Low-intensity pulsed ultrasound for chronic patellar tendinopathy: a randomized, double-blind, placebo-controlled trial.

OBJECTIVE: Patellar tendinopathy (PT) is a common and significant clinical condition for which there are few established interventions. One intervention that is currently being used clinically to manage PT symptoms is the introduction of low-intensity pulsed ultrasound (LIPUS). The aim of this study was to investigate the clinical efficacy of LIPUS in the management of PT symptoms. METHODS: A randomized, double-blind, placebo-controlled study was conducted. Volunteers with clinically and radiologically confirmed PT were randomly allocated to either an active-LIPUS (treatment) or inactive-LIPUS (placebo) group. LIPUS was self-administered by participants for 20 min/day, 7 days/week for 12 weeks. All participants also completed a daily, standardized eccentric exercise programme based on best practice. Primary outcomes were change in pain during the participant's most aggravating activity in the preceding week, measured on 10 cm visual analogue scales for both usual (VAS-U) and worst (VAS-W) tendon pain. RESULTS: Out of 156 individuals who volunteered, 37 met the eligibility criteria and were randomized to either active-LIPUS (n = 17) or inactive-LIPUS (n = 20). Using an intention-to-treat analysis, VAS-U and VAS-W for the entire cohort decreased by 1.6 +/- 1.9 cm (P < 0.01) and 2.5 +/- 2.4 cm (P < 0.01), respectively. There were no differences between the active- and inactive-LIPUS groups for change in VAS-U (-0.2 cm; 95% CI, -1.5, 1.1 cm) (P = 0.74) or VAS-W (-0.5 cm; 95% CI, -2.1, 1.1 cm) (P = 0.57). A per-protocol analysis provided similar results. CONCLUSIONS: These findings suggest that LIPUS does not provide any additional benefit over and above placebo in the management of symptoms associated with PT.

Navicular stress fractures: outcomes of surgical and conservative management.

OBJECTIVE: To compare the long term outcomes of the two treatment options for navicular stress fractures: non-weightbearing cast immobilisation and surgical fixation. DESIGN: Retrospective case study. PARTICIPANTS: Subjects aged 18 years and older who had been treated for a navicular stress fracture more than two years previously. MAIN OUTCOME MEASURES: Questionnaire based analogue pain score and function score; tenderness on palpation; abnormality detected on computed tomography (CT). RESULTS: In all, 32 fractures in 26 subjects were investigated. No significant differences were found between surgical and conservative management for current pain (p = 0.984), current function (p = 0.170), or abnormality on CT (p = 0.173). However, surgically treated patients more often remained tender over the "N spot" (p = 0.005), even after returning to competition for two years or more. CONCLUSIONS: Surgical fixation of navicular stress fractures appears to be as effective as conservative management over the longer term. However, there remains a small but measurable degree of pain and loss of function over this period. The value of using "N spot" tenderness as the sole clinical predictor of treatment success requires further investigation, as some patients remained tender despite successful completion of treatment and return to competition.

High reproducibility of patellar tendon vascularity assessed by colour Doppler ultrasonography: a reliable measurement tool for quantifying tendon pathology.

BACKGROUND: This study examined whether patellar tendon vascularity could be quantified accurately in the clinical setting using colour Doppler ultrasonography. METHODS: A sonographer and two radiologists visually estimated tendon vascularity in millimetres in 74 tendons during ultrasound (US) examination and from hard copy films. These estimates were then compared to the length of vessels measured from the digital image in millimetres and the correlation between them was determined. A subset of 16 tendons was used to compare the estimates of vascularity by two examiners at US examination. RESULTS: The estimation of vascular length at US examination correlated highly with the measured vascular length (r = 0.92; 95% confidence interval (CI) 0.87 to 0.94), as did the length estimated from the films (r = 0.94; 95% CI 0.9 to 0.96). The correlation between examiners was 0.84 (95% CI 0.51 to 0.94) for the estimates made during US examination and 0.85 (95% CI 0.59 to 0.95) for the vessel lengths measured from the digital images. CONCLUSIONS: These excellent correlations indicate that tendon vascularity can be reliably estimated using colour Doppler ultrasonography and tendon vascularity could therefore be used by clinicians to rate clinical change. This method of quantifying tendon vascularity could also be used in research to investigate the effects of tendon treatments on vascularity.

