Jumper's knee: postoperative assessment

Oliva

International Orthopaedics (SICOT)

et al. 2014

Purpose Open surgery for patellar tendinopathy allows patients with unilateral and bilateral tendinopathy to return to high levels of physical activity. Materials Two groups of 23 athletes each underwent open surgical exploration for management of patellar tendinopathy. One group suffered from unilateral patellar tendinopathy (unilateral group), and the other group had bilateral (bilateral group) patellar tendinopathy. Maximum voluntary isometric contraction and anthropometric measures were assessed pre-operatively and at an average follow-up of seven years. The Victorian Institute of Sport Assessment (VISA)-P scoring system was also administered; functional outcomes were classified from excellent to poor according to a modification of Kelly's criteria. Results At the final follow-up, in both groups, VISA-P scores were significantly improved compared with preoperative values, with no intergroup differences. Clinical results were excellent or good in 21 patients in the unilateral and 19 in the bilateral group. Twenty of 23 patients in the unilateral group and 17 of 23 in the bilateral group were still active in sports (p=0.2). In the unilateral group, at the last follow-up, thigh volume and strength were significantly improved compared with baseline, with significant difference between operated and nonoperated limbs. In the bilateral group, there were no significant differences in thigh volume and strength between the dominant and nondominant limbs both before and after the index procedure. Conclusions This procedure is not technically demanding and provides a high rate of good and excellent outcomes in the long term.

Section: Discussionmentioning

confidence: 99%

Surgery for unilateral and bilateral patellar tendinopathy: a seven year comparative study

Oliva

International Orthopaedics (SICOT)

et al. 2014

Knee Surg, Sports Traumatol, Arthrosc

“…Many authors have regarded these problems as overuse or repetitive strain injuries [3,5]. It has been postulated in numerous articles and chapters that repetitive tensile forces create microinjuries in the tendon [4,11,12]. Eventually a significant injury is thought to develop as the reparative capabilities of the tendon are exceeded by the repeated microtrauma.…”

mentioning

confidence: 99%

Strain patterns in the patellar tendon and the implications for patellar tendinopathy

Almekinders

Vellema

Weinhold

2001

This study investigated the strain pattern in human patellar tendon in an area of the tendon where changes commonly associated with patellar tendinitis are found. Eight fresh frozen human knees were instrumented with strain gauges on both the anterior and posterior side of the proximal patellar tendon. Both static and dynamic measurements were carried out in a range from 0 degrees to 60 degrees of flexion. We found uniform tensile strain in the tendon with the knee in full extension. However, as the knee was brought into flexion, the tensile strain increased on the anterior side but decreased on the posterior side in the central, proximal location of the tendon. The posterior side of the proximal patellar tendon is most commonly affected in patellar tendinopathy. This study indicates that this area of the tendon may not subjected to the highest tensile loads in the functional flexion range. It is possible that stress shielding is more important etiological factor in insertional tendinopathy as opposed to repetitive tensile loads.

“…23 Moreover, decortication at the distal pole of the patella has been previously described to maximize healing potential. 18,31,32 Marcheggiani Muccioli et al 32 evaluated open and arthroscopic techniques previously described for treatment of chronic patellar tendinopathy. No statistically significant differences were found regarding return to sports and surgical success rates between the arthroscopic and open procedures after review of 21 studies.…”

Section: Discussionmentioning

confidence: 99%

Open Patellar Tendon Tenotomy, Debridement, and Repair Technique Augmented With Platelet-Rich Plasma for Recalcitrant Patellar Tendinopathy

Kruckeberg

Chahla

Ferrari

et al. 2017

Arthroscopy Techniques

Patellar tendinopathy is a disabling condition that frequently affects the athletic population, especially athletes undergoing repetitive impact forces as a result of jumping and landing activities. Most cases are initially treated conservatively, but if symptoms persist, surgical treatment is warranted. Options for surgical treatment include both arthroscopic and open techniques. The purpose of this Technical Note is to detail our open patellar tendon tenotomy, debridement, and repair technique augmented with platelet-rich plasma.