Materiały źródłowe

• #1

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10280536/

  Patellar tendinopathy (PT) mainly affects athletes who use the tendon for repeated energy storage and release activities. It can have a striking impact on athletes careers, although data on its real prevalence and incidence are sparse. Research efforts should start from the results of reliable and updated epidemiological research to help better understand the impact of PT and underpin preventative measures. […] A total of 28 studies, with 28,171 participants, were selected and used for the qualitative and quantitative analysis. The general and athletes populations reported an overall PT prevalence of 0.1% and 18.3%, respectively. In athletes, the prevalence of PT was 11.2% in women and 17% in men (P = .070). The prevalence of PT in athletes 18 years was 10.1%, while it was 21.3% in athletes 18 years (P = .004). The prevalence of PT was 6.1% in soccer players, 20.8% in basketball players, and 24.8% in volleyball players. Heterogeneous PT diagnostic approaches were observed. Higher prevalence values were found when PT diagnoses were made using patient-reported outcomes versus clinical evaluations (P = .004).

• #2 Epidemiology of Patellar Tendinopathy in Athletes and the General Population: A Systematic Review and Meta-analysis – PubMed

  https://pubmed.ncbi.nlm.nih.gov/37347023/

  Patellar tendinopathy (PT) mainly affects athletes who use the tendon for repeated energy storage and release activities. It can have a striking impact on athletes’ careers, although data on its real prevalence and incidence are sparse. […] The general and athletes’ populations reported an overall PT prevalence of 0.1% and 18.3%, respectively. In athletes, the prevalence of PT was 11.2% in women and 17% in men (P = .070). The prevalence of PT in athletes 18 years was 10.1%, while it was 21.3% in athletes 18 years (P = .004). The prevalence of PT was 6.1% in soccer players, 20.8% in basketball players, and 24.8% in volleyball players. […] This review demonstrated that PT is a common problem in the male and female sport-active populations. There are twice as many athletes aged 18 years than there are 18 years. Volleyball and basketball players are most affected by PT.

• #3

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10280536/

  This review demonstrated that PT is a common problem in the male and female sport-active populations. There are twice as many athletes aged 18 years than there are 18 years. Volleyball and basketball players are most affected by PT. […] The PT prevalence was 0.1% (95% CI, 0.1-0.2 [2 studies1,67]) and the incidence was 0.1% (95% CI, 0.0-0.2 [2 studies1,67]) in the general population. The athletes had a higher PT prevalence and incidence (P .0005). […] The most important finding of this review was the quantification of an overall PT prevalence of 18.3% in the sport-active population, with volleyball and basketball players being the most affected by PT. Also, PT epidemiology varied by age, with a prevalence of 10.1% in younger athletes and doubling to 21.3% in older athletes. A different scenario was found in the general population, with a PT prevalence and incidence of only 0.1%.

• #4 Epidemiology – patellartendinopathy

  https://patellartendinopathy.trekeducation.org/epidemiology/

  Patellar tendinopathy is a common cause of knee pain in the general and sport population that leads to decreases in physical performance and detrimental impacts to sports careers. […] In the general population, the prevalence of patellar tendinopathy ranges from 1.1 to 1.6 per 1,000 person-year. The incidence ranges from 0.5 to 1.6 per 1,000 person-year. […] There is no important difference in the prevalence of patellar tendinopathy between men and women. […] Unlike the findings in the general population, patellar tendinopathy seems to affect men athletes at a larger extent than women athletes. Among recreational athletes, the prevalence in men and women is 10% and 6%, respectively. Similarly, in elite sport, the prevalence of patellar tendinopathy is 14% and 6% in men and women, respectively.

• #5

  https://www.orthobullets.com/knee-and-sports/3015/patellar-tendinitis

  Patellar tendinitis is tendinopathy of the patellar tendon associated with activity-related anterior knee pain. […] Incidence: up to 20% of jumping athletes. […] Risk factors: volleyball most common, more common in adolescents/young adults, poor quadriceps and hamstring flexibility.

