- Title
- Anterior knee pain and patellar tendon development in adolescent athletes
- Creator
- Harris, Meaghan
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2022
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Background: Adolescent athletes who frequently run, jump, land, and change direction in their sport often self-report anterior knee pain (AKP). Adolescence is a critical time point, marked by rapid periods of musculoskeletal growth. The patellar tendon is one structure implicated in AKP. Diagnostic imaging of the patellar tendon using ultrasound may reveal alterations in tendon structure (i.e., patellar tendon abnormality (PTA)), which is a risk factor for the development of a type of AKP; patellar tendinopathy. Diagnostic imaging in a non-invasive technique that may identify at what time point these abnormalities develop. Aim: This thesis investigated adolescent athletes who jump, land, and change direction in their sport. Our aim was to (1) identify the point prevalence of AKP; (2) quantify changes in proximal patellar tendon structure over a longitudinal three-year period and; (3) investigate the development of proximal PTA(s) over a longitudinal three-year period. Methods: Two hundred and seventeen adolescent male and female athletes (11 to 15 years) were recruited for this longitudinal multi-site study from sporting programs of basketball, Australian Rules football, volleyball, and tennis. Biannually for up to a three-years, data was collected: a single leg decline squat, performed bilaterally by participants who then reported, if present, the level of AKP on a visual analogue score; bilateral ultrasound tissue characterisation (UTC) scans of the patellar tendon to quantify tendon structure into four echotypes and anthropometric measurements to quantify maturation status. Generalised additive models and generalised additive mixed models were used to assess change in echotype by chronological age and maturation status. Results: Point prevalence of AKP for adolescent athletes was 39% (n=76); irrespective of chronological age, maturation status, sport played or sex. For athletes who maintained normal patellar tendon structure (no abnormality), their tendon structure demonstrated a stronger linear association with skeletal maturity over chronological age alone. The proximal tendon attachment was shown to improve in structure with increased maturity offset. Patellar tendon abnormalities appeared inert i.e., they did not improve or worsen, despite these athletes remaining in environments of high external load. Sex differences are observed in the timing of the onset of development of PTA during adolescent with development of PTA occurring one year after their peak growth spurt in males but most often one year either side of their peak growth spurt in females. Conclusions: The high prevalence of AKP found within this thesis highlights that it affects adolescent athletes of all ages, sexes, and different sporting codes. Its clinical management during adolescence is of critical concern for future research to address. When assessing tendon structure during adolescence, maturity status was found to provide a better indicator of tendon development and thus should be considered by clinicians when assessing adolescent athletes at risk of developing tendon problems. Even when an adolescent athlete develops a PTA, their overall tendon structure continues to improve and the proportion of disorganised tissue structure in these abnormal tendons appears inert despite continued exposure to high loading environments. Novel findings of sex and maturational differences in the onset of PTA warrants further exploration, particularly as it relates to exposure to loading at critical time points.
- Subject
- patellar tendon; imaging; adolescence; maturation; ultrasound; basketball; volleyball
- Identifier
- http://hdl.handle.net/1959.13/1513639
- Identifier
- uon:56753
- Rights
- Copyright 2022 Meaghan Harris
- Language
- eng
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