Self-reported jumpers' knee is common in elite basketball athletes - But is it all patellar tendinopathy?

OBJECTIVES: To describe the prevalence and pain location of self-reported patellar tendinopathy and patellar tendon abnormality in a male elite basketball population. DESIGN: Cross-sectional. SETTING: Pre-season tournament. PARTICIPANTS: Sixty male athletes from the Australian National Basketball League. MAIN OUTCOME MEASURES: Self-reported patellar tendinopathy (PT) using the Oslo Sports Trauma Research Centre Overuse Questionnaire (OSTRC). Pain location using pain mapping (dichotomised: focal/diffuse) and severity during the single leg decline squat. Ultrasound tissue characterisation scans of both patellar tendons. RESULTS: Thirteen participants (22.7%) self-reported PT. Only 3 who reported PT had localised inferior pole pain. Thirty athletes reported pain during the decline squat, 15 described focal pain; 10 diffuse pain (5 missing data). Those with diffuse pain had greater years played [Md = 21 (13-24), n = 10 than focal pain (Md = 12 (7-26), n = 15), p = 0.042, r = 0.3]. Bilateral tendon abnormality was found in 45% of athletes and 15% had unilateral tendon abnormality. CONCLUSION: Elite male basketball athletes self-reporting PT had heterogeneity in pain location. When focal pain with loading was used as a primary definition of PT, 'jumpers' knee' was not common in this cohort. This study found that abnormality of the patellar tendon was common and did not correlate with symptoms.

Successful management of unilateral congenital patellar tendon aplasia: case report.

Anatomical variation is discovered frequently in humans, and much such variation in the musculoskeletal system has been reported. We present a rare case of unilateral congenital patellar tendon aplasia with concomitant apparent shortness of the bilateral halluces as a result of shortened first metatarsals as an anatomical variant.

Lower Limb Dominance, Morphology, and Sonographic Abnormalities of the Patellar Tendon in Elite Basketball Players: A Cross-Sectional Study.

CONTEXT: Patellar tendinopathy is common in basketball players, and structural ultrasound abnormalities can be found in symptomatic and asymptomatic tendons. Lower limb dominance may also be a critical load factor, potentially leading to overloading of the patellar tendon. OBJECTIVE: To describe and compare the prevalence by lower limb dominance of patellar tendons with structural and vascular abnormalities and to describe the morphologic measures of tendons without abnormalities among adult male elite basketball players. DESIGN: Cross-sectional study. SETTING: Medical center of a professional basketball team in the Spanish league. PATIENTS OR OTHER PARTICIPANTS: A total of 73 adult male elite basketball players (146 patellar tendons; age = 26.8 ± 4.9 years, height = 198.0 ± 0.1 cm, mass = 95.4 ± 11.4 kg). MAIN OUTCOME MEASURE(S): We used ultrasound to screen the patellar tendons for the presence of structural and vascular abnormalities. Tendons were categorized as abnormal if they demonstrated a focal area of hypoechogenicity, thickening, or neovascularization. We also examined the cross-sectional area and thickness of tendons without abnormalities. Prevalence and morphologic measures were compared by limb dominance. RESULTS: A total of 35 players (48%) had bilateral abnormalities, whereas 21 (28.7%) had unilateral abnormalities. Among the 91 abnormal tendons, 90 (61.6% of 146 tendons) exhibited a focal area of hypoechogenicity, 59 (40.4% of 146 tendons) exhibited thickening, and 14 (9.6% of 146 tendons) exhibited neovascularization. No group differences were detected between the dominant and nondominant limbs. Among the 55 normal patellar tendons, 34 were bilateral (from 17 players) and 21 were unilateral. Approximately 25% (n = 14) of all 55 normal tendons had a cross-sectional area that was greater than 182.8 mm2 and a thickness greater than 7.2 mm. Among the 34 bilateral normal tendons, no group differences were observed between the dominant and nondominant limbs for either cross-sectional area or thickness. CONCLUSIONS: The prevalence of abnormal tendons was high among adult male elite basketball players, and bilateral presentations were more frequent. Structural abnormalities were most common.

