passed through the proximal patella. Patients who experienced comminuted inferior patellar pole fractures within 3 weeks were included, and the outcome was evaluated radiologically and clinically by Bostman score after a minimum of 12 months following surgery. Further evaluation included the operation time and complication rate. Results: A total of 20 patients (10 males, 10 females) with a mean age of 54 ± 14.5 years (26–83 years) and a follow-up of 18.9 ± 6.6 months (12–36 months) were evaluated. The average operation time was 45.7 ± 8.8 min (30–60 min). At final follow-up, the average range of motion was 131.3° ± 3.5° (125°–135°), and the mean Bostman score was 29.4 ± 0.7 points (28–30) and graded excellent in all cases. Two patients experienced occasional giving way of the knee. Radiologically no loss of reduction, implant breakage, nonunion or skin irritation was observed. Conclusions: The cerclage-wire-augmented SVW with cerclage wiring passed through the proximal patella appears to be a safe and simple technique which can effectively treat the comminuted inferior patellar pole fractures. [ABSTRACT FROM AUTHOR]

This placebo-controlled, explanatory, randomized, controlled trial demonstrated that adding pain science education to exercise for Achilles tendinopathy did not enhance improvements in pain and function. Exercise is the standard of care for Achilles tendinopathy (AT), but 20% to 50% of patients continue to have pain following rehabilitation. The addition of pain science education (PSE) to an exercise program may enhance clinical outcomes, yet this has not been examined in patients with AT. Furthermore, little is known about how rehabilitation for AT alters the fear of movement and central nervous system nociceptive processing. Participants with chronic AT (N = 66) were randomized to receive education about AT either from a biopsychosocial (PSE) or from a biomedical (pathoanatomical education [PAE]) perspective. Simultaneously, all participants completed an exercise program over 8 weeks. Linear mixed models indicated that there were no differences between groups in (1) movement-evoked pain with both groups achieving a clinically meaningful reduction (mean change [95% CI], PSE: −3.0 [−3.8 to −2.2], PAE = −3.6 [−4.4 to −2.8]) and (2) self-reported function, with neither group achieving a clinically meaningful improvement (Patient-Reported Outcomes Measurement Information System Physical Function-PSE: 1.8 [0.3-3.4], PAE: 2.5 [0.8-4.2]). After rehabilitation, performance-based function improved (number of heel raises: 5.2 [1.6-8.8]), central nervous system nociceptive processing remained the same (conditioned pain modulation: −11.4% [0.2 to −17.3]), and fear of movement decreased (Tampa Scale of Kinesiophobia, TSK-17: −6.5 [−4.4 to −8.6]). Linear regression models indicated that baseline levels of pain and function along with improvements in self-efficacy and knowledge gain were associated with a greater improvement in pain and function, respectively. Thus, acquiring skills for symptom self-management and the process of learning may be more important than the specific educational approach for short-term clinical outcomes in patients with AT. [ABSTRACT FROM AUTHOR]

Background: The authors aimed to compare the effects of a one-time ultrasound (US)-guided subacromial corticosteroid injection and three-time ozone (O2-O3) injection in patients with chronic supraspinatus tendinopathy. Methods: Participants were randomly assigned to the corticosteroid group (n = 22) or ozone group (n = 22). Injections in both groups were administered into subacromial bursa with an US-guided in-plane posterolateral approach. Primary outcome measure was the change in the Western Ontario Rotator Cuff Index (WORC) score between baseline and 12-weeks post-injection. Secondary outcome measures included visual analog scale and Shoulder Pain and Disability Index scores. Assessments were recorded at baseline, and 4-weeks and 12-weeks post-injection. Results: Forty participants completed this study. Based on repeated measurement analysis of variance, a significant effect of time was found for all outcome measures in both groups. Both the groups showed clinically significant improvements in shoulder pain, quality of life, and function. Baseline, 4-week post-injection, and 12-week post-injection WORC scores (mean ± standard deviation) were 57.91 ± 18.97, 39.10 ± 20.50 and 37.22 ± 27.31 in the corticosteroid group, respectively and 69.03 ± 15.89, 39.11 ± 24.36, and 32.26 ± 24.58 in the ozone group, respectively. However, no significant group × time interaction was identified regarding all outcome measures. Conclusions: Three-time ozone injection was not superior to a one-time corticosteroid injection in patients with chronic supraspinatus tendinopathy. It might be as effective as corticosteroid injection at 4-weeks and 12-weeks post-injection in terms of relieving pain and improving quality of life and function. [ABSTRACT FROM AUTHOR]

Objective: Inferior pole fractures of patella are notorious fractures where it is difficult to obtain rigid internal fixation by conventional methods. The objective of the study was to introduce the Hand Plating System (HPS), which was a novel surgical technique for inferior pole fractures of patella, and to report the radiological and clinical outcomes following the application of the surgical technique. Methods: The study was designed as a retrospective cohort study. Between July 2017 and December 2018, 30 patients who were diagnosed with inferior pole fracture of the patella without additional orthopaedic injuries were enrolled in this case series. After X‐ray and 3D‐CT examinations, all patients underwent open reduction and internal fixation by HPS with or without supplementary cannulated screw and lag screw stabilization. The bony union time, final range of motion (ROM), Bostman score, visual analog scale (VAS), and complications were measured as the clinical outcomes under a minimum of 12 months of follow‐up. Results: All of the operations went well with the mean operative time of 76.2 ± 15.3 min. Bony union achieved in all the cases at an average of 9.5 ± 1.4 weeks after surgery. There was no loss of reduction, fixative failure, or surgical implant removal during follow‐up. The average range of motion 1 year postoperatively was 0°–123.3°. The mean Bostman Score at the last follow‐up was 26.8 ± 2.1 with the satisfactory rate of 100%. The pain feeling during walking as measured by VAS averaged at 0.9 ± 1.3. No complications developed except for one case of poor incision healing, which healed eventually after surgical debridement. Conclusions: HPS was demonstrated as a secure fixation and as a kind of tension band for inferior pole fractures of the patella. Satisfactory recovery of knee function and low complication rate, including no need for hardware removal, could be expected. [ABSTRACT FROM AUTHOR]

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Context: Soft tissue injuries are often treated with injectables such as corticosteroids and platelet-rich plasma (PRP) to reduce inflammation and promote healing. There is increasing evidence examining the use of hyaluronic acid (HA) for the management of soft tissue injuries. Objective: To evaluate the treatment effect and role of HA for available soft tissue indications. Data Sources: A search of PubMed, MEDLINE, EMBASE, and CENTRAL from the inception date of each database through February 24, 2021, was conducted for all randomized controlled trials (RCTs) involving the use of HA for soft tissue indications. Two reviewers independently screened articles for eligibility and extracted data from included studies for analysis. We assessed risk of bias for all included studies and pooled outcomes using a fixed-effects model. Outcomes (ie, function and pain relief) were categorized to short-term (<6 weeks, 6-12 weeks) and mid-term (>12 weeks) data. We present effect estimates as mean differences (MDs) and standardized mean differences (SMDs) and present the estimate of effect of HA for available indications in relation to available comparators. Study Design: Meta-analysis of RCTs. Level of Evidence: Level 1. Results: Of the 6930 articles screened, 19 RCTs (n = 1629 patients) were eligible and included in this review. HA was evaluated across a variety of soft tissue indications including rotator cuff disease, elbow pain, ankle sprains, Achilles tendinopathy, patellar tendinopathy, and trigger finger. Of the 19 RCTs, 11 were placebo-controlled and 9 used active comparators (PRP, cortisone, prolotherapy, or extracorporeal shockwave therapy). The pooled treatment effect of HA across most soft indications against placebo and active comparators demonstrated benefit in short-term pain <6 weeks (MD visual analogue scale [VAS] 2.48, 95% CI 2.31-2.65) and 6 to 12 weeks (MD VAS 2.03, 95% CI 1.86-2.20). Mid-term pain relief also favored HA over comparators across indications >12 weeks from administration (MD VAS 3.57, 95% CI 3.35-3.78). High heterogeneity was present with rotator cuff (10 trials, I2 = 94%), and elbow tendinopathy (2 trials, I2 = 99%). We identified uncertain benefit for trigger finger (2 trials, I2 = 67%). Heterogeneity for ankle sprains, patellar tendinopathy and Achilles tendinopathy could not be assessed as they only had 1 trial each. Conclusion: This systematic review and meta-analysis support HA's efficacy in the treatment of a variety of soft tissue indications. Understanding the relative effects of HA to other injectable modalities requires additional, large trials. [ABSTRACT FROM AUTHOR]