Eccentric decline squat protocol offers superior results at 12 months compared with traditional eccentric protocol for patellar tendinopathy in volleyball players.

BACKGROUND: Conservative treatment of patellar tendinopathy has been minimally investigated. Effective validated treatment protocols are required. OBJECTIVES: To investigate the immediate (12 weeks) and long term (12 months) efficacy of two eccentric exercise programmes for the treatment of patellar tendinopathy. METHODS: This was a prospective randomised controlled trial of 17 elite volleyball players with clinically diagnosed and imaging confirmed patellar tendinopathy. Participants were randomly assigned to one of two treatment groups: a decline group and a step group. The decline group were required to perform single leg squats on a 25 degrees decline board, exercising into tendon pain and progressing their exercises with load. The step group performed single leg squats on a 10 cm step, exercising without tendon pain and progressing their exercises with speed then load. All participants completed a 12 week intervention programme during their preseason. Outcome measures used were the Victorian Institute of Sport Assessment (VISA) score for knee function and 100 mm visual analogue scale (VAS) for tendon pain with activity. Measures were taken throughout the intervention period and at 12 months. RESULTS: Both groups had improved significantly from baseline at 12 weeks and 12 months. Analysis of the likelihood of a 20 point improvement in VISA score at 12 months revealed a greater likelihood of clinical improvements in the decline group than the step group. VAS scores at 12 months did not differ between the groups. CONCLUSIONS: Both exercise protocols improved pain and sporting function in volleyball players over 12 months. This study indicates that the decline squat protocol offers greater clinical gains during a rehabilitation programme for patellar tendinopathy in athletes who continue to train and play with pain.

Are unilateral and bilateral patellar tendinopathy distinguished by differences in anthropometry, body composition, or muscle strength in elite female basketball players?

BACKGROUND: Overuse injury to the patellar tendon (patellar tendinopathy) is a major reason for interrupted training and competition for elite athletes. In both sexes, the prevalence of unilateral and bilateral tendinopathy has been shown to differ. It has been proposed that bilateral pathology may have a different aetiology from unilateral pathology. Investigation of risk factors that may be unique to unilateral and bilateral patellar tendinopathy in female athletes may reveal insights into the aetiology of this condition. OBJECTIVES: To examine whether anthropometry, body composition, or muscle strength distinguished elite female basketball players with unilateral or bilateral patellar tendinopathy. METHODS: Body composition, anthropometry, and muscle strength were compared in elite female basketball players with unilateral (n = 8), bilateral (n = 7), or no (n = 24) patellar tendinopathy. Body composition was analysed using a dual energy x ray absorptiometer. Anthropometric measures were assessed using standard techniques. Knee extensor strength was measured at 180 degrees /s using an isokinetic dynamometer. z scores were calculated for the unilateral and bilateral groups (using the no tendinopathy group as controls). z scores were tested against zero. RESULTS: The tibia length to stature ratio was approximately 1.3 (1.3) SDs above zero in both the affected and non-affected legs in the unilateral group (p<0.05). The waist to hip ratio was 0.66 (0.78) SD above zero in the unilateral group (p<0.05). In the unilateral group, leg lean to total lean ratio was 0.42 (0.55) SD above zero (p<0.07), the trunk lean to total lean ratio was 0.63 (0.68) SD below zero (p<0.05), and leg fat relative to total fat was 0.47 (0.65) SD below zero (p<0.09). In the unilateral group, the leg with pathology was 0.78 (1.03) SD weaker during eccentric contractions (p<0.07). CONCLUSIONS: Unilateral patellar tendinopathy has identifiable risk factors whereas bilateral patellar tendinopathy may not. This suggests that the aetiology of these conditions may be different. However, interpretation must respect the limitation of small subject numbers.

Anthropometry, physical performance, and ultrasound patellar tendon abnormality in elite junior basketball players: a cross-sectional study.