Intramedullary Insertion of the Patellar Tendon, a Rare Anatomical Variant, Its Sequelae, and Surgical Management: A Case Report.

CASE: We report a rare cause of patella baja in a 25-year-old man presenting with right knee pain. He was found to have patella baja and a genu recurvatum deformity. Imaging revealed an extremely unusual variant of the patellar tendon-identified to have an intramedullary tibial insertion. A patellar tendon reconstructive procedure was performed. CONCLUSIONS: An intramedullary insertion of the patellar tendon is a fascinating and rare cause of patella baja with subsequent altered biomechanics of the extensor mechanism. We believe this is the first case report to describe its surgical presentation and an operative approach to its management.

Intermediate patellar ligament desmopathy often occurs in conjunction with other stifle abnormalities.

Intermediate patellar ligament (IPL) desmopathy is a relatively uncommon injury previously reported to have a poor prognosis for return to athletic activity. There is little documentation of the clinical and ultrasonographic features, clinical significance, and outcome for return to work following IPL injury in horses. The aim of this retrospective descriptive study was to describe the clinical and ultrasonographic features of IPL desmopathy, its association with other injuries of the stifle, and outcome for return to work following injury. Forty-two stifles with an ultrasound diagnosis of IPL desmopathy over a 5-year time period were included. Data regarding signalment, clinical presentation, diagnostic imaging findings, treatment, and outcome are described. Intermediate patellar ligament desmopathy occurred most commonly in the midbody (35/42; 83%) of the ligament and lesions were predominantly hypoechoic discrete tears (31/42; 74%) that were obliquely oriented in a craniolateral to caudomedial direction (28/42; 67%). Rarely (1/42; 2%) was IPL desmopathy the only ultrasonographic abnormality detected. Of 13 horses that underwent recheck ultrasound examination, the majority (11/42; 85%) either did not improve or worsened ultrasonographically. Despite this, of 25 horses with long-term follow-up, 23 (92%) returned to work, 16 at the same level or higher. A variety of treatments were utilized. The clinical significance of IPL desmopathy is difficult to determine because it is usually found in conjunction with other stifle abnormalities. Although IPL desmopathy rarely shows ultrasonographic improvement over time, prognosis can be good for return to work.

The lateral patellar retinaculum defect: anatomical study using ultrasound.

OBJECTIVE: The purpose of this study was to evaluate whether ultrasound allows precise assessment of a focal defect at the lateral patellar retinaculum (LPR) and to determine its anatomical significance. MATERIALS AND METHODS: This work was initially undertaken in four cadaveric specimens and followed by high-resolution ultrasound study in 48 healthy adult volunteers (96 knees) by two musculoskeletal radiologists. Dimension and location of the LPR defect and its relations to adjacent anatomical structures were analyzed. RESULTS: A focal defect of the LPR through which vessels penetrated was constantly identified by ultrasound in our population. The mean transverse diameter of the defect was 2.4 mm (range, 1-6 mm). The defect was located a mean of 23.7 mm (range, 18-30 mm) proximal to the lateral tibial plateau and 6.6 mm (range, 4-9 mm) lateral to the patellar tendon. Anatomical dissection demonstrated that the LPR defect is related to perforating vessels that originate from the peripatellar anastomotic ring. CONCLUSIONS: The focal defect of the LPR can be depicted by ultrasonography. Reproducible anatomical landmarks for its detection could be defined. Our data suggest the LPR defect may be considered a normal variant rather than a pathologic change.

A case of crossed-doubled patellar tendon: an atavistic variant, simple mutation or pathologic finding?

Anatomical variants can be found throughout the whole body. Especially in the knee region, some variability has been reported concerning the osseous, tendinous, and muscular system. Beside a few cases of patellar tendon aplasia, no anatomical variations of this tendon are known. We present a rare case of a doubled patellar tendon as an anatomical variant, which to our knowledge, has not been described previously.

