Patellar Tendinopathy and Potential Risk Factors: An International Database of Cases and Controls.

<h3>Background</h3> Patellar tendinopathy (PT) is an injury which has a high prevalence in sports, especially in those involving jumping. Because successful treatment of PT remains challenging, prevention is of utmost importance. Before effective prevention programs can be developed, it is important to identify the risk factors that play a role in the development of this injury. <h3>Objective</h3> The aim of this study was to review the literature and to identify risk factors associated with PT. <h3>Design</h3> Systematic review of the literature. <h3>Setting</h3> A search of the Pubmed, EMBASE and AMED databases was conducted to identify studies. Studies were included in the systematic review if they contained: (1) empirical research that investigated factors associated with PT; and (2) a patient group with PT and a comparison group (or tested for differences across groups in a cross-sectional survey). <h3>Assessment of risk factors</h3> The methodological quality of the studies was assessed with a methodological quality assessment list. A strength of evidence criterion was used to identify risk factors. This criterion took into account the percentage of studies that found an association for a factor and the methodological quality of these studies. <h3>Results</h3> 11 studies were included in the review investigating over 40 potential risk factors. The overall methodological quality score of the studies was low. Potential risk factors were categorised in four groups; demographics, anthropometrics, sports related factors and strength/flexibility. The present review found evidence for two risk factors for PT: waist-to-hip ratio and hip and knee flexibility. <h3>Conclusion</h3> Waist-to-hip ratio and hip and knee flexibility were identified as risk factors for PT. There is a clear need for high quality studies in order to identify the exact risk factors associated with PT.

Introduction: Tendinopathy of the patellar ligament, often referred to as “jumper's knee,” is a significant health problem for athletes subjected to repeated knee strains. The condition, resulting from microtrauma and degeneration of collagen fibers, leads to chronic pain and impaired function of the patellar ligament. Aim of the study: The aim of this study was to present current knowledge about new techniques to prevent and treat patellar tendinopathy. Analyzing current informations, understanding risk factors, and recognizing pathophysiology of patellar tendinopathy can prevent many sportsmen to withdraw from competitions. Materials and methods: A systematic review of scientific and medical literature from the PubMed and Google Scholar databases was conducted. Results: A review of the literature has identified key risk factors for patellar ligament tendinopathy. An analysis of available studies indicates that various therapeutic interventions, including shockwave therapy, eccentric exercise programs can provide pain relief and improve patellar ligament function. However, the effectiveness of these methods may vary depending on individual patient characteristics. Conclusions: Recognition of risk factors, early education and prevention, and prompt introduction of treatment at an early enough stage of the disease allow for the best treatment results and rapid return of patients to sports activities before the onset of pain, and significantly improve patients' quality of life. These findings underscore the comprehensive nature of the management of patellar ligament tendinopathy, including both therapeutic and preventive interventions. Keywords: patellar tendinopathy, orthopeadics, sport medicine, knee

Objective The aim of the present study is to determine whether previous shoulder and knee injuries were associated with isokinetic fatigue index and agonist/antagonist ratio of shoulder internal/external rotators and knee flexors/extensors in male volleyball athletes. Methods The current study is a cross-sectional investigation of 49 male elite volleyball players competing at a high level in Brazil. Isokinetic fatigue index and agonist/antagonist profiles were assessed during the preseason. Additionally, in order to record previous injuries, the athletes answered a standardized questionnaire. We conducted a receiver operating characteristic (ROC) curve analysis to determine the association strength and the clinically relevant cut-off point for variables presenting statistical significance for the area under the curve (AUC) (α = 0.05). An independent t-test was used to compare isokinetic variables between athletes with and without previous injury (α = 0.05). Results The results of the ROC curve analysis indicated that hamstring fatigue index values at 300 o /s were associated with the presence of previous knee injury (area under the curve [AUC] = 73%, p = 0.004), and shoulder external rotators fatigue index values at 360°/s were not associated with the presence of previous shoulder injury (AUC = 68%, p = 0.053). Conclusions Elite volleyball athletes who reported previous knee injuries were prone to a higher fatigue index than those reporting no injuries. Knee flexor resistance training might be useful for those athletes who reported knee injuries in the previous season.