• #6 Patellar tendinitis – Wikipedia

  https://en.wikipedia.org/wiki/Patellar_tendinitis

  It is relatively common with about 14% of athletes currently affected.[1] […] Males are more commonly affected than females.[2]

• #7 Patellar Tendinopathy

  https://mobile.fpnotebook.com/Ortho/Knee/PtlrTndnpthy.htm

  Males affected more often (6:1 ratio) […] Ages 25 to 40 most often affected […] Tendonitis without rupture occurs in teen boys […] Associated with jumping sport during growth spurt.

• #8 Tendonitis: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/809692-overview

  Middle-aged adults are most susceptible to the development of tendinopathy. […] The proximal patellar tendon is most commonly affected in jumper’s knee. […] Patellar tendinitis: MR imaging features, with suggested pathogenesis and proposed classification.

• #9

  https://link.springer.com/article/10.2165/00007256-198603040-00005

  Jumpers knee is a typical functional overload injury because it affects those athletes who submit their knee extensor mechanisms to intense and repeated stress, e.g. volleyball and basketball players, high and long jumpers. According to the classification of Perugia and colleagues, it is an insertional tendinopathy affecting, in order of frequency, the insertion of the patellar tendon into the patella (65% of cases), attachment of the quadriceps tendon to the patella (25%) and the attachment of the patellar tendon to the tibial tuberosity (10%). The frequent occurrence of this injury in athletes led to the study of factors that may contribute to its onset and aggravation. These factors are divided into extrinsic (i.e. kind of sport practised and training methods used) and intrinsic (i.e. connected with the somatic and morphological characteristics of the athletes).

• #10 Epidemiology – patellartendinopathy

  https://patellartendinopathy.trekeducation.org/epidemiology/

  The prevalence of patellar tendinopathy varies among different sports and different levels of training. The prevalence of this condition is greater in sports with high-impact loads on the knee extensor mechanism, such as volleyball, basketball and athletics. Sports with a low-impact load, such as cycling, have lower prevalence than high-impact sports. […] In recreational athletes, the sport with the highest prevalence of patellar tendinopathy is volleyball (14%), followed by handball (13%) and basketball (12%). In elite athletes, there is a significant increase in the prevalence of patellar tendinopathy to 45% in volleyball, 15% in handball and 32% in basketball athletes. In soccer, the prevalence also follows a similar trend increasing from 2.5% in recreational athletes to 5 to 13% in elite athletes. Patellar tendinopathy has also a high prevalence (13%) in rugby players.

• #11 Patellar Tendonitis – WikiSM (Sports Medicine Wiki)

  https://wikism.org/Patellar_Tendonitis

  Prevalence 7% of 14-18 year old junior Australian basketball players had clinical signs of patellar tendinopathy. The prevalence of patellar tendon pain was 5.8% among 760 athletes across 16 different sports. Among Elite volleyball players, Ferretti found the incidence to be 22.8%. Taunton found 4.8% of runners had patellar tendon pain. Among Norwegian athletes, the overall prevalence was 14.2%, highest in volleyball (44.6%) and basketball (31.9%). Among non-elite athletes, the overall prevalence was 8.5% with the highest in volleyball (14.4%) (need citation).

• #12

  https://link.springer.com/article/10.2165/00007256-198603040-00005

  On the basis of our experience and after a review of the literature it appears, contrary to what has been repeatedly claimed in the past, the extrinsic factors are more important than the intrinsic in the aetiology of jumpers knee. […] The intrinsic causes of jumpers knee, can be sought in the mechanical properties of tendons (resistance, elasticity and extensibility) rather than in morphological or biomechanical abnormalities of the knee extensor mechanism. […] Ferretti A, Puddu G, Mariani PP, Neri M. Jumpers knee: an epidemiological study of volleyball players. Physician and Sportsmedicine 12: 97106, 1984. […] Ferretti A, Puddu G, Mariani PP, Neri M. The natural history of jumpers knee. International Orthopaedics (SICOT) 8: 239242, 1985.

