Characterising the proximal patellar tendon attachment and its relationship to skeletal maturity in adolescent ballet dancers

TY - JOUR

T1 - Characterising the proximal patellar tendon attachment and its relationship to skeletal maturity in adolescent ballet dancers

AU - Rudavsky, Aliza

AU - Cook, Jillianne

AU - Magnusson, Stig Peter

AU - Kjaer, Michael

AU - Docking, Sean

PY - 2017/4

Y1 - 2017/4

N2 - Background: It is unknown how and when the proximal attachment of the patellar tendon matures; puberty may be key in ensuring normal tendon formation. The aim of this study was to investigate the features of the proximal patellar tendon attachment at different stages of skeletal maturity, to help gain an understanding of how and when the tendon attachment matures. Methods: Sixty adolescent elite ballet students (ages 11-18) and eight mature adults participated. Peak height velocity (PHV) estimated skeletal maturity. Ultrasound tissue characterisation (UTC) scan was taken of the left knee and analysed for stability of echopattern. An image-based grading scale for greyscale ultrasound was developed to describe the tendon appearance. Anterior-posterior thickness was measured at the inferior pole of the patella, 1 and 2 centimetres distally. Outcomes were compared with skeletal maturity. Results: Mid-portion patellar tendon thickness increased with skeletal maturity (p=0.001 at 1cm and p=0.007 at 2 cm). There was more variance in structural appearance (greyscale classification and UTC echopattern) in pre and peri-PHV participants. Tendon attachment one-year post PHV appeared similar to mature tendons. Conclusions: Early adolescence was associated with highly variable tendon appearance, whereas the tendon appeared mature after PHV. Adolescence may be a critical time for the formation of normal tendon attachment. Level of evidence: IIb individual cohort study.

AB - Background: It is unknown how and when the proximal attachment of the patellar tendon matures; puberty may be key in ensuring normal tendon formation. The aim of this study was to investigate the features of the proximal patellar tendon attachment at different stages of skeletal maturity, to help gain an understanding of how and when the tendon attachment matures. Methods: Sixty adolescent elite ballet students (ages 11-18) and eight mature adults participated. Peak height velocity (PHV) estimated skeletal maturity. Ultrasound tissue characterisation (UTC) scan was taken of the left knee and analysed for stability of echopattern. An image-based grading scale for greyscale ultrasound was developed to describe the tendon appearance. Anterior-posterior thickness was measured at the inferior pole of the patella, 1 and 2 centimetres distally. Outcomes were compared with skeletal maturity. Results: Mid-portion patellar tendon thickness increased with skeletal maturity (p=0.001 at 1cm and p=0.007 at 2 cm). There was more variance in structural appearance (greyscale classification and UTC echopattern) in pre and peri-PHV participants. Tendon attachment one-year post PHV appeared similar to mature tendons. Conclusions: Early adolescence was associated with highly variable tendon appearance, whereas the tendon appeared mature after PHV. Adolescence may be a critical time for the formation of normal tendon attachment. Level of evidence: IIb individual cohort study.

KW - Ballet students

KW - Jumper’s knee

KW - Jumping athletes

KW - Patellar tendon development

KW - Skeletal maturity

KW - Ultrasound tissue characterisation

U2 - 10.11138/mltj/2017.7.2.306

DO - 10.11138/mltj/2017.7.2.306

M3 - Journal article

C2 - 29264342

AN - SCOPUS:85029789552

SN - 2240-4554

VL - 7

SP - 306

EP - 314

JO - Muscles, Ligaments and Tendons Journal

JF - Muscles, Ligaments and Tendons Journal

IS - 2

ER -