Patear tendnts (tendonts) s characterzed by nammaton of

the patear tendon

1
, whch serves to attach the nferor porton of the
patea to the superor porton of the tba. Durng actvty, the patear
tendon works n con|uncton wth the quadrceps and the quadrceps
tendon to extend the eg.
2
The ocaton and functon of the patear
tendon requres substanta forces to be transferred through the
tendon, and sports that nvove swft changes n drecton and frequent
|umpng further ncrease stress to ths area. Whe patear tendnts
nvoves the acute onset of nammaton, the repettve nature of
certan sports can ead to the degeneraton of the patear tendon over
tme. Ths chronc degeneraton s caed patear tendnopathy.
3
Both
patear tendnts and patear tendnopathy are most common n
sports such as basketba and voeyba where the athetes are
frequenty requred to |ump, cut, and stop suddeny. However, they
can aso be found n sports such as soccer, cycng, and weghtftng.
4

Indvduas who suher from patear tendnts w most often
compan of anteror knee pan that becomes aggravated durng
actvtes that produce arge eccentrc oads on the quadrceps. Ths
pan key becomes more pronounced durng papaton to the nferor
poe of the patea. Snce the nferor poe of the patea serves as the
proxma attachment ste for the patear tendon, the tendon can aso
become thckened at the proxma thrd.
5
Over tme, sport-specc
movements that produce excess stran on the patear tendon w aso
cause esons to deveop n the proxma area of the tendon. These
esons can be dented through coagen ber dsrupton, and become
more evdent f the pan nducng actvtes contnue wthout proper
recovery tme.
6
Yet, whe t has become apparent that the proxma
patear tendon s nvoved wth ths pathoogy, other components of
the tendons structura damage are not we understood. Research has
shown that the tendons posteror bers tend to suher the most
damage from patear tendnts, but contradctory evdence has shown
that the posteror bers can wthstand much greater tense strength
than ther anteror counterparts.
4

Generay, patear tendnts s consdered an overuse n|ury n
whch repettve, voent forces are transferred through the patear
tendon. Ths eads to tssue breakdown and nammaton near the
tendons proxma attachment. Natura heang processes hep to
rebud the damaged coagen bers wthn the tendon, but the
tendons abty to regenerate becomes compromsed f these
excessve forces contnue.
7
Therefore, the tendon becomes more
susceptbe to further n|ury, whch can ead to the deveopment of
patear tendnopathy. Because of the tremendous amount of stran
paced of the patear tendon durng the |ump-andng phase, patear
tendnopathy has aso been referred to as |umpers knee. The
prevaence of |umpers knee n sports that requre recurrent |umpng
mechansms, such as basketba or voeyba, can be as hgh as 40-
50%.
8
There are a number of both ntrnsc and extrnsc rsk factors
that can ead an ndvdua to deveop patear tendnts and patear
tendnopathy. Extrnsc rsk factors ncude ncreased duraton,
ntensty, and frequency of tranng sessons, mproper footwear,
nadequate stretchng, payng surface, and years of payng the same
sport.
7,9
Sports have become more mportant from a soceta
standpont n recent years, and the pressure on athetes to perform s
greater than ever. Many hgh ntensty tranng programs have even
begun to operate year-round. As a resut, frequency of tranng has
become the most sgncant predctor of patear tendnopathy wthn
the same sport.
7
Intrnsc factors that can ead to patear tendnts and
tendnopathy ncude maagnment of the ower extremtes, musce
ength, and musce mbaances.
7
Musce weakness has aso been
assocated wth the deveopment of |umpers knee, but ts roe s not as
cear. These weak musces ncude the quadrceps and gastrocnemus,
but research hasnt been abe to dstngush whether ths weakness s a
cause or ehect of the pathoogy.
9
Fnay, natura |umpng abty may
actuay have a detrmenta ehect on the ntegrty of an athetes
patear tendon. In what has become known as the |umpers knee
paradox, athetes who show the abty to |ump hgher than ther
counterparts are actuay more susceptbe to deveopng patear
tendnopathy.
Patear tendnts and utmatey tendnopathy have proven to be
among the most common debtatng pathooges n skeetay mature
aduts.
4
Neary one thrd of ete basketba payers suher from chronc
patear tendnopathy, whe the rate n ete voeyba payers reaches
a staggerng 45%.
10
However, the prevaence of patear tendnopathy
can aso reach aarmng heghts n sports where |umpng mechancs
arent necessary a prorty. Recurrng bouts of md tendnopathy
have been found n over one fourth of ete soccer payers, and n
neary one haf of veteran track and ed athetes (veteran dened as
35 years or oder).
10,11
Another factor shown to have a ro n the
deveopment of patear tendnopathy s gender. Research ndcates
that the ncdence of batera tendnopathy s equa n both maes and
femaes, but maes are twce as key to deveop unatera
tendnopathy.
4

