title: At What Age Do Children and Adolescents Develop Lower Limb Tendon Pathology or Tendinopathy? A Systematic Review and Meta-analysis.
abstract: BACKGROUND
  Tendon pathology and tendinopathy have been reported in children and adolescents; however, the age at onset and prevalence of the conditions have not been examined systematically.
  
  
  OBJECTIVE
  To examine the prevalence of lower limb tendon pathology and tendinopathy in children and adolescents, and the factors associated with these conditions in this population.
  
  
  METHODS
  Six databases were searched (MEDLINE, the Cochrane Central Register of Controlled Trials, Embase, Scopus, the Web of Science and the Allied and Complementary Medicine Database). Studies were included if the prevalence of lower limb tendon pathology and/or tendinopathy were reported in humans under the age of 18 years. Studies were divided according to the method of diagnosis (physical examination, ultrasound or a questionnaire) and further divided into studies that reported prevalence data by tendon [reported two data points (right and left) for each participant] and those that reported prevalence data for each participant [reporting one data point (right or left) per participant].
  
  
  RESULTS
  Seventeen studies met the inclusion criteria. Lower limb tendinopathy prevalence (presence of pain and dysfunction) ranged between 8.2 and 33.3%, and increased in prevalence as age increased up to 18 years. The odds ratio for studies reporting tendinopathy by tendon was 0.37 (95% confidence interval 0.20-0.69) in favour of boys presenting with tendinopathy. Study aims and reporting methods were heterogeneous.
  
  
  CONCLUSIONS
  The age at onset of lower limb tendinopathy in children and adolescents has not been widely studied. This systematic review found that tendinopathy is present in children and adolescents, and increases in prevalence with age up to 18 years. Male sex is significantly associated with tendinopathy in studies that report tendinopathy by tendon.
authors.affiliation: Department of Physiotherapy, Monash University Peninsula, Building G, McMahons Road, Frankston, Melbourne, VIC, 3199, Australia. mitchell.simpson92@gmail.com.
authors.forename: Mitchell
authors.initials: M
authors.lastname: Simpson
authors.affiliation: Department of Physiotherapy, Monash University Peninsula, Building G, McMahons Road, Frankston, Melbourne, VIC, 3199, Australia.
authors.forename: Ebonie
authors.initials: E
authors.lastname: Rio
authors.affiliation: Department of Physiotherapy, Monash University Peninsula, Building G, McMahons Road, Frankston, Melbourne, VIC, 3199, Australia.
authors.forename: Jill
authors.initials: J
authors.lastname: Cook
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D005260:Female; D006801:Humans; D035002:Lower Extremity / Q000473:pathology*; D008297:Male; D011627:Puberty; D012737:Sex Factors; D052256:Tendinopathy / Q000453:epidemiology*; D013710:Tendons / Q000473:pathology*; D055815:Young Adult