Patellar ligament (PL) injuries are increasingly being reported in horses, but few studies have described the normal PL ultrasonographic appearance in horses. The aims of this prospective observational study were to describe the ultrasonographic appearance of the PLs and infrapatellar fat pad in a population of horses in training and to relate the ultrasonographic findings to objectively measured movement asymmetry. B-mode and color Doppler ultrasonographic examination of the PLs and infrapatellar fat pad in both hind limbs and objective gait analyses were performed on the 116 riding and trotting horses included in the study. The association between ultrasonographic findings, horse age, and movement asymmetry during the trot was then investigated. Distinct or diffuse hypoechoic regions were commonly found in the intermediate PL (24/116; 20.7%), especially in the caudal aspect of the mid-third of the ligament. The infrapatellar fat pad had a hypoechoic striated appearance in all horses except one, in which it was hyperechoic. No association was found between ultrasonographic findings in the PLs and infrapatellar fat pad and lameness. It is important to recognize that there is biological variation in PL appearance, which may or may not be associated with pain in this area, therefore emphasizing the use of local analgesia to determine the location of the lameness., (© 2024 The Author(s). Veterinary Radiology & Ultrasound published by Wiley Periodicals LLC on behalf of American College of Veterinary Radiology.)

Aim: To find out which exercise, isometric or eccentric is the best intervention to reduce the patellar tendon pain and maximise the jump performance. Materials and Methods: The participants were screened and selected according to the inclusion and exclusion criteria. The demographic data, pain and Victorian Institute of Sport Assessment– Patella (VISA-P) scale were measured pre-intervention and pos-tintervention. A total of 25 players of mean age 17.00±16.54 years, mean weight 67.76±60.84 kg and 89.63±17.67 cm mean height were taken through the single-blinded randomised sampling and were allocated into two groups Group A (n=12) of isometric exercise intervention and Group B (n=13) of Eccentric (EC) exercise intervention for 12 weeks. Results: There was a statistically non significant difference seen for the demographic values between the groups (p>0.05) for all the variables. There was a statistically highly significant difference seen for the values between the groups (p<0.01) for post VISA-P with higher values in EC group. There was a statistically non significant difference seen for the values between the groups (p>0.05) for pre VISA-P. Conclusion: In this trial, among volleyball players with chronic patellar tendinopathy, treatment with eccentric exercise is superior to isometric. Coaches, sport scientists and volleyball players may use the eccentric exercise as a training protocol to improve the game skills. This could aid coaches in planning and controlling training, making appropriate performance enhancement decisions, and avoiding hand injuries. [ABSTRACT FROM AUTHOR]

Background: Autologous hamstrings and patellar tendon have historically been considered the gold standard grafts for anterior cruciate ligament reconstruction (ACLR). In the last decades, the utilization of synthetic grafts has re-emerged due to advantageous lack of donor site morbidity and more rapid return to sport. The Ligament Augmentation and Reconstruction System (LARS) has demonstrated to be a valid and safe option for ACLR in the short term. However, recent studies have pointed out the notable frequency of associated complications, including synovitis, mechanical failure, and even chondrolysis requiring joint replacement. Case presentation: We report the case of a 23-year-old male who developed a serious foreign body reaction with wide osteolysis of both femoral and tibial tunnels following ACLR with LARS. During first-stage arthroscopy, we performed a debridement of the pseudocystic mass incorporating the anterior cruciate ligament (ACL) and extending towards the tunnels, which were filled with autologous anterior iliac crest bone graft chips. Histological analysis revealed the presence of chronic inflammation, fibrosis, and foreign body giant cells with synthetic fiber inclusions. Furthermore, physicochemical analysis showed signs of fiber depolymerization, increased crystallinity and formation of lipid peroxidation-derived aldehydes, which indicate mechanical aging and instability of the graft. After 8 months, revision surgery was performed and ACL revision surgery with autologous hamstrings was successfully carried out. Conclusions: The use of the LARS grafts for ACLR should be cautiously contemplated considering the high risk of complications and early failure. [ABSTRACT FROM AUTHOR]

Background: The trunk is the foundation for transfer and dissipation of forces throughout the lower extremity kinetic chain. Individuals with knee disorders may employ trunk biomechanical adaptations to accommodate forces at the knee or compensate for muscle weakness. This systematic review aimed to synthesize the literature comparing trunk biomechanics between individuals with knee disorders and injury-free controls. Methods: Five databases were searched from inception to January 2022. Observational studies comparing trunk kinematics or kinetics during weight-bearing tasks (e.g., stair negotiation, walking, running, landings) between individuals with knee disorders and controls were included. Meta-analyses for each knee disorder were performed. Outcome-level certainty was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE), and evidence gap maps were created. Results: A total of 81 studies investigating trunk biomechanics across six different knee disorders were included (i.e., knee osteoarthritis [OA], total knee arthroplasty [TKA], patellofemoral pain [PFP], patellar tendinopathy [PT], anterior cruciate ligament deficiency [ACLD], and anterior cruciate ligament reconstruction [ACLR]). Individuals with knee OA presented greater trunk flexion during squatting (SMD 0.88, 95% CI 0.58–1.18) and stepping tasks (SMD 0.56, 95% CI 0.13–.99); ipsilateral and contralateral trunk lean during walking (SMD 1.36; 95% CI 0.60–2.11) and sit-to-stand (SMD 1.49; 95% CI 0.90–2.08), respectively. Greater trunk flexion during landing tasks in individuals with PFP (SMD 0.56; 95% CI 0.01–1.12) or ACLR (SMD 0.48; 95% CI 0.21–.75) and greater ipsilateral trunk lean during single-leg squat in individuals with PFP (SMD 1.01; 95% CI 0.33–1.70) were also identified. No alterations in trunk kinematics of individuals with TKA were identified. Evidence gap maps outlined the lack of investigations for individuals with PT or ACLD, as well as for trunk kinetics across knee disorders. Conclusion: Individuals with knee OA, PFP, or ACLR present with altered trunk kinematics in the sagittal and frontal planes. The findings of this review support the assessment of trunk biomechanics in these individuals in order to identify possible targets for rehabilitation and avoidance strategies. Trial registration: PROSPERO registration number: CRD42019129257. [ABSTRACT FROM AUTHOR]

