The prevalence of patellar tendinopathy in elite academy rugby players: a role for measuring ground reaction forces?
Discussions with rugby team doctors and physiotherapists suggest that the prevalence of patellar tendinopathy (PT) in rugby populations is increasing. However, from a review of the published literature patellar tendinopathy is not a condition commonly reported in rugby athletes. PT can have serious consequences for an athlete, which may even be career ending. Some of the characteristic ultrasound features of tendinopathy can be seen prior to an athlete developing symptoms of the disease. This would suggest that players should be regularly examined with ultrasound. However, such an approach is prohibitive because of the cost, both of the equipment and the professional expertise required. Therefore, a screening method, which did not involve the use of expensive equipment and trained personnel, and which could predict the presence of patellar tendon disease, especially when the athlete is asymptomatic, is highly desirable. To date, such a screening method does not exist. The aims of this study were to investigate, in a sample of elite academy rugby players: 1) the prevalence of patellar tendinopathy, 2) the prevalence of asymptomatic patellar tendon disease on ultrasound imaging, 3) whether patellar tendon disease is associated with weight or playing position, 4) whether vertical ground reaction force (VGRF) data from drop-landing tasks can predict the presence of patellar tendon disease and avoid the need for costly ultrasound screening. A group of academy rugby players from Wales (n=46) received a combination of clinical and ultrasound examination of their patellar tendons. Ultrasound examination was used to establish the presence of a patellar tendon abnormality (PTA). VGRF data were measured during a drop-landing task from a 30 cm platform situated immediately behind a portable force plate. Peak VGRF and loading rate VGRF data were recorded. Sixteen players (35%) were found to have patellar tendon disease (a PTA) on ultrasound imaging. The prevalence of clinically apparent PT, with associated ultrasound changes, in this cohort was found to be 15.2% (n=7). There was no iii difference in either body mass or playing position between those players with patellar tendon disease and those with healthy patellar tendons. VGRF data from a drop-landing task was unable to predict the presence of patellar tendon disease. The study suggests that the prevalence of patellar tendon disease is higher than previously reported. The study does not support the use of VGRF to predict the presence of patellar tendon disease. Due to the high prevalence of disease, and the potential consequences for those affected, the study recommends further research into prevalence, risk factors and screening for this condition in elite rugby players.
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