Dr Suzi Edwards

PURPOSE: Patellar tendon abnormality (PTA) on diagnostic imaging is part of the diagnostic criteria for patellar tendinopathy. PTA and altered landing strategies are primary risk factors that increase the likelihood of asymptomatic athletes developing patellar tendinopathy. Therefore, the aim of this study was to examine the risk factors that are predictors of the presence and severity of a PTA in junior pre-elite athletes. METHODS: Ten junior pre-elite male basketball athletes with a PTA were matched with 10 athletes with normal patellar tendons. Participants had patellar tendon morphology, Victorian Institute of Sport Assessment (VISA) score, body composition, lower limb flexibility, and maximum vertical jump height measured before performing five successful stop-jump tasks. During each stop-jump task, both two-dimensional and three-dimensional kinematics and ground reaction forces were recorded. Multiple regression analyses were used to identify factors for estimating PTA presence and severity, and discriminate analysis was used to classify PTA presence. RESULTS: Sixty-eight percent of variance for presence of a PTA was accounted for by hip joint range of motion (ROM) and knee joint angle at initial foot-ground contact (IC) during stop-jump task and quadriceps flexibility, whereas hip joint ROM during stop-jump task and VISA score accounted for 62% of variance for PTA severity. Prediction of the presence of a PTA was achieved with 95% accuracy and 95% cross-validation. CONCLUSIONS: An easily implemented, reliable, and valid movement screening tool composed of three criteria enables coaches and/or clinicians to predict the presence and severity of a PTA in asymptomatic athletes. This enables identification of asymptomatic athletes at higher risk of developing patellar tendinopathy, which allows the development of effective preventative measures to aid in the reduction of patellar tendinopathy injury prevalence. Copyright © 2013 by the American College of Sports Medicine.

Purpose: Risk factors associated with a clinical presentation of patellar tendinopathy are patellar tendon ultrasonographic abnormality (PTA) and excessive loading. It remains unknown whether characteristics of an athlete's landing technique contribute to this excessive patellar tendon loading. This study investigated whether asymptomatic athletes with and without PTA had different landing strategies and hypothesized that asymptomatic athletes with a PTA would create higher patellar tendon loading and a different lower-limb landing strategy compared with athletes with normal patellar tendons. Methods: Seven athletes with no previous history or clinical signs of patellar tendon injury with a PTA were matched to athletes with normal patellar tendons (controls). Participants performed five successful trials of a stop-jump task, which involved a simultaneous two-foot horizontal and then vertical landing. During each trial, the participants' ground reaction forces and lower-limb electromyographic data were recorded, the three-dimensional kinematics measured, and the peak patellar tendon force calculated by dividing the net knee joint moment by the patellar tendon moment arm. Results: Significant between-group differences in landing technique were mostly observed during the horizontal landing phase. Participants with a PTA created similar patellar tendon loading to the controls, but with altered sequencing, by landing with significantly greater knee flexion and extending their hips while the controls flexed their hips as they landed, reflecting a different muscle recruitment order compared with the PTA group. Conclusions: The crucial part in the development of PTA and, in turn, patellar tendinopathy may not be the magnitude of the patellar tendon load but rather the loading patterns. This research provides clinicians with important landing assessment criteria against which to identify athletes at risk of developing patellar tendinopathy. Copyright © 2010 by the American College of Sports Medicine.

This study aimed to determine whether the landing phase of a drop landing (DL) differed with respect to a complete jumping and landing task, a spike jump (SJ), and whether fatigue altered the landing of these movements. Fourteen male volleyball players performed five DL and SJ in a counterbalanced order under two experimental conditions: non-fatigued and fatigued. Fatigue, induced by repetitive jumping sets, was confirmed by decrements in vertical jump height > 25% and increased blood lactate > 6 mmol/L. Each landing task was characterized by the resultant ground reaction forces (GRF), sagittal plane kinematics and muscle recruitment patterns of six lower extremity muscles. Two-way repeated analysis of variance results indicated a main effect of movement on many of the GRF, kinematic and electromyographic variables characterizing landing, indicating that the two tasks required substantially different lower limb biomechanics during landing. Although fatigue did not alter the GRF in either task, there were significant movement × fatigue condition interactions. The significant between-task differences in the biomechanical variables characterizing landing and the differential effects of fatigue on each landing task, question the validity of using a DL as an experimental task to investigate lower limb landing mechanics of whole jumping and landing movements. © 2009 John Wiley & Sons A/S.