Preventing Patellar Tendinitis
Abstract & Commentary
Synopsis: In a prospective study, quadriceps tightness was the leading predictor of athletes developing patellar tendinitis.
Source: Witvrouw E, et al. Intrinsic risk factors for the development of patellar tendinitis in an athletic population. Am J Sports Med. 2001;29(2):190-195.
Patellar tendinitis symptoms are common in athletes, and numerous intrinsic and extrinsic factors have been assessed for contributing to its development. However, prospective studies are lacking, until now. Witvrouw and colleagues from Belgium used a captive audience of 480 students that were involved in an aggressive physical education program that included 12-14 hours of sports per week. The physician and therapist prospectively followed the patients after initial assessment. Numerous measures were obtained, including leg alignment, any leg length discrepancy, Q-angle, muscular tightness, muscular strength with isokinetic testing, and history. Patients with a history of prior patellofemoral problems were excluded. After these exclusions plus any patients that were noncompliant with the program, Witvrouw et al were left with 138 student-athletes who were followed over 2 years. Sports participation was carefully documented as well as any outside activities beyond the scope of the study.
During these 2 years, 19 of the 138 athletes developed patellar tendinitis. This was diagnosed by tenderness and pain localized to the patellar tendon insertion on the patella and was confirmed by ultrasound. Of all the variables measured, only muscular tightness reached statistical significance. Those athletes developing patellar tendinitis had quadriceps flexibility of only 86° compared to those who did not develop symptoms having a mean flexibility of 132°. A similar though less striking result was seen for hamstring tightness with 84° vs. 101° for the popliteal angle. Strength, Q-angle, alignment, gender, and sports-specific activities all did not reach statistical significance.
Comment by David R. Diduch, MS, MD
Patellar tendinitis is a common complaint of athletically active individuals. Although numerous intrinsic factors have been assessed, such as leg alignment or muscular imbalance, as well as extrinsic factors such as variations in training surfaces, methods, or footwear, little data exist that have been obtained in a standardized, prospective fashion. Witvrouw et al are to be congratulated for constructing a prospective study that, I am sure, was difficult to perform with these large athlete numbers over 2 years. The data appear convincing. Athletes with quadriceps tightness definitely appear to be at risk for developing patellar tendinitis.
The take-home message is clear. During screening physical exams, as well as at any opportunity that we have, we should look for quadriceps tightness and, to a lesser degree, hamstring tightness in our athletes. Those should be addressed early with an appropriate stretching program in hopes of preventing patellar tendinitis that would cause them to miss participation.
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