This study aimed to investigate static and dynamic postural balance inter-limb asymmetries in athletes with unilateral patellar tendinopathy (UPT) and estimate subsequent lower extremity musculoskeletal injury risk compared to controls. Twenty-eight athletes with UPT were recruited. Twenty-eight healthy athletes served as controls. Static postural balance inter-limb asymmetry (symmetry index: SI) was assessed based on differences in the mean centre of pressure (CoP) velocity (CoPv) values between the affected leg (AL) and non-affected leg (NAL) for the UPT group, and the dominant leg (DL) and non-dominant leg (NDL) for controls. Outcome variables were dynamic postural balance, assessed with inter-limb asymmetry using the Y Balance Test (YBT), and injury risk. In static balance, SI values were significantly (P<0.001) higher in the UPT group compared to controls. In dynamic balance, normalized inter-limb asymmetry values were also significantly higher in athletes with UPT compared to controls in anterior (P<0.001), posteromedial (P<0.001) and posterolateral (P<0.01) directions, and in the composite score (P<0.001). Furthermore, the incidence of sustaining a non-contact lower extremity injury during the follow-up period (10 months) was significantly higher (P<0.05) in the UPT group compared to controls. Athletes with UPT had postural balance inter-limb asymmetries. Moreover, they had increased subsequent lower extremity musculoskeletal injury risk compared to controls. Since most athletes with UPT continue to train and compete, adequate training and rehabilitation programmes should be implemented to prevent potential subsequent injury occurrence. [ABSTRACT FROM AUTHOR]

An advanced ultrasound imaging technique, sonoelastography (SE) is used to evaluate tissue elasticity. To determine SE potential to detect pathological-related changes, and characteristics related to tendon pathology we aimed to (1) compare quadriceps and patellar tendon findings in individuals with knee osteoarthritis (KOA) and asymptomatic older adults (AC), and (2) explore associations between SE, participant characteristics (age, BMI, and leg circumference) and KOA status. 84 participants (47; KOA and 37; asymptomatic older adults) underwent SE examination of quadriceps (distal) and patellar (distal, proximal) tendon in a supine position with the knee bent at 30°. Colour score (CS) and Elasticity Ratio (ER) analysis were performed by a blinded experienced operator using Esaote Mylab 70 XVG Ultrasound equipment. Significantly reduced elasticity in the distal quadriceps (median (IQR) 2(2), 3(1), p = 0.033 for KOA and AC, respectively) and proximal patellar (3(1), 3(0), p = 0.001) tendons and more elastic distal patellar (1.50 (0.55), 1.87 (0.72), p = 0.034) tendons were observed in the KOA group. Significant associations) were identified between SE and participant BMI (Rs = − 0.249–0.750, p < 0.05) and leg circumference (Rs = − 0.260–0.903, p < 0.05). Age, BMI and KOA status, were independent explanatory variables of SE CS findings at the distal quadriceps tendon patellar tendon, proximal patellar tendon and distal patellar tendon, explaining 66%, 81% and 64% of variance, respectively. Age, BMI and KOA status were independent explanatory variables of SE ER findings at the distal patellar tendon explaining 19% of variance. Potentially clinically relevant altered tendon stiffness were observed between individuals with KOA and asymptomatic controls. Key KOA risk factors and participant characteristics explained variance in tendon stiffness. Findings provide context for future studies to investigate the potential for targeted SE detected early clinical management based on associated participant characteristics. [ABSTRACT FROM AUTHOR]

COVID-19 is associated with musculoskeletal disorders. Ultrasound is a tool to assess muscle architecture and tendon measurements, offering an idea of the proportion of the consequences of the disease, since significant changes directly reflect the reduction in the ability to produce force and, consequently, in the functionality of the patient; however, its application in post-COVID-19 infection needs to be determined. We aimed to assess the intra- and inter-rater reliability of ultrasound measures of the architecture of the vastus lateralis (VL), rectus femoris (RF), vastus medialis (VM), gastrocnemius lateralis (GL), gastrocnemius medialis (GM), soleus (SO), and tibialis anterior (TA) muscles, as well as the patellar tendon (PT) cross-sectional area (CSA) in post-COVID-19 patients. An observational, prospective study with repeated measures was designed to evaluate 20 post-COVID-19 patients, who were measured for the pennation angle (θp), fascicular length (Lf), thickness, echogenicity of muscles, CSA and echogenicity of the PT. The intra-class correlation coefficient (ICC) and 95% limits of agreement were used. The intra-rater reliability presented high or very high correlations (ICC = 0.71–1.0) for most measures, except the θp of the TA, which was classified as moderate (ICC = 0.69). Observing the inter-rater reliability, all the evaluations of the PT, thickness and echogenicity of the muscles presented high or very high correlations. For the Lf, only the RF showed as low (ICC = 0.43), for the θp, RF (ICC = 0.68), GL (ICC = 0.70) and TA (ICC = 0.71) moderate and the SO (ICC = 0.40) low. The ultrasound reliability was acceptable for the muscle architecture, muscle and tendon echogenicity, and PT CSA, despite the low reliability for the Lf and θp of the RF and SO, respectively. [ABSTRACT FROM AUTHOR]

Purpose: In children with cerebral palsy, flexion deformities of the knee can be treated with a distal femoral extension osteotomy combined with either patellar tendon advancement or patellar tendon shortening. The purpose of this study was to establish a consensus through expert orthopedic opinion, using a modified Delphi process to describe the surgical indications for distal femoral extension osteotomy and patellar tendon advancement/patellar tendon shortening. A literature review was also conducted to summarize the recent literature on distal femoral extension osteotomy and patellar tendon shortening/patellar tendon advancement. Method: A group of 16 pediatric orthopedic surgeons, with more than 10 years of experience in the surgical management of children with cerebral palsy, was established. The group used a 5-level Likert-type scale to record agreement or disagreement with statements regarding distal femoral extension osteotomy and patellar tendon advancement/patellar tendon shortening. Consensus for the surgical indications for distal femoral extension osteotomy and patellar tendon advancement/patellar tendon shortening was achieved through a modified Delphi process. The literature review, summarized studies of clinical outcomes of distal femoral extension osteotomy/patellar tendon shortening/patellar tendon advancement, published between 2008 and 2022. Results: There was a high level of agreement with consensus for 31 out of 44 (70%) statements on distal femoral extension osteotomy. Agreement was lower for patellar tendon advancement/patellar tendon shortening with consensus reached for 8 of 21 (38%) of statements. The literature review included 25 studies which revealed variation in operative technique for distal femoral extension osteotomy, patellar tendon advancement, and patellar tendon shortening. Distal femoral extension osteotomy and patellar tendon advancement/patellar tendon shortening were generally effective in correcting knee flexion deformities and extensor lag, but there was marked variation in outcomes and complication rates. Conclusion: The results from this study will provide guidelines for surgeons who care for children with cerebral palsy and point to unresolved questions for further research. Level of evidence: level V. [ABSTRACT FROM AUTHOR]

Objective: To compare the cost-effectiveness of three patellar tendinopathy treatments. Design: Secondary (cost-effectiveness) analysis of a blinded, randomised controlled trial, with follow-up at 10 and 22 weeks. Settings: Recruitment was performed in sport clubs. The diagnosis and the intervention were carried out at San Jorge University. Participants: The participants were adults between 18 and 45 years (n = 48) with patellar tendinopathy. Interventions: Participants received percutaneous needle electrolysis, dry needling or sham needling, all of which were combined with eccentric exercise. Main outcome measures: Costs, quality-adjusted life years and incremental cost-effectiveness ratio were calculated for each group. Results: The total cost per session was similar in the three groups: €9.46 for the percutaneous needle electrolysis group; €9.44 for the dry needling group; and €8.96 for the sham group. The percutaneous needle electrolysis group presented better cost-effectiveness in terms of quality-adjusted life years and 96% and 93% probability of being cost-effective compared to the sham and dry needling groups, respectively. Conclusion: Our study shows that percutaneous needle electrolysis has a greater probability of being cost-effective than sham or dry needling treatment. [ABSTRACT FROM AUTHOR]