This study aimed at evaluating the burden and risk factors of patellar and Achilles tendinopathy among youth basketball players. Patellar and Achilles tendinopathy were prospectively monitored in 515 eligible male and female youth basketball players (11–18 years) through a competitive season. Overall, the season prevalence of patellar tendinopathy was 19.0% (95% CI: 15.7–22.7%), 23.2% (95% CI: 18.6–28.2%) in males and 12.5% (95% CI: 8.3–17.9%) in females. The season prevalence of Achilles tendinopathy was 4.3% (95% CI: 2.7–6.4%), 4.1% (95% CI: 2.2–7.0%) in males and 4.5% (95% CI: 2.1–8.4%) in females. Median proportion of symptoms duration was 83% of average total weeks of basketball exposure for patellar tendinopathy and 75% for Achilles tendinopathy. Median time to patellar tendinopathy onset was 8 weeks for male players and 6 weeks for female players. Higher odds of patellar tendinopathy risk were seen in males (OR: 2.23, 95% CI: 1.10–4.69) and players with previous anterior knee pain had significantly elevated odds (OR: 8.5, 95% CI: 4.58–16.89). The burden and risk of patellar tendinopathy is high among competitive youth basketball players. Risk factors include sex and previous anterior knee pain. These findings provide directions for practice and future research.

Background: Patellar tendinopathy is common among athletes in jumping sports and in sports with prolonged repetitive stress of the knee extensor apparatus. The epidemiology in soccer is not well described. Purpose: This study was undertaken to investigate and describe the epidemiology of patellar tendinopathy in elite male soccer players and evaluate potential risk factors. Study Design: Cohort study; Level of evidence, 2. Methods: Between 2001 and 2009, the authors followed 51 European elite soccer clubs (2229 players) from 3 different cohorts: the Swedish First League cohort (SWE) and Union of European Football Associations (UEFA) Champions League cohort (UCL), both playing on natural grass; and the Artifical Turf cohort (ART), playing on third-generation artificial turf. Individual player exposure in training and matches and time-loss injuries were recorded. Results: In total, 137 patellar tendinopathies were recorded, comprising 1.5% of all injuries and corresponding to an incidence of 0.12 injuries/1000 hours. Each season, 2.4% of players were affected, with most injuries (61%) resulting in absence up to 1 week or less. Twenty percent of tendinopathies were recurrent complaints. No significant difference in season prevalence (odds ratio [OR], 0.93; 95% confidence interval [CI], 0.60-1.44; P = .74) or incidence (rate ratio [RR] 1.20; 95% CI, 0.82-1.75; P = .36) was observed between teams playing on artificial turf and natural grass, respectively. Multivariate logistic regression showed that a high total exposure hours (OR, 1.02 per 10-hour increase; 95% CI, 1.00-1.04; P = .033) was a significant risk factor for patellar tendinopathy, and increased body mass was borderline significant (OR, 1.15 per 5-kg increase; 95% CI, 1.00-1.33; P = .055). In addition, 2 acute partial tendon ruptures were recorded, but no total rupture. Conclusion: Although mainly mild in nature, patellar tendinopathy is a fairly common condition in elite soccer and the recurrence rate is high. Exposure to artificial turf did not increase the prevalence or incidence of injury. High total amount of exposure was identified as a risk factor for patellar tendinopathy.