The Accuracy of the VISA-P Questionnaire, Single-Leg Decline Squat, and Tendon Pain History to Identify Patellar Tendon Abnormalities in Adult Athletes.

Study Design Cross-sectional clinical assessment. Background Patellar tendinopathy is not always accompanied by patellar tendon abnormalities (PTAs). Thus, clinical screening tools to help identify patients with patellar tendon pain who have PTAs could enhance clinical decision making and patient prognosis. Objectives To test the diagnostic accuracy of the Victorian Institute of Sport Assessment-Patella (VISA-P) questionnaire, a single-leg decline squat (SLDS), tendon pain history, age, and years of sports participation to identify athletes with symptomatic patellar tendons who have PTAs confirmed on imaging. Methods Data provided by ultrasound examination, the VISA-P questionnaire, the SLDS, tendon pain history, age, and years of sport participation were collected in 43 athletes. A classification and regression tree (CART) model was developed to verify variables associated with PTA occurrence. Likelihood ratios (LRs) were computed for positive and negative tests. Results The SLDS, VISA-P questionnaire, and tendon pain history were associated with PTA occurrence. Athletes with negative results on all 3 tests (CART model) had a lower likelihood of having PTAs (negative LR = 0.3; 95% confidence interval [CI]: 0.2, 0.5). The isolated use of the SLDS or tendon pain history (positive LR = 4.2; 95% CI: 2.3, 7.14 and 4.5; 95% CI: 1.8, 11.1, respectively) had similar influence on probability of PTA presence compared to the CART model (positive LR = 4.1; 95% CI: 2.5, 6.3). Conclusion Although the objective was to investigate a clinical test to identify PTAs, the combined use of the tests had greater accuracy to identify individuals without PTAs. Level of Evidence Diagnosis, level 3b. J Orthop Sports Phys Ther 2016;46(8):673-680. Epub 3 Jul 2016. doi:10.2519/jospt.2016.6192.

Medial patellofemoral muscle: report of a rare variant / Músculo patelofemoral medial: reporte de una rara variante

Muscle anatomic variants range from absence of a muscle to supernumerary muscles, with a spectrum of possibilities that include anomalous course, anomalous origin or insertion, accessory slips, and others. The most common muscle variants around the knee include aberrant origin and accessory slips of the gastrocnemius muscles, presence of tensor fascia suralis muscle, and accessory popliteus. The medial patellofemoral ligament is a distinct extra-articular condensation of fibers located superficially to the medial joint capsule. We describe the presence of an accessory medial patellofemoral muscle in the expected location of the medial patellofemoral ligament, which to our knowledge has not been described in the literature before.

Las variantes anatómicas musculares van desde la ausencia de un músculo hasta la presencia de músculos supernumerarios, en un espectro de posibilidades que incluyen trayecto anómalo, origen anómalo o inserción, fascículos accesorios, y otros. Las variantes más comunes de músculos presentes alrededor de la rodilla incluyen el origen aberrante y fascículos accesorios del músculo gastrocnemio, la presencia del músculo tensor de la fascia sural y el músculo poplíteo accesorio. El ligamento medial patelofemoral es una clara condensación extra-articular de fibras localizado superficialmente a la cápsula articular medial. Se describe la presencia de un músculo patelofemoral medial accesorio en la ubicación esperada del ligamento patelofemoral medial, que a nuestro conocimiento no se ha descrito antes en la literatura.

[The Linburg-Comstock phenomenon: a review]. / Die Linburg-Comstock-Variante: Eine Übersicht.