Background: Mid-portion Achilles Tendinopathy (AT) is a common musculoskeletal condition with varying rehabilitation success rates. Despite the prevalence of this condition, a considerable proportion of individuals experience persisting pain and functional deficits. Current treatment approaches bias the biomedical model which emphasises physically treating and loading the tendon. Overall, there is a lack of consideration for the central nervous system that is commonly implicated in chronic injuries. The aim of this pilot study was to explore the feasibility of combining Action Observation Therapy (AOT), a treatment technique which targets central changes and influences motor learning, with eccentric exercises in the treatment of mid-portion AT. AOT involves the observation of movements and is commonly followed by the physical performance of these same movements. Methodology: This was a double-blinded randomised controlled pilot feasibility study. All participants underwent the 12-week Alfredson eccentric training protocol. The intervention group watched videos of the exercises prior to performing these exercises, whilst the control group watched nature videos before performing the same exercises. Study feasibility was the primary outcome measure, with the Victorian Institute of Sports Assessment- Achilles (VISA-A) selected as the primary clinical outcome measure. Results: Thirty participants were recruited, reflecting a 75% eligibility rate and 100% of eligible participants enrolled in the study. The retention rate at week 12 was 80%. At week six the mean VISA-A score improved by 18.1 (95% CI 10.2–26.0) in the intervention group and 7.7 (95% CI 0.3–14.9) in the control group, and 75% and 33% of participants in the intervention and control group respectively exceeded the minimal clinically important difference (MCID). At week 12 the mean VISA-A score from baseline improved by 22.25 (95% CI 12.52–31.98) in the intervention group and 16.5-(95% CI 8.47–24.53) in the control group, equating to 75% and 58% in each group respectively exceeding the MCID. Conclusion: The positive feasibility outcomes and exploratory data from the clinical outcome measures suggest that a larger scaled RCT is warranted to further investigate the impact of AOT in the rehabilitation of mid-portion AT. Trial registration ISRCTN58161116, first registered on the 23/12/2020. [ABSTRACT FROM AUTHOR]

Researchers have not established if overloading or underloading movement profiles are present in symptomatic and asymptomatic athletes with patellar tendon structural abnormality (PTA) compared with healthy athletes. To compare involved-limb landing biomechanics between male athletes with and those without patellar tendinopathy. Cross-sectional study. Laboratory. A total of 43 male athletes were grouped based on patellar tendon pain and ultrasound imaging of the proximal patellar tendon: symptomatic with PTA (SYM; n = 13; age = 19.62 ± 1.61 years, height = 1.82 ± 0.05 m, mass = 83.46 ± 5.12 kg), asymptomatic with PTA (ASYM; n = 15; age = 21.13 ± 1.88 years, height = 1.84 ± 0.07 m, mass = 81.45 ± 13.26 kg), and healthy control (CON; n = 15; age = 19.60 ± 1.55 years, height = 1.84 ± 0.09 m, mass = 79.09 ± 12.37 kg). Three-dimensional biomechanics were collected during a double-limb jump-landing task. Kinematic (knee-flexion angle [KF]) and kinetic (vertical ground reaction force, internal knee-extension moment [KEM], patellar tendon force [FPT]) variables were analyzed as continuous waveforms during the stance phase for the involved limb. Mean values were calculated for each 1% of stance, normalized over 202 data points (0%–100%), and plotted with 95% CIs. Statistical significance was defined as a lack of 95% CI overlap for a minimum of a consecutive 3% of the stance phase. The SYM group had less KF than the CON group throughout the stance phase (8%–76%: Cohen d = 1.14 ± 0.12, mean difference [MD] = 15.83° ± 2.71°). The ASYM group had less KF than the CON group in the early (8%–13%: Cohen d = 0.99 ± 0.04, MD = 7.99° ± 0.39°; 21%–24%: Cohen d = 1.01 ± 0.01, MD = 11.11° ± 0.32°) and late (74%–94%: Cohen d = 0.96 ± 0.07, MD = 9.55° ± 1.13°) stance phases. The SYM group had a smaller KEM (6.5%–9%: Cohen d = 1.21 ± 0.08, MD = 0.04 ± 0.004 N·m/[Nbw·mht]) and less FPT (6%–9%: Cohen d = 1.15 ± 0.15, MD = 0.85 ± 0.15 body weight) than the CON group in the early stance phase. The SYM group also displayed a smaller KEM (38%–56%: Cohen d = 1.17 ± 0.06, MD = 0.03 ± 0.001 N·m/[Nbw·mht]) and less FPT (36%–60%: Cohen d = 1.22 ± 0.08, MD = 0.66 ± 0.05 body weight) than the ASYM group in the midstance phase. The SYM group demonstrated a patellar tendon load-avoidance profile compared with the ASYM and CON groups. The ASYM group showed no evidence of overloading compared with the CON group. Our findings support the need for individualized treatments for athletes with tendinopathy to maximize load capacity. [ABSTRACT FROM AUTHOR]

Objective: Most inferior pole fractures of the patella are comminuted. Therefore, an ideal treatment method has not been determined. We have presented a modified tension band fixation technique—the Krachow suturing, Nice knot combined with tension band fixation—and reported the results of the procedure. Methods: A total of 16 inferior patellar pole fractures were treated at our institution between January 2019 and October 2020, 15 of which underwent treatment with the modified tension band fixation technique consisting of Krachow suturing with Nice knots combined with tension band fixation. The primary measures: knee motion, Bostman score, anterior knee pain, fixation failure. Results: Bone union occurred at a mean of 9 weeks postoperatively (range: 8–13). There were no cases of postoperative anterior knee pain, refracture of the inferior patellar pole or wire breakage. The patients regained full ROM of the knee joint without functional deficits during follow‐up; the mean ROM was 128.46° ± 7.07° (range: 113.4°–137.8°). At the last follow‐up, all patients had a mean Bostman score of 28.40 ± 1.29 (range: 26–30), with an excellent score in 11 patients and a good score in four patients. Conclusion: The modified tension band fixation technique for the treatment of inferior patellar pole fractures is a simple and easy‐to‐perform surgical technique that provides stable fixation and good functional results. [ABSTRACT FROM AUTHOR]

Background: The Victorian Institute of Sport Assessment questionnaire for patellar tendinopathy (VISA-P) is currently not available in the Arabic language. Purpose: To translate and culturally adapt the VISA-P questionnaire into Arabic and to evaluate its reliability and validity. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Translation of the VISA-P questionnaire was implemented in compliance with international guidelines. In total, 111 participants (53 with patellar tendinopathy and 58 healthy controls) were recruited to validate the Arabic-language version of the VISA-P (VISA-P-Ar). The patients with patellar tendinopathy completed the 36-item Short Form Health Survey (SF-36) and rated their knee pain using the numeric pain rating scale (NPRS). They completed the VISA-P-Ar twice (within a week) to assess test-retest reliability. Scores between the patients and controls were compared with the Mann-Whitney U test, construct validity was assessed with Spearman rank-order correlation, internal consistency was assessed with the Cronbach alpha, and test-retest reliability was assessed with the intraclass correlation coefficient (ICC). Results: There was a significant difference in VISA-P-Ar scores between the patellar tendinopathy group (mean, 41.35 ± 13.56) and the control group (mean, 95.22 ± 8.22) (P <.001). In addition, scores on the VISA-P-Ar were significantly positively correlated with the SF-36 (r = 0.630; P <.001) and significantly negatively correlated with the NPRS (r = −0.681; P <.001). The items in the VISA-P-Ar had good internal consistency (α = 0.709) and showed high test-retest reliability (ICC, 0.941; P <.001). Conclusion: The results of this study indicated that the VISA-P-Ar is a valid and reliable tool for assessing symptoms of patellar tendinopathy in the Saudi population and can be used in clinical and research settings. [ABSTRACT FROM AUTHOR]