Objectives(1) To determine the association between patellar tendon stiffness and the presence of patellar tendinopathy (PT). (2) To evaluate the reliability of shear-wave elastography (SWE).MethodsParticipants were consecutively enrolled between January 2017 and June 2019. PT was diagnosed clinically and confirmed by either grayscale US or power Doppler US, or both. Controls had no history of anterior knee pain and no clinical signs of PT. Patellar tendon stiffness (kilopascal, kPa) was assessed using SWE. Logistic regression was used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Reliability analyses included coefficients-of-variation (CV), coefficients-of-repeatability (CR), intraclass correlation coefficient (ICC) for intraobserver and interobserver reliability, and Bland-Altman analysis.ResultsIn total, 76 participants with PT (58 men, mean age 24.4 ± 3.8 years) and 35 asymptomatic controls (16 men, mean age 21.5 ± 3.8 years) were included. Univariate analyses (OR 1.094, 95% CI 1.061–1.128, p < .001) and adjusted multivariate analyses (OR 1.294, 95% CI 1.044–1.605, p = .018) showed that athletes with PT had significantly increased patellar tendon stiffness. ICC for intraobserver reliability was 0.95 (95% CI 0.92–0.97), CR (CV) 12 kPa (10%) and 0.79 (95% CI 0.65–0.88), CR (CV) 18 kPa (21%) for interobserver reliability. Mean differences from Bland-Altman analysis were 5.6 kPa (95% CI 3.1–8.1, p < .001) for intraobserver reliability and 4.6 kPa (95% CI 1.9–7.2, p < .001) for interobserver reliability.ConclusionsPT is associated with significantly higher patellar tendon stiffness. SWE measurements demonstrate excellent intraobserver reliability and good interobserver reliability. Therefore, SWE is a promising tool to implement in longitudinal studies and future studies should evaluate its prognostic value and utility as a monitoring tool in athletes with PT.Key Points• Patellar tendon stiffness measured with shear-wave elastography (SWE) is higher in athletes with patellar tendinopathy than in healthy controls, also after adjusting for potential confounders.• Excellent intraobserver reliability and good interobserver reliability were found for the quantitative assessment of patellar tendon stiffness using SWE.

Infantile hemangioma (IH) is one of the most common tumors in infants. Its pathogenesis is complex and poorly understood. The risk factors of IH have been extensively studied from clinical and epidemiological perspectives in recent years, but the conclusions in the literature reports are inconsistent. To provide a reference for the prevention of hemangioma, we conducted a meta-analysis of the published studies of potential risk factors for IH. The Cochrane Library, Ovid, PubMed, and Web of Science databases were searched systematically. Log odds ratios (log ORs), logistic regression standard errors and 95% confidence intervals (CIs) were used to compare the correlation between IH and potential risk factors. Review Manager 5.3.3 was used for the statistical analysis. Six studies were included and 17 potential risk factors were eventually evaluated. P values < 0.05 were found for female gender (P < 0.01, OR 2.04, 95% CI 1.65-2.51), low birth weight (P < 0.01, OR 4.39, 95% CI 3.05-6.31), multiple gestation (P = 0.01, OR 2.39, 95% CI 1.21-4.71), preterm birth (P = 0.03, OR 2.37, 95% CI 1.07-5.23), progesterone therapy (P < 0.01, OR 2.73, 95% CI 2.12-3.51), and family history (P = 0.01, OR 1.98, 95% CI 1.16-3.38). This meta-analysis revealed that risk factors, including female gender, low birth weight, multiple gestation, preterm birth, progesterone therapy, and family history may affect the occurrence of IH.

Although the majority of patients with patellar tendinopathy (PT) can be treated nonoperatively, operative management may be indicated for recalcitrant cases. While several surgical techniques have been described, there is limited understanding of postoperative outcomes and expectations regarding return to activity and sport. The purpose of this study was to characterize the clinical outcomes associated with the surgical management of PT with an emphasis on return to sport (RTS) rates. We hypothesized that surgical management would lead to clinically important improvements in patient-reported outcomes (PROs) with high rates of RTS and RTS at the same level. A comprehensive search of the PubMed, Medline, and Embase databases was performed in December 2020. Level of evidence studies I through IV, investigating results of surgical management for PT (PRO, functional outcomes, pain, and/or RTS), were included. The search was performed in accordance with the Preferred Reported Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Forty clinical studies reporting on surgery for PT satisfied inclusion criteria, with 1,238 total knees undergoing surgery for PT. A comparison of pre- and postoperative Victorian Institute of Sport Assessment, patellar tendon (VISA-P) scores (mean difference: 41.89, p < 0.00001), Lysholm scores (mean difference: 41.52, p < 0.00001), and visual analogue scale (VAS) pain scores (mean difference: 5, p < 0.00001) demonstrated clinically and statistically significant improvements after surgery. The overall RTS rate following operative management was 89.8% (95% confidence interval [CI]: 86.4-92.8, I 2 = 56.5%) with 76.1% (95% CI: 69.7.5-81.9, I 2 = 76.4%) of athletes returning to the same level of activity. Surgery for PT provides meaningful improvement in patient reported outcomes and pain while allowing athletes to RTS at high rates with levels of participation similar to that of preinjury. Comparative studies of open and/or arthroscopic surgery are still limited but current evidence suggests better rates of RTS for arthroscopic surgery compared with open surgery. This is a systematic review of level-I to -IV studies.