OBJECTIVE: Patellar tendinopathy has been reported to be associated with many intrinsic risk factors. Few have been fully investigated. This cross-sectional study examined the anthropometric and physical performance results of elite junior basketball players with normal or abnormal patellar tendons to see if any measures were associated with changes in tendon morphology. METHODS: Agility, leg strength, endurance, and flexibility were measured in 71 male and 64 female players. A blinded radiologist ultrasonographically examined their patellar tendons and athletes were grouped as having normal or abnormal tendons. One-way ANOVA was used to test for differences in anthropometric and physical performance data for athletes whose tendons were normal or abnormal (unilateral or bilateral tendinopathy) on ultrasound. RESULTS: Results show that females with abnormalities in their tendons had a significantly better vertical jump (50.9+/-6.8 cm) than those with normal tendons (46.1+/-5.4 cm) (p = 0.02). This was not found in males. In males, the mean sit and reach in those with normal tendons (13.2+/-6.7 cm) was greater (p<0.03) than in unilateral tendinopathy (10.3+/-6.2 cm) or in bilateral tendinopathy (7.8+/-8.3 cm). In females, those with normal tendons (13.3+/-4.8 cm) and bilateral tendinopathy (15.8+/-6.2 cm) were distinctly different from those with unilateral tendinopathy (7.9+/-6.6 cm). CONCLUSION: Flexibility and vertical jump ability are associated with patellar tendinopathy and the findings warrant consideration when managing young, jumping athletes.

Reproducibility and clinical utility of tendon palpation to detect patellar tendinopathy in young basketball players. Victorian Institute of Sport tendon study group.

BACKGROUND: Palpation is an important clinical test for jumper's knee. OBJECTIVES: To (a) test the reproducibility of palpation tenderness, (b) evaluate the sensitivity and specificity of palpation in subjects with clinical symptoms of jumper's knee, and (c) determine whether tenderness to palpation may serve as a useful screening test for patellar tendinopathy. The yardstick for diagnosis of patellar tendinopathy was ultrasonographic abnormality. METHODS: In 326 junior symptomatic and asymptomatic athletes' tendons, palpation was performed by a single examiner before ultrasonographic examination by a certified ultrasound radiologist. In 58 tendons, palpation was performed twice to test reliability. Tenderness to palpation was scored on a scale from 0 to 3 where 0 represented no pain, and 1, 2, and 3 represented mild, moderate, and severe tenderness respectively. RESULTS: Patellar tendon palpation was a reliable examination for a single examiner (Pearson r = 0.82). In symptomatic tendons, the positive predictive value of palpation was 68%. As a screening examination in asymptomatic subjects, the positive predictive value of tendon palpation was 36-38%. Moderate and severe palpation tenderness were better predictors of ultrasonographic tendon pathology than absent or mild tenderness (p<0.001). Tender and symptomatic tendons were more likely to have ultrasound abnormality than tenderness alone (p<0.01). CONCLUSIONS: In this age group, palpation is a reliable test but it is not cost effective in detecting patellar tendinopathy in a preparticipation examination. In symptomatic tendons, palpation is a moderately sensitive but not specific test. Mild tenderness in the patellar tendons in asymptomatic jumping athletes should be considered normal.

Asymptomatic hypoechoic regions on patellar tendon ultrasound: A 4-year clinical and ultrasound followup of 46 tendons.

Patellar tendon ultrasound appearance is commonly used in clinical practice to diagnose patellar tendinopathy and guide management. Using a longitudinal study design we examined whether or not the presence of a hypoechoic ultrasonographic lesion in an asymptomatic patellar tendon conferred a risk for developing jumper's knee compared with a tendon that was ultrasonographically normal. Ultrasonographic, symptomatic and anthropometric assessment was completed at baseline and followup. Magnetic resonance imaging was performed on four tendons that resolved ultrasonographically in the study period. Forty-six patellar tendons were followed over 47+/-11.8 months. Eighteen tendons were hypoechoic at baseline and 28 were ultrasonographically normal. Five tendons resolved ultrasonographically in the study period. Magnetic resonance imaging in four of these tendons was normal. Seven normal patellar tendons at baseline developed a hypoechoic area but only two became symptomatic. Analysis of ultrasonography at baseline and clinical outcome with Fisher's exact test shows there is no association between baseline ultrasound changes and symptoms at followup. In this study there is no statistically significant relationship between ultrasonographic patellar tendon abnormalities and clinical outcome in elite male athletes. Management of jumper's knee should not be solely based on ultrasonographic appearance; clinical assessment remains the cornerstone of appropriate management.