Background: Dorsiflexion range of motion restriction has been associated with patellar tendinopathy, but the mechanisms of how dorsiflexion restriction could contribute to knee overload remain unknown. Hypothesis: Peak ankle dorsiflexion and ankle dorsiflexion excursion are negatively associated with peak vertical ground-reaction force (vGRF) and loading rate, and with peak patellar tendon force and loading rate, and positively associated with peak ankle plantar flexor moment. Study Design: Cross-sectional study. Level of Evidence: Level 4. Methods: Kinematic and kinetic data of 26 healthy recreational jumping athletes were measured during a single-leg drop vertical jump. Pearson's correlation coefficients were calculated to establish the association between peak ankle dorsiflexion and ankle dorsiflexion excursion with peak vGRF and vGRF loading rate, with peak patellar tendon force and patellar tendon force loading rate, and with peak ankle plantar flexor moment. Results: Ankle dorsiflexion excursion negatively correlated with peak vGRF loading rate (r = −0.49; P = 0.011) and positively correlated with peak ankle flexor plantar moment (r = 0.52; P = 0.006). In addition, there was a positive correlation between peak ankle dorsiflexion and peak vGRF (r = 0.39; P = 0.05). Conclusion: Ankle kinematics are associated with vGRF loading rate, ankle flexor plantar moment and peak vGRF influencing knee loads, but no association was observed between ankle kinematics and patellar tendon loads. Clinical Relevance: These results suggest that increasing ankle dorsiflexion excursion may be an important strategy to reduce lower limb loads during landings but should not be viewed as the main factor for reducing patellar tendon force. [ABSTRACT FROM AUTHOR]

The aim of this systematic review and meta-analysis was to determine the therapeutic efficacy of extracorporeal shockwave therapy (ESWT) for athletes with patellar tendinopathy. We searched PubMed, EBSCOHost and Ovid for randomized controlled trials (RCTs) which evaluated the therapeutic efficacy of ESWT in athletes with jumper's knee. The methodological quality of RCTs was rated with the Physiotherapy Evidence Database scale. Data in the meta-analysis were expressed as standardized mean difference (SMDs) and 95% confidence intervals (CIs). Heterogeneity was assessed with I2 statistics. Of 192 records identified, a total of seven articles met the inclusion criteria. The ESWT and control groups with any other conservative treatment did not differ significantly with respect to the Visual Analogue Scale (VAS) long-term scores obtained at ≥ 6 months of therapy completion (SMD: -0.33; 95% CI: -4.64 to 3.98; p = 0.87; I2= 98%). Furthermore, no significant differences were found between the ESWT and control groups regarding the pooled Victorian Institute of Sports Assessment for Patella (VISA-P) scores for long-term outcomes (SMD: 8.21; 95% CI: -39.3 to 55.73; p = 0.73; I2= 99%). The ESWT and control groups did not differ significantly on the VAS and VISA-P scores for long-term outcomes. In both cases, heterogeneity was considered to be high. Hence, no clear and generalized conclusions can be drawn regarding ESWT effectiveness in athletes with patellar tendinopathy. [ABSTRACT FROM AUTHOR]

Purpose: Whole body vibration (WBV) triggers anabolic responses in various tissues, including tendons, without requiring high force production. In this waitlist-controlled equivalence trial, we tested its clinical effectiveness as an alternative treatment for patellar tendinopathy against conventional heavy slow resistance training (HSR). Methods: Thirty-nine patients were randomized to either 3 months of WBV training (n = 13), HSR training (n = 11), or a waitlist control (WLC) group (n = 15). In a partly cross-over design, 14 patients of the WLC group were redistributed to one of the two intervention groups (5 in WBV, 9 in HSR). Pre- and postintervention testing included pain assessments (VAS), functional limitations (VISA-P), knee extension strength and tendon morphological, mechanical and material properties. Follow-up measurements (VAS, VISA-P) were performed in the WBV and HSR groups 6 months after the intervention. Results: Comparisons with the WLC group revealed significant improvements in VISA-P and VAS scores after HSR (41%, p = 003; 54%, p = 0.005) and WBV (22%, p = 0.022; 56%, p = 0.031) training. These improvements continued until follow-up (HSR: 43%, 56%; WBV: 24%, 37%). Pre-post improvements in VAS scores were equivalent between WBV and HSR groups but inconclusive for the VISA-P score and all pre-test to follow up comparisons. The mid-tendon crosssectional area was significantly reduced after WBV (-5.7%, p = 0.004) and HSR (-3.0%, p = 0.004) training compared to WLC although the equivalence test between interventions was inconclusive. Conclusion: Whole body vibration improved symptoms typically associated with patellar tendinopathy. This type of intervention is as effective as HSR against maximum pain, although equivalence could not be confirmed for other variables. The beneficial responses to WBV and HSR treatments persisted for 6 months after the end of the intervention. [ABSTRACT FROM AUTHOR]

The clinical relevance of altered tendon structure in patellar tendinopathy is contested since structural change persists after symptom resolution. The purpose of this study was to explore the relationships between tendon structure and clinical impairments in patellar tendinopathy. In this retrospective, secondary analysis of individuals with patellar tendinopathy (n = 41), tendon structure (thickness, cross‐sectional area [CSA], shear modulus, and viscosity), symptom severity, lower extremity function (counter‐movement jump [CMJ] height), and quadriceps muscle performance (knee extension force and central activation ratio [CAR]) were recorded for the symptomatic limb. Relationships among structure, symptom severity, lower extremity function, and quadriceps muscle performance were examined using sequential regression models. Adjusting for age, sex, body mass index, and pain levels, there were significant positive relationships for thickness (p < 0.001, β = 0.718) and viscosity (p = 0.006, β = 0.496) with CMJ height. There were significant negative relationships between CSA with both CMJ height (p = 0.001, β = −0.538) and CAR (p = 0.04, β = −0.517). This is the first study to demonstrate relationships between tendon structure and lower extremity function or quadriceps muscle performance in patients with patellar tendinopathy. Clinical significance: Since structural changes persist after symptom resolution, addressing these changes may assist in restoring lower extremity function and quadriceps muscle performance. [ABSTRACT FROM AUTHOR]

A 3-year-old boy was found to have a painless mass over his right anterior lateral knee for the previous 6 months. The mass was hardly identified during knee extension and became visible upon squatting. There was no specific finding on ultrasound imaging over his right knee at the supine extended position. During squatting, ultrasound imaging showed an ill-demarcated hyperechoic mass protruding next to the cartilage overlying the distal femur towards the subcutaneous layer through a slit over the lateral patellar retinaculum. Herniation of the fat pad through a defect in the lateral patellar retinaculum was diagnosed. Our case highlights the usefulness of ultrasound examination as regards the lateral patellar retinaculum defect in pediatric knees, as well as its capability for dynamic scanning to capture the exact "pathological moment". [ABSTRACT FROM AUTHOR]