• #13 Patellar tendinitis – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/patellar-tendinitis/symptoms-causes/syc-20376113

  Patellar tendinitis, also known as jumper’s knee, is most common in athletes whose sports involve frequent jumping such as basketball and volleyball. However, even people who don’t participate in jumping sports can get patellar tendinitis. […] Patellar tendinitis is a common overuse injury, caused by repeated stress on your patellar tendon. The stress results in tiny tears in the tendon, which your body attempts to repair. […] A combination of factors may contribute to the development of patellar tendinitis, including: Physical activity. Running and jumping are most commonly associated with patellar tendinitis. Sudden increases in how hard or how often you engage in the activity also add stress to the tendon, as can changing your running shoes. […] If you try to work through your pain, ignoring your body’s warning signs, you could cause increasingly larger tears in the patellar tendon. Knee pain and reduced function can persist if you don’t tend to the problem, and you may progress to the more serious patellar tendinopathy.

• #14 Patelllar Tendonitis – Symptoms and Diagnosis

  https://martinkoban.com/patellar-tendonitis/

  Patellar tendonitis is most common in jumping sports such as volleyball or basketball. However, it can occur in non-athletes as well. […] Risk factors for patellar tendonitis include: High training volume (e.g., 8.94-times normal risk for more than 20 hours of weekly training time) […] Participation in jumping sports, especially volleyball or basketball. […] Epidemiology of patellar tendinopathy in elite male soccer players. […] Patellar Tendinopathy and Potential Risk Factors: An International Database of Cases and Controls. […] Epidemiology of jumper’s knee. […] Risk factors for developing jumper’s knee in sport and occupation: a review.

• #15 Jumper’s Knee

  https://www.webmd.com/fitness-exercise/jumpers_knee

  Jumpers knee affects around 18% of athletes. It affects male athletes slightly more than female athletes. […] Jumpers knee is one of the more common tendinopathies affecting athletes with mature skeletons. […] Jumpers knee happens due to repeated stress on the patellar or quadriceps tendon during jumping activities. […] This injury mostly affects athletes in sports that involve jumping, such as basketball, volleyball, and high or long jumping. […] Problems related to jumpers knee include weak quadriceps and hamstrings. […] Youre more likely to get jumpers knee if you: Were assigned male at birth, Have a higher body weight, Are bowlegged or knock-kneed, Have a wider knee angle, Have kneecaps that are higher (called patella alta) or lower (called patella baja) than usual, Have one leg thats longer than the other, Overtrain or play on hard surfaces.

• #16 Patellar Tendonitis (Jumper’s Knee) : Wheeless’ Textbook of Orthopaedics

  https://www.wheelessonline.com/joints/patellar-tendonitis-jumpers-knee/

  – Epidemiology of Jumper’s Knee […] […] – Jumper’s knee. […] […] – Patellar tendinitis (jumper’s knee). […] […] – seen in athletes involved in running, jumping, and kicking sports; – occurs usually in skeletally mature adults, Age range 16 to 40 years, males slightly females – excessive foot pronation and running hills can exacerbate these symptoms; […] […] – Epidemiology of Jumper’s Knee – Knee joint dynamics predict patellar tendinitis in elite volleyball players. […] […] – Intrinsic risk factors for the development of anterior knee pain in an athletic population. A two-year prospective study. […] […] – Long-term prognosis for jumper’s knee in male athletes. A prospective follow-up study. […] […] – Epidemiology of Jumper’s Knee.

• #17 Insertional tendinopathies – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/insertional-tendinopathies/

  Patellar tendonitis is an overuse injury of the patellar tendon at the distal portion of the patella. […] Epidemiology typically affects athletes. […] Risk factors include high BMI, limb-length discrepancy, and pes planus. […] Symptoms worsen with knee flexion and prolonged activity. […] For refractory or recurrent pain: Obtain imaging. […] Initial test: x-ray (AP, lateral, tangential patella view) to exclude differential diagnoses. […] Advanced imaging: ultrasound or MRI without contrast. […] Differential diagnoses of patellar tendonitis include Osgood-Schlatter disease, Sinding-Larsen-Johansson syndrome, patellofemoral pain syndrome, and meniscus tears. […] Initial management: physical therapy with strength training on a board or block at a declined angle.

