Biomechanics of the knee extensor mechanism and its relationship to patella tendinopathy: A review

Dan, Michael J.; Parr, William C.; Broe, David; Cross, Mervyn J.

doi:10.1002/jor.24120

Cited by 44 publications

(33 citation statements)

References 55 publications

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“…12,21,35,37 The pathology underlying this condition is characterized by microinjury to tendon fibers, local mucoid degeneration, necrosis, and loss of transitional fibrocartilaginous tissue that attaches tendon to bone, often without inflammation. 9,10 The incidence of patellar tendinopathy is increasing throughout a wide age range in the athletic population and has been reported to be as high as 55% in elite men’s basketball players. 28,31,41 Professional and recreational athletes with patellar tendinopathy continue to play with mild and moderate pain and aggravate their condition or cause partial patellar tendon tears (PPTTs).…”

mentioning

confidence: 99%

Rethinking Patellar Tendinopathy and Partial Patellar Tendon Tears: A Novel Classification System

et al. 2020

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Background: Patellar tendinopathy is an overuse injury of the patellar tendon frequently affecting athletes involved in jumping sports. The tendinopathy may progress to partial patellar tendon tears (PPTTs). Current classifications of patellar tendinopathy are based on symptoms and do not provide satisfactory evidence-based treatment guidelines. Purpose: To define the relationship between PPTT characteristics and treatment guidelines, as well as to develop a magnetic resonance imaging (MRI)–based classification system for partial patellar tendon injuries. Study Design: Cohort study (prognosis); Level of evidence, 2. Methods: MRI characteristics and clinical treatment outcomes were retrospectively reviewed for 85 patients with patellar tendinopathy, as well as 86 physically active control participants who underwent MRI of the knee for other conditions. A total of 56 patients had a PPTT and underwent further evaluation for tear size and location. The relationship between tear characteristics and clinical outcome was defined with use of statistical comparisons and univariate and logistic regression models. Results: Of the 85 patients, 56 had partial-thickness patellar tendon tears. Of these tears, 91% involved the posterior and posteromedial regions of the proximal tendon. On axial MRI views, patients with a partial tear had a mean tendon thickness of 10 mm, as compared with 6.2 mm for those without ( P < .001). Eleven patients underwent surgery for their partial-thickness tear. All of these patients had a tear >50% of tendon thickness (median thickness of tear, 10.3 mm) on axial views. Logistic regression showed that tendon thickness >8.8 mm correlated with the presence of a partial tear, while tendon thickness >11.45 mm and tear thickness >55.7% predicted surgical management. Conclusion: Partial-thickness tears are located posterior or posteromedially in the proximal patellar tendon. The most sensitive predictor for detecting the presence of a partial tear was patellar tendon thickness, in which thickness >8.8 mm was strongly correlated with a tear of the tendon. Tracking thickness changes on axial MRI may predict the effectiveness of nonoperative therapy: athletes with patellar tendon thickness >11.5 mm and/or >50% tear thickness on axial MRI were less likely to improve with nonoperative treatment. A novel proposed classification system for partial tears, the Popkin-Golman classification, can be used to guide treatment decisions for these patients.

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confidence: 99%

Rethinking Patellar Tendinopathy and Partial Patellar Tendon Tears: A Novel Classification System

et al. 2020

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“…Some say it would be better termed the, "patellar ligament," given its bony attachments. However, histologically its makeup is more consistent with tendinous origin [49] . Additionally, it functions as a tendon, connecting the quadriceps musculature to the tibia through the patella.…”

Section: Anatomy/biomechanicsmentioning

confidence: 86%

Knee Extensor Mechanism Disruptions: A Review

Myers¹,

Glazier²,

Taylor³

2020

International Journal of Orthopaedics

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“…While our patient had characteristic patella alta as defined by the Insall-Salvati13 ratio but not the Caton-Deschamps,14 we believe these measurements are largely incorrect as a measure to investigate patella tendinopathy. Patella length is an indirect determinant of patella tendon force and resultant strain 4. As such current patella height measurements, which are known to show diagnostic disagreement between measurements,15 do not truly reflect patella tendon kinetics.…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, a renewed interest in the literature has emerged, exploring the causation of patella tendinopathy and its relationship to extensor mechanism biomechanics 4 5. This case study reports a case of severe patella tendinopathy that was treated successfully with a distalising tibial tubercle osteotomy.…”

Section: Introductionmentioning

confidence: 99%

Treatment of patella tendinopathy by distalising tibial tubercle osteotomy

Dan¹,

Walsh

Cross³

et al. 2019

BMJ Case Rep

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Biomechanics of the knee extensor mechanism and its relationship to patella tendinopathy: A review

Abstract: The aim of this review is to direct future research into biomechanical risk factors for developing patella tendinopathy and subsequently, possible treatments. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.

Cited by 44 publications

References 55 publications

Rethinking Patellar Tendinopathy and Partial Patellar Tendon Tears: A Novel Classification System

Rethinking Patellar Tendinopathy and Partial Patellar Tendon Tears: A Novel Classification System

Knee Extensor Mechanism Disruptions: A Review

Treatment of patella tendinopathy by distalising tibial tubercle osteotomy

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