Simultaneous flexion of thumb and fingers is described as the Linburg-Comstock phenomenon. Congenital and acquired coupling of the flexor pollicis longus (FPL) and flexor digitorum profundus (FDP) tendons is the reason for this clinical entity. Additionally, coupling of the FPL and the flexor digitorum superficialis II or III has been described. The coupling can be between the muscles, the tendon sheaths or the tendons themselves. Asymptomatic and symptomatic coupling should be differentiated. In general symptomatic congenital or acquired coupling demands surgical intervention. We report about a 35-year-old patient with a congenital asymptomatic coupling of FPL and FDP-II who suffered a distorsion of the thumb. Afterwards she complained of pain and strength loss. An accessory tendon of 3 mm in diameter and 3.5 cm length between FPL and FDP-II was identified during surgery. The patient recovered completely after resection of this coupling.

Patellar tendon tenodesis in association with tibial tubercle distalization for the treatment of episodic patellar dislocation with patella alta.

BACKGROUND: The association between patella alta and episodic patellar dislocation (EPD) has been well described, but its pathophysiology is not completely clear. Patella alta causes decreased contact between the patella and trochlea and decreased resistance to lateral translation of the patella. Additionally, increased patellar tendon length may allow pathologically increased coronal plane patellar motion. It may thus be desirable to address the length of the patellar tendon itself rather than just its insertion site. HYPOTHESIS: Tenodesis of the patellar tendon in association with tibial tubercle distalization in patients with EPD and abnormally long patellar tendons (>52 mm) results in significant reduction in patellar tendon length, prevention of further patellar dislocation, and good knee function at long-term follow-up. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Twenty-seven knees in 22 patients with EPD and patella alta were treated with patellar tendon tenodesis and tibial tubercle distalization. Following tubercle distalization, the patellar tendon was tenodesed into the original location of the tibial tubercle with suture anchors. Changes in patellar tendon length and patellar height were measured radiographically. Any recurrent dislocation was documented, and patients completed an International Knee Documentation Committee (IKDC) subjective form at a mean of 9.6 years (range, 6-14 years) after surgery. RESULTS: The mean length of the patellar tendon decreased from 56.3 ± 2.7 mm to 44.3 ± 8.6 mm (P < .0001). The Caton-Deschamps index decreased from 1.22 ± 0.17 to 0.95 ± 0.22 (P < .0001), and the Insall-Salvati ratio decreased from 1.42 ± 0.17 to 0.91 ± 0.18 (P < .0001). No patellar dislocations occurred postoperatively. The mean postoperative subjective IKDC score was 75.6 ± 9.5. CONCLUSION: Patellar tendon tenodesis and tibial tubercle distalization result in normalization of patellar tendon length, a stable patellofemoral joint, and good long-term knee function in patients with patella alta and EPD.

Effect of implanting a soft tissue autograft in a central-third patellar tendon defect: biomechanical and histological comparisons.

Previous studies by our laboratory have demonstrated that implanting a stiffer tissue engineered construct at surgery is positively correlated with repair tissue stiffness at 12 weeks. The objective of this study was to test this correlation by implanting a construct that matches normal tissue biomechanical properties. To do this, we utilized a soft tissue patellar tendon autograft to repair a central-third patellar tendon defect. Patellar tendon autograft repairs were contrasted against an unfilled defect repaired by natural healing (NH). We hypothesized that after 12 weeks, patellar tendon autograft repairs would have biomechanical properties superior to NH. Bilateral defects were established in the central-third patellar tendon of skeletally mature (one year old), female New Zealand White rabbits (n = 10). In one limb, the excised tissue, the patellar tendon autograft, was sutured into the defect site. In the contralateral limb, the defect was left empty (natural healing). After 12 weeks of recovery, the animals were euthanized and their limbs were dedicated to biomechanical (n = 7) or histological (n = 3) evaluations. Only stiffness was improved by treatment with patellar tendon autograft relative to natural healing (p = 0.009). Additionally, neither the patellar tendon autograft nor natural healing repairs regenerated a normal zonal insertion site between the tendon and bone. Immunohistochemical staining for collagen type II demonstrated that fibrocartilage-like tissue was regenerated at the tendon-bone interface for both repairs. However, the tissue was disorganized. Insufficient tissue integration at the tendon-to-bone junction led to repair tissue failure at the insertion site during testing. It is important to re-establish the tendon-to-bone insertion site because it provides joint stability and enables force transmission from muscle to tendon and subsequent loading of the tendon. Without loading, tendon mechanical properties deteriorate. Future studies by our laboratory will investigate potential strategies to improve patellar tendon autograft integration into bone using this model.