Association of Metabolic Syndrome With Proximal and Synchronous Colorectal Neoplasm

Desmoid Tumors in a Dutch Cohort of Patients With Familial Adenomatous Polyposis

Central Adiposity and Risk of Barrett’s Esophagus

Hamstring muscle strain-type injuries are common in sports that involve sprinting,1 acceleration, deceleration, rapid change in direction and jumping.2 ,3 Occurring in both recreational and professional sports, these injuries can...

Neutrophil-to-lymphocyte ratio on admission is an independent risk factor for the severity and mortality in patients with coronavirus disease 2019

PurposeAnterior cruciate ligament (ACL) injuries are a common severe type of football injury at all levels of play. A football-specific ACL registry providing both prospective ACL injury data according to the skill level and risk factors for ACL injury is lacking in the literature.MethodsThis study is based on the prospective ‘ACL registry in German Football’ implemented in the 2014–15 season. Professional (1st–3rd league), semi-professional (4th–6th league) and amateur leagues (7th league) were analysed regarding the incidence and risk factors for ACL injuries. Injuries were registered according to the direct reports of the injured players to the study office and double-checked via media analysis. After injury registration, the players received a standardised questionnaire. Data were analysed from the 2014–15 to the 2018–19 football season.ResultsOverall, 958 ACL injuries were registered during the 5-year study period. The incidence of ACL injuries was highest in amateur football (0.074/1000 h football exposure) compared to professional (0.058/1000 h; p < 0.0001) and semi-professional football (0.043/1000 h; p < 0.0001). At all skill levels, match incidence (professional: 0.343; semi-professional: 0.249; amateur: 0.319) was significantly higher than training incidence (professional: 0.015; semi-professional: 0.004; amateur: 0.005). Major risk factors were previous ACL injury (mean: 23.3%), other knee injuries (mean: 19.3%) and move to a higher league (mean: 24.2%).ConclusionThis sports-specific ACL registry provides detailed information on the incidence and risk factors for ACL injuries in football over five years. Risk factors are skill level, match exposure, move to a higher league and previous knee injury. These factors offer potential starting points for screening at-risk players and applying targeted prevention.Level of evidenceII.

BackgroundSport injuries are now becoming a major issue affecting training in paddle sports. This study was to investigate the distribution and prevalence of injuries among adolescent flat-water kayak and canoe athletes.MethodsWe performed a retrospective design study to survey one-hundred forty Chinese elite adolescent flat-water kayak and canoe athletes (89 kayakers and 51 canoers; 81 males and 59 females, with an average age of 16 years) using a self-reported questionnaire. The questionnaire investigated basic information and kayak- and canoe-related injuries over the past year. The primary outcome measures were the distribution of kayak- and canoe-related injuries and the injury rate per 1,000 training hours with a 95% confidence interval (CI).ResultsA total of 207 injuries were reported from all the participants, including 138 injuries related to flat-water kayak and 69 injuries related to canoe. The most common injured site in flat-water kayak athletes was the lower back, followed by the shoulder, wrist, and knee. In flat-water canoe athletes, the most common injured site was the shoulder, followed by the lower back, back, and knee. Regarding injury rates, the flat-water kayak athletes showed 0.90 injuries per 1,000 training hours (95% CI = 0.75–1.05). The female kayak athletes had 1.02 injuries per 1,000 training hours (95% CI = 0.81–1.23), while the male kayak athletes had 0.74 injuries per 1,000 training hours (0.53–0.95). Notably, the injury rate per 1,000 training hours was significantly higher in female canoe athletes (1.51, 95% CI = 1.05 to 1.98) than in male canoe athletes (0.47, 95% CI = 0.30 to 0.64).ConclusionThe findings indicated that flat-water kayak- and canoe-related injuries mostly involved in the shoulder and lower back among Chinese elite adolescent athletes, with female athletes, particularly in canoe, being more susceptible to injury. These insights are critical for enhancing athlete injury prevention strategies and providing coaches and athletes with comprehensive reference data on injury.