Objective: Pain in supraspinatus tendinopathy can often be reduced with conservative or minimally invasive treatment options, including pulsed radiofrequency of the suprascapular nerve (PRFSN) and transcutaneous pulsed radiofrequency (TPRF). However, there is no study in which these two methods are applied together. In the current study, the aim was to investigate possible changes in the analgesic effect when TPRF was added to PRFSN. Methods: The study included 64 patients. In 36 of these patients, only 4 minutes of pulsed radiofrequency was applied to the suprascapular nerve, and this group was called Group S. In the remaining 28 patients, 4 minutes of pulsed radiofrequency plus 8 minutes of TPRF were applied to the suprascapular nerve, and this group was defined as Group S+T. The Numerical Rating Scale (NRS) scores of the two groups were compared before and after the procedure and at the 3rd and 6th month follow-up evaluations. Results: There was no significant difference between the groups in terms of gender. However, a statistically significant difference was found in relation to the mean age, with the group receiving the combined treatment having a higher mean age (p=0.001). A significant difference was observed between the pre- and post-procedure NRS scores in both groups. However, while there was no significant difference between the two groups in terms of the initial and 3rd month NRS scores, a significant difference was detected at the 6th month follow-up (p=0.01), indicating an increase in pain in Group S. Although there was an increase in pain from the 3rd to 6th month NRS scores of Group S, this was not statistically significant. When the initial NRS scores were compared with the 6th month values, the mean NRS score decreased from 7.3 to 3.6 in Group S and from 7.2 to 2.6 in Group S+T. Conclusion: The combined treatment was found to be more effective than PRFSN. [ABSTRACT FROM AUTHOR]

Injuries (rupture, avulsion) of the triceps tendon are considered infrequent injuries, which mainly affect the male gender and are directly associated with injuries that occur during sports and in a high percentage due to the consumption of steroids. The diagnosis and treatment must be carried out early, especially in those patients with high functional demand or elite athletes, in order to obtain good functional results. The clinical examination should be accompanied by diagnostic imaging studies. There is conservative treatment for lesions affecting less than 50% of the tendon, but those lesions that compromise over 50% of the tendon, surgical treatment is the indication. It could be performed through an open approach or via arthroscopic (barely described in the literature). The time of injury is the key point the early surgical treatment has shown to have optimal outcomes. However, there is no consensus on the surgical approach and its functional outcome. [ABSTRACT FROM AUTHOR]

The features of Patellar-Tendinopathy are (1): pain localised to the inferior pole of the patellar; (2): the presence of load-related pain. Body-Weight and Body-Mass-Index, as two easily-measured variables, could potentially aid the prediction of PT. This review aims to establish relationships between Body-Weight and Body-Mass-Index and Patellar-Tendinopathy via synthesising the evidence from prospective-cohort and cross-sectional studies in elite basketball and volleyball players. Seven databases (PubMed, EMBASE, CINAHL, Google Scholar, Health-Management-Information-Consortium, National-Technical-Information-Service, ClinicalTrial.gov) and citation chasing were used to identify English peer-review articles from 2000 to 2022. An adapted version of the Newcastle-Ottawa scale was used for critical appraisal. Two reviewers were involved in literature searching, data extraction, and quality review. Two prospective cohort and five cross-sectional studies met the inclusion criteria, providing 849 subjects (male:female: 436:413). Five studies found BW is associated with PT. Three studies found a relationship between BMI and PT. Six out of seven studies were classified as very good studies. All studies were level IV evidence. The very low certainty evidence suggests an association between BW and PT. There is moderate certainty evidence that BMI is associated with PT. These preliminary findings should be treated cautiously due to the lack of strong evidence. [ABSTRACT FROM AUTHOR]

Objectives: Patellar tendinopathy is prevalent in elite jumping athletes, with a particularly high risk in basketball players. Previous prospective research has demonstrated that ultrasound (US) findings, primarily the presence of hypoechoic regions within the tendon, are prevalent in both symptomatic and asymptomatic elite jumping athletes and thus do not necessarily indicate patellar tendon pathology. Other studies have suggested that hypoechoic regions within asymptomatic tendons are predictive of new onset symptomatic patellar tendinopathy. None of these previous studies evaluated the utility of patellar tendon thickness as a predictive measure. The purpose of this study is to build on the previous literature to identify whether preseason US is a clinically relevant preseason screening tool in elite basketball players. We hypothesized that increased preseason anteroposterior (AP) thickness of the proximal patellar tendon, as well as hypoechoic regions, are predictive of symptomatic patellar tendinopathy and associated sequelae. Methods: Thirty-one male National Collegiate Athletic Association (NCAA) Division I basketball players voluntarily participated in this prospective cohort study. Both patellar tendons of each athlete were evaluated at preseason, midseason, and postseason time points, resulting in a total of 52 patellar tendons from 27 athletes included in this analysis after exclusion of 4 tendons that were previously operated on and 6 tendons from 3 athletes who transferred to a new team during the season. Basic demographic data were collected for each athlete. At each time point, Victorian Institute of Sports Assessment - Patellar Tendon (VISA-P) scores, patellar tendon AP thickness, and presence of proximal patellar tendon hypoechoic regions were evaluated. Outcome measures included 1) proximal patellar tendon hypoechoic region, 2) trip to the training room (TTR), 3) time-loss symptomatic patellar tendinopathy (TLPT), and 4) patellar tendon rupture. TTR was defined as symptomatic patellar tendinopathy causing the athlete to seek evaluation by team medical staff. TLPT was a binary outcome that involved 1 or more missed game due to patellar tendinopathy symptoms. Measurement of patellar tendon AP thickness was performed using the Butterfly iQ portable US probe (Butterfly Network, Inc., Burlington, MA) and accompanying iPhone mobile application (Apple, Cupertino, CA) (Figure 1). Two distinct images were saved for each patellar tendon at each time point. Each of these images were independently evaluated by two reviewers, one of which was a fellowship- trained musculoskeletal radiologist. Intra- and interrater reliability was calculated. Covariates evaluated in multivariate regression model included age and body mass index (BMI). Significance was set to p<.05. Results: Of the total of 52 tendons (mean age 20.67 ± 1.22 years, mean BMI 24.1 ± 1.57), the mean preseason AP thickness was 4.78 ± 1.22 mm. Intra- and interrater reliability for AP thickness were both excellent (ICC=0.99, p<.01 and ICC=0.98, p<.01, respectively). Compared to preseason values, there was a significant increase in mean AP thickness at both midseason (p<.01) and postseason (p<.01) evaluation (Table 1, Figure 2). VISA-P scores decreased from preseason to midseason (p=.04), but increased from midseason to postseason (p=.03) (Table 1). A total of 9 patellar tendons resulted in a TTR (17.31%) (Table 2). Preseason AP thickness was associated with an increased odds of TTR (aOR=7.58 [2.09, 29.66], p<.01). Assuming mean age and BMI, an 8mm tendon at baseline predicted a 97.19% probability of a TTR during the season, while a 4mm tendon predicted a 0.90% probability. Of the 9 tendons that demonstrated preseason hypoechoic regions, 5 (55.56%) resulted in a TTR (aOR=12.60, p<.01). Preseason VISA-P scores (p=.36) were not predictive of TTR. There were 4 cases of TLPT (7.69%) (Table 2). There was a significant association between preseason AP thickness and increased odds of TLPT (aOR=1.61 [1.02, 2.54], p=.04). Assuming mean age and BMI, an 8mm tendon at baseline demonstrated a 24.83% probability of resulting in TLPT, while a 4mm tendon demonstrated a 4.26% probability. Preseason VISA-P scores (p=.39) were not predictive of TLPT. Conclusions: This is the first analysis evaluating patellar tendon thickness and patellar tendon sequelae in elite basketball players at more than two time points. This study demonstrated the ability for preseason US screening to identify symptomatic patellar tendinopathy and associated sequelae during the season. Additionally, there was a significant increase in mean AP thickness from preseason to midseason as well as from midseason to postseason. This is in contrast to VISA-P scores, which initially increased, but then decreased to preseason levels at postseason evaluation. Patellar tendon AP thickness may thus serve as a more stable and precise measure of patellar tendinopathy severity when compared to VISA-P scores. Further research with increased sample size may establish US as a clinically relevant screening tool in elite jumping athletes. [ABSTRACT FROM AUTHOR]