• #18 The Best Current Research on Patellar Tendinopathy: A Review of Published Meta-Analyses

  https://www.mdpi.com/2075-4663/12/2/46

  Patellar tendinopathy has gained relevance in recent years, especially in the sports field, constituting the second most frequent knee injury after medial collateral ligament injuries in athletes. A prevalence of over 20% has been reported in collegiate basketball players, and 12% showed signs of patellar tendinopathy upon ultrasonography. The incidence varies according to factors such as age, diagnostic methods, competitive level, and body morphotype, but there has been an increase in diagnosis due to the greater use of imaging techniques such as ultrasound and magnetic resonance imaging. The use of these modalities has allowed for the identification of individuals at high risk of developing this condition, enabling the early detection of structural abnormalities to initiate unloading and treatment before the onset of symptoms, aiming to prevent progression to chronic conditions.

• #19 Management of Achilles and patellar tendinopathy: what we know, what we can do | Journal of Foot and Ankle Research | Full Text

  https://jfootankleres.biomedcentral.com/articles/10.1186/s13047-020-00418-8

  Patellar tendinopathy (PT) typically presents with anterior knee pain at to the inferior pole of the patella. The term Jumpers knee was introduced in 1973 by Blazina et al. to describe the condition, as it occurs more commonly in athletes who participate in jumping sports such as basketball and volleyball. Cook et al. found that more than one-third of athletes presenting for treatment for PT were unable to return to sport within 6 months. […] Several theories about its pathogenesis, including vascular, mechanical, impingement-related causes, have been hypothesised, but the most commonly proposed is chronic repetitive tendon overload. The increased strain is located in the deep posterior portion of the tendon, especially with increased knee flexion, between the inferior pole of the patella and the rotation centre of the knee. Microscopic failure occurs at high loads within the tendon and leads alterations at the cellular level, with fibril degeneration which decrease the mechanical properties of the tendon. Studies in vitro and in vivo have shown neovascularisation and increased quantity of proteins and enzymes which can contribute to tendon degeneration. Other studies showed that vascular endothelial growth factor (VEGF) and matrix metalloproteinase (MMP) activity have also been linked to tendon breakdown. A second hypothesised aetiology is the impingement of the inferior patellar pole showed on MRIs during flexion of the knee. The hallmark clinical features of PT consist in pain localised to the inferior pole of the patella and load related pain that increases with the extension of the knee, notably in activities that store and release energy in the patellar tendon. Tendon pain occurs with loading and usually decreases almost immediately when the load is removed. In patients with symptomatic PT, the Royal London Hospital test showed lower sensitivity and higher specificity than manual palpation. Both tests should be performed to formulate a clinical diagnosis of PT. Imaging assessment should be performed as a confirmatory test. PT imaging does not confirm the pain; indeed, intratendinous abnormalities may be observed using US in asymptomatic individuals. Serial imaging is not recommended because, often, symptoms improve without changes in US or MRI. There is no consensus regarding the best management. Avoidance of jumping activities with stretching after physical activity may help in the early phases.

• #20 Tendinopathy – Wikipedia

  https://en.wikipedia.org/wiki/Tendinopathy

  Tendon injury and resulting tendinopathy are responsible for up to 30% of consultations to sports doctors and other musculoskeletal health providers. Tendinopathy is most often seen in tendons of athletes either before or after an injury but is becoming more common in non-athletes and sedentary populations. […] For example, the majority of patients with Achilles tendinopathy in a general population-based study did not associate their condition with a sporting activity. […] In another study the population incidence of Achilles tendinopathy increased sixfold from 1979-1986 to 1987-1994. […] The incidence of rotator cuff tendinopathy ranges from 0.3% to 5.5% and annual prevalence from 0.5% to 7.4%.

