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Modifiable risk factors for patellar tendinopathy in athletes: a systematic review and meta-analysis
  1. Andrew L Sprague1,
  2. Angela H Smith2,
  3. Patrick Knox2,
  4. Ryan T Pohlig3,
  5. Karin Grävare Silbernagel1,2
  1. 1 Department of Biomechanics and Movement Science, University of Delaware, Newark, Delaware, USA
  2. 2 Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
  3. 3 Biostatistic Core Facility, College of Health Sciences, University of Delaware, Newark, Delaware, USA
  1. Correspondence to Dr Karin Grävare Silbernagel, Department of Physical Therapy, University of Delaware, Newark, DE 19713, USA; kgs{at}udel.edu

Abstract

Objective To perform a systematic review and meta-analysis identifying (1) potential modifiable risk factors and (2) associated modifiable factors for patellar tendinopathy in athletes.

Design A systematic review and meta-analysis was conducted. Risk of bias was assessed using the Newcastle-Ottawa Scale and grouped based on study design. Meta-analytic statistics were performed for items reported by five or more studies. A strength of evidence rating is provided for items not appropriate for meta-analysis.

Data sources PubMed, Web of Science, Scopus and Cinahl were searched on 14 November 2017.

Eligibility criteria Quantitative, original research reporting potential modifiable risk factors or associated factors, comparing athletes with patellar tendinopathy with a group without the injury.

Results 862 records were screened and 31 articles were included (6 prospective, 25 cross-sectional). There was a lack of strong evidence for any potential modifiable risk factor or associated factors. There was limited or conflicting evidence that decreased ankle dorsiflexion range of motion, decreased posterior thigh and quadriceps flexibility, greater volume of jump training, more volleyball sets played per week, greater countermovement jump (CMJ) height and greater activity volume are potential modifiable risk factors. Meta-analysis supported greater activity volume (Cohen’s d=0.22, 95% CI 0.06 to 0.39, p=0.008), higher body weight (0.36, 0.17 to 0.55, p<0.001) and greater CMJ height (0.31, 0.07 to 0.56, p=0.01) as associated modifiable factors.

Conclusions There is a lack of strong evidence for any potential modifiable risk factors or associated factors. Factors with lower levels of support may be of interest in designing prevention programmes but require further research in high-quality, prospective studies.

  • injury prevention
  • sports rehabilitation programs
  • training load
  • tendon
  • tendinopathy

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Footnotes

  • Contributors ALS, AHS and KGS were responsible for the concept and design of this study, as well as the article screening process. ALS and PK conducted the quality assessment and data extraction. RTP provided statistical expertise. All authors assisted with interpretation of the results and revision of the manuscript.

  • Funding The research was funded in part by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institute of Health (#T32HD007490-18) and by a Florence P Kendall Doctoral Scholarship and a Promotion of Doctoral Studies I Scholarship from the Foundation for Physical Therapy.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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