Patellar tendinopathy in junior basketball players: a controlled clinical and ultrasonographic study of 268 patellar tendons in players aged 14-18 years.

Anterior knee pain is a common presenting complaint amongst adolescent athletes. We hypothesised that patellar tendinopathy may occur at a younger age than is generally recognised. Thus, we studied the patellar tendons in 134 elite 14- to 18-year-old female (n=64) and male (n=70) basketball players and 29 control swimmers (17 female, 12 male) clinically and with ultrasonography. We found that of 268 tendons, 19 (7%) had current patellar tendinopathy on clinical grounds (11% in males, 2% in females). Twenty-six percent of the basketball players' patellar tendons contained an ultrasonographic hypoechoic region. Ultrasonographic abnormality was more prevalent in the oldest tertile of players (17-18 years) than the youngest tertile (14-15.9 years). Of tendons categorised clinically as 'Never patellar tendinopathy', 22% had an ultrasonographic hypoechoic region nevertheless. This study indicates that patellar tendinopathy can occur in 14- to 18-year-old basketball players. Ultrasonographic tendon abnormality is 3 times as common as clinical symptoms.

Prospective imaging study of asymptomatic patellar tendinopathy in elite junior basketball players.

To evaluate the ability of ultrasonography to predict eventual symptoms in an at-risk population, 52 elite junior basketball players' patellar tendons were studied at baseline and again 16 months later. The group consisted of 10 study tendons (ultrasonographically hypoechoic at baseline) and 42 control tendons (ultrasonographically normal at baseline). By design, all tendons were asymptomatic at baseline. No differences were noted between subjects and controls at baseline for age, height, weight, training hours, and vertical jump. Functional (P < 0.01) and symptomatic outcome (P < 0.05) were poorer for subjects' tendons than for controls. Relative risk for developing symptoms of jumper's knee was 4.2 times greater in case tendons than in control tendons. Men were more likely to develop ultrasonographic changes than women (P < 0.025), and they also had significantly increased training hours per week (P < 0.01) in the study period. Half (50%) of abnormal tendons in women became ultrasonographically normal in the study period. Our data suggest that presence of an ultrasonographic hypoechoic area is associated with a greater risk of developing jumper's knee symptoms. Ultrasonographic patellar tendon changes may resolve, but this is not necessary for an athlete to become asymptomatic. Qualitative or quantitative analysis of baseline ultrasonographic images revealed it was not possible to predict which tendons would develop symptoms or resolve ultrasonographically.

Open and arthroscopic patellar tenotomy for chronic patellar tendinopathy. A retrospective outcome study. Victorian Institute of Sport Tendon Study Group.

Chronic patellar tendinopathy often requires surgical treatment. We compared the outcomes in 25 subjects (29 tendons) who had had open patellar tenotomy and 23 subjects (25 tendons) who had had arthroscopic patellar tenotomy at a mean follow-up of 3.8 and 4.3 years, respectively. At follow-up, outcomes in the open and arthroscopic groups were as follows: 1) symptomatic benefit was seen in 81% of open and 96% of arthroscopic tenotomy patients, 2) sporting success was seen in 54% of open and 46% of arthroscopic tenotomy patients, 3) median time to return to preinjury level of activity was 10 months for open and 6 months for arthroscopic tenotomy patients, and 4) median Victorian Institute of Sport Assessment score at follow-up was 88 for open and 77 for arthroscopic tenotomy patients. There were no significant differences between groups for all outcomes. The appearance of the tendon on sonography remained abnormal in over 70% of subjects at follow-up, and sonographic appearance did not correlate with clinical outcome. Thus, arthroscopic patellar tenotomy was as successful as the traditional open procedure. Both procedures provided virtually all subjects with symptomatic benefit, but only about half the subjects who underwent either open or arthroscopic patellar tenotomy were competing at their former sporting level at follow-up.