• #21 The Best Current Research on Patellar Tendinopathy: A Review of Published Meta-Analyses

  https://www.mdpi.com/2075-4663/12/2/46

  Some biomechanical risk factors that have been investigated include hip range of motion and knee angle during landing, as well as quadricep flexibility. However, despite this knowledge, prevention programs have not proven to be effective in reducing the risk and may even increase the likelihood of injury in individuals with preexisting tendon changes. As a result, 10% of patients ultimately require surgery due to the failure of conservative treatments. It is clear that more research is needed on preventive and therapeutic strategies for this prevalent condition. […] There is controversy regarding the comparison of conservative treatments versus surgical interventions for patellar tendinopathy. Eccentric exercise has shown similar improvements to surgery in parameters such as The Victorian Institute of Sport Assessment Scale for Patellar Tendinopathy (VISA-P), strength, and pain, with no significant differences in satisfaction, return to sports, or overall assessment in the medium term. However, surgical evidence may be biased by the way results are reported. Among infiltrative therapies, corticosteroids provide short-term relief, while eccentric exercise is superior in the long term. Other options, such as polidocanol, aprotinin, and arthroscopic ablation, have shown promising preliminary results. Platelet-rich plasma (PRP) has been proposed as a second-line alternative for refractory tendinopathies, although its use needs to be optimized based on PRP biology and application modalities. Recent evidence suggests that PRP has a greater benefit compared to extracorporeal shockwave therapy, but more randomized trials are needed before recommending it as the standard over non-PRP injections. Despite advancements such as shockwave therapy or cryotherapy, surgery is still necessary in advanced cases refractory to previous conservative treatments. Open approaches such as debridement are technically straightforward and effective in the long term. Arthroscopic techniques are gaining relevance due to their advantages.

• #22 Management of Achilles and patellar tendinopathy: what we know, what we can do | Journal of Foot and Ankle Research | Full Text

  https://jfootankleres.biomedcentral.com/articles/10.1186/s13047-020-00418-8

  Approximately 10% of patients are refractory to conservative treatment, and in these patients surgical treatment is indicated. There is no consensus on the ideal surgical technique, including whether open techniques are preferable to arthroscopic methods. The use of arthroscopy is another possibility, and some surgeons have reported their experience with debridement of the patellar tendon alone, while others have described treating both the tendon and bone. Arthroscopic management may be used to debride the adipose tissue of the Hoffas body on the posterior aspect of the patellar tendon, to remove the area of neovascularity, to debride the abnormal portion of the patellar tendon, and excise the lower pole of the patella. The surgical approach starts with examination of the knee to exclude coexistent lesions: hypertrophy of the Hoffa fat pad and mucous ligament can often be present, and moderate to severe synovial hypertrophy can be present around the lower pole of the patella. The removal of these tissues also allows visualisation of the articular side of the tendon, its insertion to the patella, and the lower pole of the patella. The amount of abnormal patellar tendon is estimated using preoperative MRI and US and used as a guide before surgical debridement. Debridement of the abnormal tendon tissue is carried using an arthroscopic shaver, until abnormal tendon is visualised. Plain radiographs and MRI are used to guide the amount of patella excised, particularly where an inferior spur is present. The inferior pole of the patella is carefully prepared using the radiofrequency probe, and excision of the lower pole of the patella is then performed. Arthroscopic surgery for patients with PT, refractory to nonoperative management, appears to provide significant improvements in symptoms and function, with improvements of the International Knee Documentation Committee (IKDC), Lysholm knee score, and Victorian Institute of Sport Assessment (VISA) -P scores maintained for 3 years follow-up. Recent studies show that partial resection of the distal pole of the patella achieved 90% good to excellent results, while arthroscopic removal of hypertrophic synovium and fat pad without resection of patellar tendon showed a 76.7% return to play rate and 90% good or excellent outcomes. Unfortunately, lack of prospective randomised controlled trials limit the significance of the related studies.

• #23 Jumper’s Knee

  https://www.webmd.com/fitness-exercise/jumpers_knee

  Tissue samples in people with jumpers knee usually dont show signs of inflammation, which is more typical in cases of true tendonitis. Experts believe the condition is more like tendinosis, which involves tendon damage without inflammation. […] Surgery is indicated for stage IV and refractory stage III tendinopathy as noted above.

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