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Risk factors for patellar tendinopathy: a review of the literature
  1. H van der Worp1,
  2. M van Ark1,
  3. S D Roerink1,
  4. G J Pepping2,
  5. I van den Akker-Scheek1,
  6. J Zwerver1
  1. 1Center for Sports Medicine, University Medical Center Groningen, University Center for Sport, Exercise and Health, Groningen, The Netherlands
  2. 2Center for Human Movement Sciences, University Medical Center Groningen, Groningen, The Netherlands


Background Patellar tendinopathy (PT) is an injury which has a high prevalence in sports, especially in those involving jumping. Because successful treatment of PT remains challenging, prevention is of utmost importance. Before effective prevention programs can be developed, it is important to identify the risk factors that play a role in the development of this injury.

Objective The aim of this study was to review the literature and to identify risk factors associated with PT.

Design Systematic review of the literature.

Setting A search of the Pubmed, EMBASE and AMED databases was conducted to identify studies. Studies were included in the systematic review if they contained: (1) empirical research that investigated factors associated with PT; and (2) a patient group with PT and a comparison group (or tested for differences across groups in a cross-sectional survey).

Assessment of risk factors The methodological quality of the studies was assessed with a methodological quality assessment list. A strength of evidence criterion was used to identify risk factors. This criterion took into account the percentage of studies that found an association for a factor and the methodological quality of these studies.

Results 11 studies were included in the review investigating over 40 potential risk factors. The overall methodological quality score of the studies was low. Potential risk factors were categorised in four groups; demographics, anthropometrics, sports related factors and strength/flexibility. The present review found evidence for two risk factors for PT: waist-to-hip ratio and hip and knee flexibility.

Conclusion Waist-to-hip ratio and hip and knee flexibility were identified as risk factors for PT. There is a clear need for high quality studies in order to identify the exact risk factors associated with PT.

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