BackgroundJumper’s knee is a degenerative condition among athletes, and it has been treated with conventional physical therapy (CPT). Ultrasound guided dry needling (USG-DN) is a relatively new technique to explore clinical outcomes in patients with tendinopathy.MethodsThis parallel group, single-blinded randomized controlled trial was carried out involving 94 athletes with clinically diagnosed jumper’s knee, divided into an intervention group (USG-DN + CPT, n = 47) and a control group (CPT, n = 47). Participants received a 4-week programme; the intervention group received ultrasound guided patellar tendon dry needling (DN) in conjunction with CPT. The control group received only CPT. The visual analog scale (VAS), Victorian institute of sports assessment-Patellar tendinopathy (VISA-P) questionnaire, Lysholm scale, Knee injury and osteoarthritis outcome score (KOOS) and ultrasonographic features of patellar tendinopathy were evaluated at baseline,1 week, 2 weeks, and 4 weeks. The data were analyzed through SPSS-26.ResultsThe study found statistically significant differences (P

Purpose: Detrimental changes in tendon structure increase the risk of tendinopathies. The aim of this study was to investigate the influence of individual internal and external training loads and leg dominance on changes in the Achilles and patellar tendon structure. Methods: The internal structure of the Achilles and patellar tendons of both limbs of 26 elite Australian footballers was assessed using ultrasound tissue characterization at the beginning and the end of an 18-wk preseason. Linear-regression analysis was used to estimate the effects of training load on changes in the proportion of aligned and intact tendon bundles for each side. Standardization and magnitude-based inferences were used to interpret the findings. Results: Possibly to very likely small increases in the proportion of aligned and intact tendon bundles occurred in the dominant Achilles (initial value 81.1%; change, ±90% confidence limits 1.6%, ±1.0%), nondominant Achilles (80.8%; 0.9%, ±1.0%), dominant patellar (75.8%; 1.5%, ±1.5%), and nondominant patellar (76.8%; 2.7%, ±1.4%) tendons. Measures of training load had inconsistent effects on changes in tendon structure; eg, there were possibly to likely small positive effects on the structure of the nondominant Achilles tendon, likely small negative effects on the dominant Achilles tendon, and predominantly no clear effects on the patellar tendons. Conclusion: The small and inconsistent effects of training load are indicative of the role of recovery between tendon-overloading (training) sessions and the multivariate nature of the tendon response to load, with leg dominance a possible influencing factor. [ABSTRACT FROM AUTHOR]

Introduction. Patellar tendinopathy (PT), common in athletes, poses a challenging diagnosis. Thermal assessment by infrared thermography (IRT) and grey-level co-occurrence matrix (GLCM) analysis of infrared images could help in the identification and characterisation of this pathology. Objectives. To evaluate thermal and textural changes in athletes with unilateral PT versus asymptomatic athletes, and to analyse their correlation with symptomatology and functionality. Methods. In this cross-sectional study we worked with a group of athletes with unilateral PT (n=27) and a group of asymptomatic athletes (n=27). Infrared images of the patellar tendons of both groups were recorded and the symptomatology and functionality of the knees were quantified using the VISA-P questionnaire. Thermal symmetry between patellar tendons and GLCM of the infrared images was analysed and finally correlated with the results of the VISA-P questionnaire. Results. As expected, the thermal difference between knees in the PT group was larger than in the control group, with an effect size of 0.79. No correlation was observed between temperature and the VISA-P scale (rxy= -0.162, p= 0.242, R2= 0.03). In relation to GLCM, the PT group showed a higher textural correlation (effect size 0.85) and a lower homogeneity (effect size of 0.47) than the control group. A significant correlation was only observed for the textural correlation in inverse and weak correlation (rho= -0.276, p= 0.013, R2= 0.18). Conclusions. The analysis of thermal symmetry and GLCM on thermal images of patellar tendons could be used as an aid in the diagnosis and clinical follow-up of patients with TR, despite not having found a correlation with knee pain and functionality measured with VISA-P scale. [ABSTRACT FROM AUTHOR]

The combination of cross-linked hyaluronate (cHA) and corticosteroid showed more rapid pain or functional improvement in knee osteoarthritis and adhesive capsulitis. However, rare evidence of this combination in treating tendinopathy has been reported. We hypothesized that the specific formulations of cHA and dexamethasone (DEX) conferred amelioration of tendinopathy via anti-apoptosis and anti-senescence. In this controlled laboratory study, primary tenocytes from the human tendinopathic long head of biceps were treated with three cHA formulations (cHA:linealized HA = 80:20, 50:50, and 20:80) + DEX with or without IL-1β stimulation. Cell viability, inflammatory cytokines, tendon-related proliferation markers, matrix metalloproteinases (MMPs), senescent markers, and apoptosis were examined. The in vivo therapeutic effects of the selected cHA + DEX combinations were evaluated in a collagenase-induced rat patellar tendinopathy model. The expression levels of inflammatory mediators, including IL-1β, IL-6, COX-2, MMP-1, and MMP-3 were significantly reduced in all cHA + DEX-treated tenocytes (p < 0.05, all). The cHA (50:50) + DEX and cHA (20:80) + DEX combinations protected tenocytes from cytotoxicity, senescence, and apoptosis induced by DEX in either IL-1β stimulation or none. Furthermore, the two combinations significantly improved the rat experimental tendinopathy by reducing ultrasound feature scores and histological scores as well as the levels of apoptosis, senescence, and senescence-associated secretory phenotypes (p < 0.05, all). We identified two specific cHA formulations (cHA (50:50) and cHA (20:80)) + DEX that could ameliorate tendinopathy through anti-senescence and -apoptosis without cytotoxicity. This study provides a possible approach to treating tendinopathy using the combination of two well-known agents. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. Objective: The 2 primary aims of this study were to identify ultrasonographic tendon abnormalities in asymptomatic runners and to examine the likelihood of developing pain in runners with ultrasound abnormalities compared with those without abnormalities. Design: Longitudinal, prospective cohort study. Setting: 2019 Salt Lake City Marathon. Participants: Recreational half-marathon and full-marathon runners. Assessment of Risk Factors: The Achilles and patellar tendons of asymptomatic runners were examined with ultrasound imaging before a running event. Runners were monitored for self-reported outcomes of pain in the examined tendons at 1, 3, 6, and 12 months after the event. Main Outcome Measures: Development of pain based on the presence of asymptomatic tendon abnormalities. Results: One hundred thirty-eight runners (36.2 ± 12.0 years, 49.3% men, and 31.2% full-marathon runners) were included. Ultrasound abnormalities of the Achilles and patellar tendons were identified in 24.6% and 39.1% of the runners before the race, respectively. Ultrasound abnormalities were significantly associated with approximately a 3-fold increase [hazard ratio (HR) = 2.55, P = 0.004] in the hazard of developing pain in the Achilles tendon and patellar tendon (HR = 1.67, P = 0.042) over the year after the race. Positive and negative predictive values of developing pain over the year were 34.1% and 87.2%, respectively, for abnormal findings in the Achilles tendon, and 22.9% and 85.0%, respectively, for the patellar tendon. Conclusions: The presence of ultrasonographic abnormalities is associated with increased development of pain in the Achilles and patellar tendons within 1 year of a marathon or half marathon. [ABSTRACT FROM AUTHOR]