Relación de longitud entre tendón rotuliano y ligamento cruzado anterior: importancia clínico-quirúrgica / Relationship between length patellar tendon and anterior cruciate ligament: clinical-surgical importance

Objetivo: Correlacionar las dimensiones del Tendón Rotuliano y del Ligamento Cruzado Anterior de lamisma rodilla en cadáveres adultos para contribuir amejorar la técnica de reconstrucción en la plástica delligamento cruzado anterior.Materiales y métodos: Utilizamos en el estudio20 rodillas aisladas formalizadas al 10% sin identificación de sexo tomadas al azar de una población de 150rodillas. Se disecaron con técnica clásica levantando larótula desde proximal liberando el tendón cuadricipitalel cual fue medido con calibre digital lo mismo que elligamento cruzado anterior que fue medido en flexión de90º.Resultados: El presente estudio nos permite observar la diferencia de longitud que existe en todos loscasos entre ambos elementos en forma permanente, lalongitud promedio fue de 42,41 milímetros para el Tendón Rotuliano y de 32,38 milímetros para el LigamentoCruzado Anterior; esta diferencia anatómica es de 1,33milímetros a favor del Tendón Rotuliano promedio conrelación a todos los casos.Conclusión: este estudio nos indica que en las plásticas ligam entarias donde utilizan el Tendón Rotuliano se necesitaría indefectiblemente suplir el Tendón Rotuliano con injerto óseo para evitar el llamadoefecto “limpia parabrisa.

Objective: correlation between patellar tendon (PT) and Anterior Cruciate Ligament (ACL) of the sameknee in cadaveric adult patients and its contribution to improve the technique in ACL surgery reconstruction.Materials and Methods: from 150 knees without gender distribution we took 20 for study. The classic dissection technique, lifting the patella from proximal and clearing the cuadricipital tendon was used. The digitalcaliber of tendon was measured at 90 degrees flexion of the knee.Results: in all cases the difference between both structures was permanent; PT in average was 1,33mmlarger than ACL. Conclusions: in this study the permanent differencefounded show us the mandatory necessity to use bone graft in this kind of surgery in order to avoid the called wiper effect.

Intramedullary insertion of the patellar tendon.

This case represents a rare presentation of an intramedullary insertion of the patellar tendon in an otherwise healthy 8-year-old girl. To our knowledge no such phenomenon has previously been reported in the English literature.

Variant attachments of the anterior horn of the medial meniscus.

The purpose of this study was to analyse the occurrence of variants of anomalous insertions of the anterior horn of the medial meniscus in human knee joints. The study was carried out on 78 human lower limbs of both sexes (42 males and 36 females). Out of 78 knee joints, 10 knee joints (12.82%) presented atypical attachments of the anterior horn of the medial meniscus. In 9 cases we found that the anterior horn of the medial meniscus was attached to the transverse ligament of the knee and in 1 case it was attached to the coronary ligament. In the remaining cases the anterior horn of the medial meniscus was attached to the anterior intercondylar area of the tibia.

Distalization of the patella during tibial callus distraction.

Consecutive distalization of the patella is described in two patients undergoing segmental transportation after high tibial corticotomy. Revision surgery with loosening and proximal reattachment of a portion of the patellar ligament bridging the callus distraction zone could re-establish the correct patellar position. Despite excellent callus formation after tibial corticotomy just below the tibial tuberositas, this procedure should be performed more distally as the fibers of the patellar tendon spread laterally and distally.