Correlation of ultrasound and magnetic resonance imaging with clinical outcome after patellar tenotomy: prospective and retrospective studies. Victorian Institute of Sport Tendon Study Group.

OBJECTIVE: To report the appearances of ultrasound (US) and magnetic resonance imaging (MRI) before and after surgery for chronic patellar tendinopathy and to correlate postoperative appearances with clinical outcome. DESIGN: A 12-month prospective longitudinal study and a retrospective study, each part using different patients. Prospective study included clinical assessment, ultrasound, and MRI all performed before and 12 months after surgery. Retrospective study included ultrasound and clinical assessment only (i.e., no MRI) 24 to 67 months after surgery. SETTING: Institutional athlete study group in Australia (Victorian Institute of Sport Tendon Study Group). PATIENTS: In the prospective study, 13 patients (all male; 15 tendons) who underwent patellar tenotomy; in the retrospective study, 17 different patients (18 tendons) who had undergone identical surgery. MAIN OUTCOME MEASURES: Ultrasound and MRI appearances and clinical assessment at baseline and 12 months after surgery (prospective study). Ultrasound appearance and clinical assessment 24 to 67 months after surgery (retrospective study). Dimensions of abnormal regions on imaging were measured. Clinical assessment included categorical rating and numerical Victorian Institute of Sport Assessment (VISA) score. RESULTS: In the prospective study, preoperative ultrasound and MRI appearances confirmed the clinical diagnosis of patellar tendinopathy. Postoperative ultrasound and MRI also revealed abnormalities consistent with patellar tendinopathy. Despite this, 11 of 15 (73%) tendons were rated clinically as either good or excellent. Imaging modalities were unable to distinguish tendons rated as good or excellent from those rated poor at 12 months. In the retrospective study, ultrasound images revealed abnormalities despite full clinical recovery. There was no correlation between dimension of ultrasound abnormality and either VISA score or time since surgery. CONCLUSION: After open patellar tenotomy, MRI and ultrasound findings remain abnormal despite clinical recovery. Thus, clinicians ought to base postoperative management of patients undergoing patellar tenotomy on clinical grounds rather than imaging findings. At present, there appears to be no role for routine postoperative imaging of patients recovering slowly after patellar tenotomy. However, this is not to suggest that imaging cannot play a role in special circumstances.

The VISA score: an index of severity of symptoms in patients with jumper's knee (patellar tendinosis). Victorian Institute of Sport Tendon Study Group.

Symptoms of jumper's knee (patellar tendinosis) are not easily quantified and this may explain why there are no evidence-based guidelines for managing the condition. A simple, practical questionnaire-based index of severity would facilitate jumper's knee research and subsequently, clinical management. Thus we devised and tested the Victorian Institute of Sport Assessment (VISA) questionnaire. The brief questionnaire assesses (i) symptoms, (ii) simple tests of function and (iii) ability to play sport. Six of the eight questions are scored on a visual analogue scale from 0-10 with 10 representing optimal health. The maximal VISA score for an asymptomatic, fully performing individual is 100 points and the theoretical minimum is 0 points. We found the VISA scale to have excellent short-term test-retest, and inter-tester reliability (both, r>0.95) as well as good short-term (one week) stability (r=0.87). Mean (SD) of the VISA scores ranged from 95 (8) points in asymptomatic control subjects to 55 (12) points in patients who presented to a sports medicine clinic with jumper's knee and 22 (17) points in patients before surgery for chronic jumper's knee. Six- and twelve-months after surgery VISA scores returned to 49 (15) and 75 (17) points respectively, mirroring clinical recovery. We conclude that the VISA score is a reliable index of the severity of jumper's knee that has potential to aid clinicians and researchers.

Patellar tendon ultrasonography in asymptomatic active athletes reveals hypoechoic regions: a study of 320 tendons. Victorian Institute of Sport Tendon Study Group.