The two most popuar evauaton technques used for patear
tendnts nvove papatng the nferor poe of the patea. The rst
cnca evauaton entas papaton of the patear tendon whe the eg
s n passve extenson, and then agan wth the knee exed at 90. For
both of these papatons, the patent shoud be yng n the supne
poston. A postve sgn woud be reduced pan and tenderness whe
the knee s n the exed poston. The other cnca evauaton nvoves
papaton of the patear tendon whe standng on the eg n fu
extenson, and then wth the knee bent 30. For these papatons, the
eg beng tested shoud be n a fu weght bearng poston. A postve
sgn woud be pan reef as the quadrceps contract.
5
Shoud the
cncan decde that further evauaton s needed, utrasound
represents the best magng method to evauate for patear tendnts
and tendnopathy. Studes usng coor Dopper utrasound to assess
patear tendnopathy have reveaed ncreased vascuarzaton and
bood ow to the areas where patents descrbe feeng pan. These
changes n vascuarzaton were often accompaned by structura
changes to the tendon, but as pan symptoms decreased, ow to these
vesses ceased. Resuts usng utrasound were not aways concusve,
but these pathoogca changes seem to be drecty reated to the
bodys response to patear tendnopathy.
12
Athough the cnca understandng of patear tendnts and
tendnopathy has ncreased over the past severa years, treatment for
these pathooges remans a very controversa topc. One study
examnng prevous pubcatons on patear tendnopathy treatment
concuded that eccentrc musce tranng was the most ehectve way to
treat patear tendnopathy.
13
Yet, a smar study dsputes ths
concuson, sayng nstead that eccentrc-concentrc sotonc oadng s
the most ehectve treatment and that evdence supportng eccentrc
oadng was conctng.
14
Research nvestgatng surgca procedures to
correct patear tendnopathy s aso ackng concusveness. In hghy
degeneratve cases, athetes may opt to have open knee surgery to
reeve some of the stress on ther patear tendon. It has been
suggested that arthroscopc knee surgery may produce better resuts
than open surgery, but there hasnt been sgncant evdence to
support ths theory. However, arthroscopc knee surgery can nvove
fewer compcatons due to ts mnmay nvasve technque.
15

Cncans have started expermentng wth more progressve methods
to treat patear tendnopathy, but they are st ackng scentc
support. Pateet-rch pasma n|ectons have become a popuar new
approach due to the possbty of acceerated heang tmes and
emnatng the need for surgery. Outcomes for these n|ectons have
been promsng for the most part, but n some cases they have
produced adverse ehects. Therefore, cncans shoud exercse cauton
n prescrbng these treatments unt more evdence becomes
avaabe.
16
Whe patear tendnts and tendnopathy are prevaent
throughout the sports word, the mechansms responsbe for damagng
the patea are st not fuy understood. Cncans are wthout
concusve evdence as to what exacty causes these pathooges, and
ths makes t even more dmcut for them to evauate for and treat
such n|ures. Future research must contnue to address these ssues f
cncans are to provde the best care possbe for a athetes suherng
from ths debtatng knee ssue. Wthout ths research, advancements
n the evauaton technques, determnaton of rsk factors, and
treatment of patear tendnopathy s not key.
References
1. M.D |C. Learn to Dagnose and Treat Patear Tendonts. Aboutcom
Orthop. 2014. Avaabe at:
http://orthopedcs.about.com/cs/pateadsorders/a/pateartendon.
htm. Accessed |uy 26, 2014.
2. Patear Tendon Tear-OrthoInfo - AAOS. Avaabe at:
http://orthonfo.aaos.org/topc.cfm?topc=a00512. Accessed |uy
26, 2014.
3. |umpers Knee | Patear tendonts Treatment, Rehabtaton,
Exercses. Avaabe at: http://www.sportsn|urycnc.net/sport-
n|ures/knee-pan/|umpers-knee. Accessed |uy 26, 2014.
4. |umpers Knee. 2013. Avaabe at:
http://emedcne.medscape.com/artce/89569-overvew. Accessed
|uy 26, 2014.
5. Rath E, Schwarzkopf R, Rchmond |C. Cnca sgns and anatomca
correaton of patear tendnts. Indian J Orthop. 2010;44(4):435-
437.
6. Lavagnno M, Arnoczky SP, Evn N, Dodds |. Patear Tendon Stran
Is Increased at the Ste of the |umpers Knee Leson Durng Knee
Fexon and Tendon Loadng Resuts and Cadaverc Testng of a
Computatona Mode. Am J Sports Med. 2008;36(11):2110-2118.
7. Hae SA. Etoogy of Patear Tendnopathy n Athetes. J Sport
Rehabil. 2005;14(3):258.
8. Vsnes H, Aandah HA, Bahr R. |umpers knee paradox--|umpng
abty s a rsk factor for deveopng |umpers knee: a 5-year
prospectve study. Br J Sports Med. 2013;47(8):503-507.
9. Tan SC, Chan O. Aches and patear tendnopathy: Current
understandng of pathophysoogy and management. Disabil
Rehabil. 2008;30(20-22):1608-1615.
10. Hggund M, Zwerver |, Ekstrand |. Epdemoogy of Patear
Tendnopathy n Ete Mae Soccer Payers. Am J Sports Med.
2011;39(9):1906-1911.
11. Longo UG, Rttweger |, Garau G, et a. Patear tendnopathy n
master track and ed athetes: nuence of mpact proe, weght,
heght, age and gender. Knee Surg Sports Traumatol Arthrosc.
2011;19(3):508-512.
12. Hoksrud A, hberg L, Afredson H, Bahr R. Coor Dopper
Utrasound Fndngs n Patear Tendnopathy (|umpers Knee). Am J
Sports Med. 2008;36(9):1813-1820.
13. Larsson M, K I, Nsson-Heander K. Treatment of patear
tendnopathy-a systematc revew of randomzed controed tras.
Knee Surg Sports Traumatol Arthrosc. 2012;20(8):1632-1646.
14. Maaras P, Barton C, Reeves N, Langberg H. Aches and Patear
Tendnopathy Loadng Programmes. Sports Med. 2013;43(4):267-
286.
15. Marcheggan Mucco G, Zahagnn S, Tsapras K, et a. Open
versus arthroscopc surgca treatment of chronc proxma patear
tendnopathy. A systematc revew. Knee Surg Sports Traumatol
Arthrosc. 2013;21(2):351-357.
16. Progresson of patear tendnts foowng treatment wth pateet-
rch pasma: case reports - Sprnger.
Stephen Escobar
MSAT 6500
7/24/14
Evaluation of Existing Research Pertaining to Patellar
Tendinitis and Tendinopathy