title: Patellar tendon morphology in volleyball athletes with and without patellar tendinopathy.
abstract: Appropriate management of patellar tendinopathy requires distinguishing between inflammatory and degenerative conditions, often difficult because tendon thickening can be a normal or pathological adaptation, and micromorphology is not observable on clinical imaging. The purpose of this study was to quantitatively examine patellar tendon micro- and macromorphology in volleyball athletes and relate those findings to reported symptoms. Longitudinal ultrasound images of proximal and distal patellar tendons were acquired from 84 male elite volleyball athletes (44 symptomatic, 40 asymptomatic) and 10 asymptomatic nonathlete controls. Micromorphology was determined using two-dimensional Fast Fourier Transform analysis providing a discriminating peak spatial frequency parameter (PSF). Macromorphology (patellar tendon thickness) was measured using Image J software. All athletes regardless of symptoms had thicker proximal tendons compared to nonathletes, suggesting a normal adaptation to training loads. However, symptomatic athletes demonstrated lower PSF than asymptomatic athletes and nonathletes at the proximal tendon, suggesting greater collagen disorganization, and tendon degeneration rather than inflammation. Only symptomatic athletes had thicker distal tendons than nonathletes, but there was no difference in PSF distally. Diagnostic ultrasound enhances the understanding of the micromorphology of patellar tendons, supporting the rationale for management that remodels the degenerated tendon instead of treating inflammation.
authors.affiliation: Jacquelin Perry Musculoskeletal Biomechanics Research Laboratory, University of Southern California, Los Angeles, California 90089, USA. kulig@usc.edu
authors.forename: K
authors.initials: K
authors.lastname: Kulig
authors.forename: R
authors.initials: R
authors.lastname: Landel
authors.forename: Y-J
authors.initials: YJ
authors.lastname: Chang
authors.forename: N
authors.initials: N
authors.lastname: Hannanvash
authors.forename: S F
authors.initials: SF
authors.lastname: Reischl
authors.forename: P
authors.initials: P
authors.lastname: Song
authors.forename: G R
authors.initials: GR
authors.lastname: Bashford
mesh_terms: D000704:Analysis of Variance; D058070:Asymptomatic Diseases; D016022:Case-Control Studies; D005583:Fourier Analysis; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D017847:Patellar Ligament / Q000000981:diagnostic imaging*; D052256:Tendinopathy / Q000000981:diagnostic imaging*; D014463:Ultrasonography; D054798:Volleyball / Q000502:physiology*; D055815:Young Adult