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  1. L Mendonça1,
  2. S Fonseca1,2,
  3. N Bittencourt1,
  4. J Ocarino1,2,
  5. G Gonçalves3,
  6. E Verhagen4
  1. 1Laboratory of Sports Injuries and Prevention (LAPREV) – Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
  2. 2Departamento de Fisioterapia – Escola de Educação Física, Fisioterapia e Terapia Ocupacional – Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
  3. 3Minas Tenis Club, Belo Horizonte, Brazil
  4. 4Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, Netherlands


Background Patellar tendon abnormalities (PTA) are frequent in volleyball and basketball athletes. Tendon degeneration happens through chronic process, related to the amount of stress applied in musculoskeletal system. An appropriated mechanical behaviour of lower limb may be key factor to properly distribute forces in patellar tendon during landing. Identify biomechanical factors associated to patellar tendinosis process could guide preventive attitudes to athletes in risk of chronic dysfunction and/or tendon rupture.

Objective To investigate the association of lower limb biomechanical factors to patellar tendon morphological abnormalities at ultrasound.

Design Cross-sectional.

Setting Institutional clinical care and sports facility.

Participants 35 basketball and volleyball athletes participating on preseason assessment with mean age of 24.0±5.7 years, body mass of 88.9±13.3 kg and height of 1.9±0.1 m.

Risk factor assessment Ankle dorsiflexion range (ADR), shank-forefoot alignment (SFA), iliotibial band flexibility (IBF), hip lateral rotators and abductors isometric strength, hip passive medial rotation range, patellar rotation and knee alignment in the frontal plane were measured during preseason assessment. Ultrasonographic evaluation was performed in both patellar tendons in longitudinal and transverse planes.

Main outcome measurements Patellar tendon hypoechoic areas and thickness at ultrasound.

Results The results showed that low ADR, high IBF and high SFA were associated to PTA. These three variables presented significant areas under ROC curve (P=.008; P=.011; P=.012, respectively). Based on ROC curve sensitivity and specificity values, cut-off points were determined. SFA presented the highest OR; 13.1 (2.1–296); with a cut-off point of 20o. ADR (cut-off point=36o) presented an OR of 4.10 (1.3–13.5) and IBF (cut-off point=-0.04o) presented an OR of 4.53 (1.2–21.6).

Conclusions High shank-forefoot varus alignment, ankle dorsiflexion restriction and iliotibial band flexible were associated to PTA. These results show that biomechanical factors could participate on patellar tendon mechanical overload in athletes.

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