OBJECTIVE: To compare patellar tendon sonographic findings in active, currently asymptomatic, elite athletes with those in nonathletic controls. DESIGN: Cross-sectional cohort study with convenience control sample. SETTING: The Victorian Institute of Sport Tendon Study Group, an institutional elite athlete study group in Australia. PATIENTS AND PARTICIPANTS: Two hundred elite male and female athletes from the sports of basketball, cricket, netball, and Australian rules football. Forty athletes who had current symptoms of jumper's knee were excluded from analysis, leaving 320 subject tendons in athletes who were currently asymptomatic. Twenty-seven nonathletic individuals served as controls. MAIN OUTCOME MEASURE: Sonographic patellar tendon appearance. We measured the dimensions of subject tendons and noted the presence or absence of hypoechoic regions and tendon calcification. Dimensions of hypoechoic regions were measured, and approximate cross-sectional areas were calculated. Chi-squared analysis was used to test the prevalence of hypoechoic regions in subjects and controls and men and women. RESULTS: In currently asymptomatic subjects, hypoechoic regions were more prevalent in athlete tendons (22%) than in controls (4%), in male subject tendons (30%) than in female subjects (14%), and in basketball players (32%) than in other athletes (9%) (all p < 0.01). Bilateral tendon abnormalities were equally prevalent in men and women but more prevalent in basketball players (15%) than in other athletes (3%) (p < 0.05). Sonographic hypoechoic regions were present in 35 of 250 (14%) patellar tendons in athletes who had never had anterior knee pain. CONCLUSIONS: Patellar tendon sonographic hypoechoic areas were present in asymptomatic patellar tendons of a proportion of elite athletes but rarely present in controls. This has implications for clinicians managing athletes with anterior knee pain.

Postoperative patellar tendon healing: an ultrasound study. VIS Tendon Study Group.

The patellar tendon donor site of 20 patients who underwent anterior cruciate ligament (ACL) reconstruction using the patellar tendon tissue as autograft was examined with high resolution 7.5 MHz ultrasound. The patients were randomly divided into four groups and studied at 3, 6, 9 or 12 months postoperatively. The size of the postoperative tendon defect was measured just distal to the lower pole of the patella. The size of the tendon defect diminished progressively from a mean of 109 mm2 at 3 months to a mean of 23 mm2 at 12 months. Increasing echogenicity was first noticed 12 months after tendon repair. Seven patients developed clinical features postoperatively of jumper's knee (patellar tendinosis). There were no ultrasound signs that differentiated these patients from asymptomatic patients. It is concluded that ultrasound provides objective evidence of patellar tendon healing after ACL reconstruction: the surgical defect diminished in size and became echogenic after a period of 12 months.

Patellar tendon ultrasonography and jumper's knee in female basketball players: a longitudinal study.

OBJECTIVE: To compare patellar tendon sonographic findings at baseline and at follow-up in active female basketball players with and without symptoms of jumper's knee. We hypothesized that baseline sonographic morphology would not reliably predict prognosis and, in particular, that it would not predict the need for surgery. DESIGN: Prospective longitudinal study with 12-month minimum follow-up. SETTING: Institutional elite athlete study group in Australia (Victorian Institute of Sport Tendon Study Group). PATIENTS AND PARTICIPANTS: A total of 15 female elite basketball players with 23 sonographically abnormal tendons and 15 matched control basketball players with 23 sonographically normal tendons. MAIN OUTCOME MEASURES: Sonographic patellar tendon appearance and clinical assessment of symptoms of jumper's knee at baseline and follow-up. Dimensions of abnormal regions were measured. RESULTS: At baseline, the 23 subject tendons contained sonographic hypoechoic regions (six currently symptomatic, eight previously symptomatic only, and nine never symptomatic). At follow-up, the hypoechoic areas in seven tendons had resolved (and caused no symptoms), the hypoechoic areas in 11 tendons had remained essentially the same size (five were symptomatic), and the hypoechoic areas in five tendons had expanded (three symptomatic). At baseline, there were no differences between the mean +/- SD cross-sectional areas of the abnormalities in the tendons that subsequently resolved (15.9 +/- 10.1 mm2) and those that remained unchanged (39.3 +/- 25.8) or expanded (25.3 +/- 12.5). The presence of a baseline sonographic abnormality predicted symptoms of jumper's knee at follow-up (p < 0.05), but the presence of symptoms of jumper's knee at baseline also predicted symptoms at follow-up (p < 0.05). No subject or control missed any games or underwent surgical treatment. CONCLUSIONS: Patellar tendon sonographic hypoechoic areas can resolve, remain unchanged, or expand in active sports-women without predicting symptoms of jumper's knee. Thus, symptoms were not directly related to sonographic tendon morphology. Sonographic hypoechoic regions ought not to constitute per se an indication for surgery.