Targeting neovessels in chronic tendinopathies has emerged as a new therapeutic approach and several embolization agents have been reported. The aim of this study was to investigate the feasibility of embolization with different agents in a porcine model of patellar tendinopathy and evaluate their safety and efficacy. Eight 3-month-old male piglets underwent percutaneous injection of collagenase type I to induce patellar tendinopathies (n = 16 tendons). They were divided into four groups (2 piglets, 4 tendons/group): the control group, 50–100 µm microspheres group, 100–300 µm microspheres group, and the Imipenem/Cilastatin (IMP/CS) group. Angiography and embolization were performed for each patellar tendon on day 7 (D7). The neovessels were evaluated visually with an angiography on day 14. The pathological analysis assessed the efficacy (Bonar score, number of neovessels/mm2) and safety (off-target persistent cutaneous ischemic modifications and presence of off-target embolization agents). The technical success was 92%, with a failed embolization for one tendon due to an arterial dissection. Neoangiogenesis was significantly less important in the embolized groups compared to the control group angiographies (p = 0.04) but not with respect to histology (Bonar score p = 0.15, neovessels p = 0.07). Off-target cutaneous embolization was more frequently depicted in the histology of the 50–100 µm microspheres group (p = 0.02). Embolization of this animal model with induced patellar tendinopathy was technically feasible with different agents and allowed assessing the safety and efficacy of neovessel destruction. Particles smaller than 100 µm seemed to be associated with more complications. [ABSTRACT FROM AUTHOR]

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Purpose: Despite substantial animal evidence, cell therapy in humans remains in its infancy. The purpose of this study was to examine the potential therapeutic effects and safety of cell therapy in the treatment of tendon disorders. Methods: According to the PRISMA guideline, a systematic review was performed on clinical studies concerning cell therapy in tendon disorders. A comprehensive search including the 5 databases of MEDLINE, Embase, Scopus, Web of Science, and Cochrane Library until December 2021 was carried out and associated with hand searching. The quality of the eligible studies was assessed using the tools suggested by Cochrane recommendations. Qualitative synthesis was performed in 2 tables and discussed separately for rotator cuff, elbow, patella, Achilles, and gluteal tendons. Results: Through 6017 records, 22 studies were included in the qualitative synthesis, including 658 patients. All the studies administered autologous cells, except one that used allogenic adipose-derived mesenchymal stem cells (Allogenic AD-MSC). Almost all studies demonstrated the safety of cell injection in their follow-up period with no serious side effects or immunologic reactions, with only a few related minor adverse events in some cases. The included studies showed the effectiveness of cell injection in tendinopathies of different sites, rotator cuff, elbow, patella, Achilles, and gluteal tendons. Among the rotator cuff studies, 4 comparative studies claimed that cell therapy is a more efficient treatment with a lower retear rate and pain level compared to the control group. However, one study found no differences between the groups. No controlled study has been performed on elbow tendinopathies, but 5 case series demonstrated the effectiveness of cell injection in elbow tendon disorders. For Achilles tendinopathies, only one randomized controlled trial (RCT) found that both cell therapy and control groups showed significant pain reduction and functional improvement with no statistical differences at the 6 months follow-up, but the cell therapy group had improved faster at earlier follow-ups. Patellar tendinopathy was studied in 2 RCTs, one did not show a significant difference and the other showed superior improvement compared to controls. Conclusion: Cell therapy showed promising results and the available evidence suggests that it is safe at several sites of tendon disease. Based on available evidence, cell therapy should be suggested in specific conditions at each site. To approve cell therapy for tendon diseases, randomized clinical trials are required with a large sample size and long-term follow-ups. Level of evidence: IV [ABSTRACT FROM AUTHOR]

Background: Running overuse injuries (ROIs) occur within a complex, partly injury-specific interplay between training loads and extrinsic and intrinsic risk factors. Biomechanical risk factors (BRFs) are related to the individual running style. While BRFs have been reviewed regarding general ROI risk, no systematic review has addressed BRFs for specific ROIs using a standardized methodology. Objective: To identify and evaluate the evidence for the most relevant BRFs for ROIs determined during running and to suggest future research directions. Design: Systematic review considering prospective and retrospective studies. (PROSPERO_ID: 236,832). Data Sources: PubMed. Connected Papers. The search was performed in February 2021. Eligibility Criteria: English language. Studies on participants whose primary sport is running addressing the risk for the seven most common ROIs and at least one kinematic, kinetic (including pressure measurements), or electromyographic BRF. A BRF needed to be identified in at least one prospective or two independent retrospective studies. BRFs needed to be determined during running. Results: Sixty-six articles fulfilled our eligibility criteria. Levels of evidence for specific ROIs ranged from conflicting to moderate evidence. Running populations and methods applied varied considerably between studies. While some BRFs appeared for several ROIs, most BRFs were specific for a particular ROI. Most BRFs derived from lower-extremity joint kinematics and kinetics were located in the frontal and transverse planes of motion. Further, plantar pressure, vertical ground reaction force loading rate and free moment-related parameters were identified as kinetic BRFs. Conclusion: This study offers a comprehensive overview of BRFs for the most common ROIs, which might serve as a starting point to develop ROI-specific risk profiles of individual runners. We identified limited evidence for most ROI-specific risk factors, highlighting the need for performing further high-quality studies in the future. However, consensus on data collection standards (including the quantification of workload and stress tolerance variables and the reporting of injuries) is warranted. [ABSTRACT FROM AUTHOR]

Kabacinski, J, Murawa, M, Fryzowicz, A, Gorwa, J, and Dworak, LB. Lower extremities strength differences in female volleyball players with stage 1 patellar tendinopathy. J Strength Cond Res 36(8): 2230–2235, 2022—The main purpose of the study was to compare the muscle strength between the involved knee (IK) and uninvolved knee (UK) in 12 female volleyball players with stage 1 chronic patellar tendinopathy. Evaluation included the isometric maximal strength to body mass (MS/BM) of the lower extremities extensors for unilateral and bilateral conditions, concentric isokinetic peak torque to body mass (PT/BM) of the hamstrings and quadriceps at 60°·s−1 and 180°·s−1, IK to UK extensors maximal strength ratio (SR), IK to UK hamstrings (or quadriceps) peak torque ratio (TR), and hamstrings to quadriceps peak TR (H/Q). The results indicated a significantly lower unilateral and bilateral MS/BM of lower extremities extensors for IK than UK (p < 0.001). However, there were no significant differences in SR variable between the unilateral condition and bilateral condition (p = 0.448). Only at the 60°·s−1 velocity, significantly lower quadriceps PT/BM for IK compared with the UK (p < 0.001) and the control group (p < 0.001) were observed. Torque ratio related to the quadriceps group was significantly lower at 60°·s−1 than 180°·s−1 (p = 0.004). Furthermore, significantly higher H/Q for IK compared with UK (p < 0.001) and control group (p = 0.008) only at 60°·s−1 was found. These findings show a significant isometric strength asymmetry for both unilateral and bilateral conditions and a significant concentric strength asymmetry at the low velocity. This study suggests strengthening the weaker quadriceps group and balancing the strength between hamstrings and quadriceps within the knee with patellar tendinopathy. [ABSTRACT FROM AUTHOR]