Patellar tendinopathy in master track and field athletes: influence of impact profile, weight, height, age and gender.

PURPOSE: Patellar tendinopathy causes significant morbidity in professional and recreational athletes. Despite the relevance of the problem, its causative factors remain poorly understood. The purpose of this cross-sectional study is to evaluate the influence of age, gender, weight, height and impact profile on developing patellar tendinopathy in master track and field athletes. METHODS: During the European Veterans Athletics Championships in Poznan in July 2006, 174 athletes (103 men and 71 women; mean age: 53.8 (SD 11.4) years, range 35-82 years) were evaluated with the VISA-P questionnaire. A fully trained orthopaedic surgeon made a diagnosis of patellar tendinopathy according to clinical criteria. RESULTS: There was no effect of gender upon the presence of patellar tendinopathy (n.s.). No significant track and field specialty effect upon the frequency of patellar tendinopathy was found on the VISA-P questionnaire scores. There was no effect of track and field specialty on the VISA-P score. No evidence of a statistically significant association was found between age and VISA-P score (n.s.). There was no statistically significant difference in either prevalence of patellar tendinopathy or VISA-P score between high-impact and low-impact athletes (n.s.). CONCLUSION: In master track and field athletes, impact profile, weight, height, age and gender did not exert any influence on developing patellar tendinopathy.

No influence of age, gender, weight, height, and impact profile in achilles tendinopathy in masters track and field athletes.

BACKGROUND: Achilles tendinopathy is commonly reported by athletes involved in activities that include running and jumping. Despite the prevalence of the problem, causative factors in Achilles tendinopathy remain poorly understood. HYPOTHESIS: In Masters track and field athletes, there is no influence of age, gender, weight, height, and impact profile in developing Achilles tendinopathy. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: During the European Veterans Athletics Championships in Poznan, Poland, in July 2006, 178 athletes (110 men and 68 women; mean age, 54.1 years; range, 35-94 years) were evaluated with the Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire. A fully trained orthopaedic surgeon made a diagnosis of Achilles tendinopathy according to clinical criteria. RESULTS: There was no effect of gender on the presence of Achilles tendinopathy (P = .14). No significant track and field specialty effect upon the frequency of Achilles tendinopathy was found on the VISA-A questionnaire scores (P = .32). Equally, there was no effect of track and field specialty on the VISA-A score (P = .31). No correlation was found between age and VISA-A score (P = .36). There was no statistically significant difference in either prevalence of Achilles tendinopathy or VISA-A score between high-impact and low-impact athletes (P = .19 and P = .31, respectively). CONCLUSION: In competing Masters track and field athletes, we did not find any influence of age, gender, weight, height, or impact profile on the development of Achilles tendinopathy. Additional research is required to improve our understanding of the causative factors in Achilles tendinopathy.

Minimally invasive dynamic hip screw for fixation of hip fractures.

We compared a minimally invasive surgical technique to the conventional (open approach) surgical technique used in fixation of hip fractures with the dynamic hip screw (DHS) device. Using a case-control design (44 cases and 44 controls), we tested the null hypothesis that there is no difference between the two techniques in the following outcome measures: duration of surgery, time to mobilisation and weight bearing postoperatively, length of hospital stay, mean difference of pre- and postoperative haemoglobin levels, position of the lag screw of the DHS device in the femoral head, and the tip-apex distance. The minimally invasive DHS technique had significantly shorter duration of surgery and length of hospital stay. There was also less blood loss in the minimally invasive DHS technique. The minimally invasive DHS technique produces better outcome measures in the operating time, length of hospital stay, and blood loss compared to the conventional approach while maintaining equal fixation stability.

Achilles tendon Doppler flow may be associated with mechanical loading among active athletes.