Osteoarthritis of the knee in retired, elite Australian Rules footballers.

OBJECTIVE: To determine the functional and radiological status of knee joints of retired Australian Rules footballers compared with those of active community members. DESIGN: Retrospective cohort study. PARTICIPANTS: Fifty retired elite footballers aged 34-85 years (mean, 53.7 years; SD, 11.4) from four AFL clubs and 50 age-matched controls (35-79 years; mean, 55.7 years; SD, 12.4) who had played no contact sport since their teenage years. MAIN OUTCOME MEASURES: Severity of knee functional osteoarthritis as determined by a questionnaire, and assessment of osteoarthritis by posteroanterior weight-bearing radiographs taken of both knees of each participant in 45-degree flexion. RESULTS: After adjusting for age, height, weight and body mass index, footballers had a significantly greater prevalence (P < 0.0001) and severity (P < 0.05) of functional and radiological osteoarthritis than controls. Footballers with a history of intraarticular ligamentous and/or meniscal injury (Group 1) had a greater risk of functional osteoarthritis (P = 0.002) and radiological (P = 0.067) osteoarthritis than those with a history of collateral ligament injury or no injury (Group 2). Compared with controls, the odds of developing moderate to severe levels of functional and radiological osteoarthritis were 6.9 times (95% CI, 1.6-29.7; P = 0.01) and 105.0 times (95% CI, 11.8-931.8; P < 0.0001), respectively, those in Group 1 footballers and 3.6 times (95% CI, 0.8-16.2; P = 0.10) and 17.7 times (95% CI, 2.2-146.2; P = 0.0075), respectively, those in Group 2 footballers. CONCLUSIONS: Elite Australian Rules footballers have a significant risk of both functional and radiological osteoarthritis, and a history of intra-articular ligament or meniscal injury increases this risk.

Patellar tendinosis (jumper's knee): findings at histopathologic examination, US, and MR imaging. Victorian Institute of Sport Tendon Study Group.

PURPOSE: To determine the histopathologic findings of patellar tendinosis ("jumper's knee") demonstrated with ultrasonography (US) and magnetic resonance (MR) imaging. MATERIALS AND METHODS: Twenty-four athletes (28 knees) with jumper's knee (23 men, one women; mean age, 30.9 years) scheduled to undergo open tenotomy underwent US patellar tendon examination. Seventeen patients (19 knees) also underwent MR imaging. Tissue was obtained for histopathologic examination in all 28 cases. Eleven age-, height-, and weight-matched athletes (22 knees) without previous knee symptoms served as control subjects for the US examination. Control material for histopathologic examination was obtained in 20 cadavers (39 knees). Data were analyzed with standard statistical methods. RESULTS: MR imaging and US both revealed an abnormal zone at the proximal patellar tendon attachment. Histopathologic examination revealed mucoid degeneration in all tendons in patients and in 8% (three of 39) of tendons in cadavers (P < .01). CONCLUSION: Jumper's knee is characterized by consistent changes at MR imaging, US, and histopathologic examination and is appropriately described as patellar tendinosis.

The bipartite tarsal navicular bone: radiographic and computed tomography findings.

Two cases of bipartite tarsal navicular bone are presented. The radiographic and computed tomography (CT) findings of this anatomical variant are described. Correct recognition of this entity is important, both because it may be the cause of symptoms per se, and because it may be misdiagnosed as a fracture. When plain films are not diagnostic, CT scanning is helpful in distinguishing between a fracture and this variant.