BACKGROUND: Tendon Doppler flow may be associated with tendon pain in symptomatic patients, but the relationship between Doppler flow and pain among athletes who are still competing is unclear. HYPOTHESIS: Among active athletes, Doppler flow may partly reflect tendon adaptation to increased mechanical load and/or asymptomatic tendinopathy. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: The Achilles tendons of 61 badminton players (24 elite, 37 recreational) were examined with gray-scale and color Doppler ultrasound. Achilles tendon pain and activity level (badminton training, badminton playing, badminton years) were measured. RESULTS: Doppler flow was not associated with current Achilles tendon pain but was associated with an increased anteroposterior tendon diameter (an indicator of tendinopathy) (P = .02). Athletes who had been playing badminton for longer were more likely to have Doppler flow (P < .01), and there was a trend toward an association between a greater number of badminton playing hours per week and Doppler flow (P = .07). CONCLUSION: Achilles tendon Doppler flow appears to be a sign of asymptomatic tendinopathy rather than pain among active athletes. The association between weekly badminton hours and badminton years and Doppler flow suggests that Doppler flow may be a response to mechanical load in this cohort.

Eccentric training programmes in the management of lateral elbow tendinopathy.

BACKGROUND: Eccentric training has shown promising results in the management of Achilles and patellar tendinopathy. Recently, studies have investigated eccentric training in the treatment of lateral elbow tendinopathy. PURPOSE: The purpose of this review was to describe eccentric training programs used to treat LET in order to inform clinicians and identify areas requiring further study. METHOD: An electronic search of publications indexed in the MEDLINE database was performed in May 2007. Studies comparing eccentric training with at least one other intervention were included. Results. Four studies investigating a total of 248 participants were identified. Three of the four studies reported superior results for eccentric training compared with other interventions, although this included one pilot study and another study that did not include an extended follow-up. There were several differences between the studies, including whether eccentric training was painful or pain-free, the duration of eccentric training (4 - 12 weeks) and whether training was performed in a clinical setting or at home. CONCLUSION: Eccentric training in the management of LET has demonstrated encouraging results, although the literature is limited and eccentric programs are varied. Future studies should investigate factors that may influence the outcome of eccentric training, including whether training is painful and the duration of eccentric training.

Traumatic patellar tendinopathy.

PURPOSE: In patellar tendinopathy, there is anterior knee pain with tenderness of the attachment of the patellar tendon over the lower pole of the patella. The condition is commonly associated with athletic overuse, but we have encountered it in some patients following direct blunt trauma to the anterior aspect of the knee. We describe the history and management of patients with traumatic patellar tendinopathy. METHOD: Between April 2000 and August 2006, we managed eight otherwise healthy well trained athletes who developed signs and symptoms compatible with classical patellar tendinopathy after a direct trauma to the anterior aspect of the patellar tendon during sport activity. RESULTS: The clinical diagnosis of patellar tendinopathy was confirmed clinically and at imaging by MRI and ultrasound scans. Patients responded to conservative or surgical management, in the same way as patellar tendinopathy secondary to overuse. CONCLUSION: A single direct traumatic event can lead to chronic tendon problems. Hence, in addition to overuse injury, patellar tendinopathy can follow a direct trauma and exhibit the same clinical features. Further research is required to better understand the pathophysiology of the clinical condition.

Surgical management of tendinopathy of biceps femoris tendon in athletes.

PURPOSE: To report on the clinical features and results of surgical management of 11 athletes who were operated on for tendinopathy of the tendon of the biceps femoris. METHODS: Eleven male athletes (average age 24.4, range 18 - 27 years) underwent surgery for tendinopathy of biceps femoris tendon. At surgery, if the tendon appeared grossly intact, with only minimal signs of adherences to the surrounding tissues, an extensive tenolysis and multiple longitudinal tenotomies were performed. If areas of tendinopathy were identified, they were excised and sent for histology. The tendon of the biceps femoris was sutured along the longitudinal tenotomy with Vicryl. If the tendon of biceps femoris was torn, the proximal end of the tendon received a Krackow stitch with Vicryl, and two suture anchors were inserted in the fibular head. The tendon of the biceps femoris was thus reconstructed. Functional ability was scored with the Cincinnati Knee Rating System. RESULTS: The Cincinnati rating system showed a statistically significant improvement from a preoperative average rating of 35 (range 23 to 54) to an average of 74 (range 62 to 80) postoperatively (p < 0.05). CONCLUSIONS: Surgery should be considered when well-supervised nonoperative management of biceps femoris tendinopathy fails. Stripping of the paratenon, removal of degenerated tissue, and multiple longitudinal tenotomies of the biceps femoris tendon should be performed. If the tendon is torn, it should be repair under appropriate tension, and, if necessary, reinserted on the head of the fibula.