Erratum: Niering, M.; Muehlbauer, T. Effects of Physical Training on Physical and Psychological Parameters in Individuals with Patella Tendinopathy: A Systematic Review and Meta-Analysis. Sports 2021, 9, 12

The authors would like to correct an error in the name of the condition in the recently published paper [...]

Case Study: The Conservative Management and Rehabilitation of Insertional Patella Tendinopathy in an Elite Footballer

Background and Purpose: Chronic insertional patella tendinopathy is a complex condition to manage within elite athletes. Pain and symptoms increase when spikes or changes in relation to training or game load are experienced. These spikes are often seen in football on return to training or in periods of fixture congestion, presenting a contemporary challenge for the sports medicine team. Study Design: Case Study. Case Description: The presented case summarises the conservative rehabilitation and pain free return to play of a 24 years (yrs) old elite professional footballer with a long-standing history of patella tendinopathy. Symptoms returned post a spike in training load during pre-season, with a diagnosis of a 7.4 mm insertional thickening detected through magnetic resonance imaging. Presented is a summary of the assessment process, 24-week treatment and rehabilitation protocol and subsequent 12-week pre-habilitation plan, routinely completed on return to training and game play. Outcomes: The implemented management strategy led to the successful symptom free return to play of the athlete. Conclusion: The management of this injury was facilitated through subjective and objective assessment markers and imaging obtained to manage the athlete’s symptoms. The authors suggest that medical and conditioning based specialists could apply a rounded loading approach with prescribed isometric and isotonic drills before progression to energy release and pitch-based training to advance the athlete through a safe and controlled return to sport clearance. Level of Evidence: 5.

Treatment of patella tendinopathy by distalising tibial tubercle osteotomy

Patella tendinopathy condition is often resistant to conservative treatment. We report a case of patella tendinopathy treated by distalisation of the tibial tubercle with excellent long-term result.

Regional differences in the cellularity and vascularity of the patellar tendon

The patellar tendon (PT) attaches to the apex of the patella and tibial tuberosity. Its response to tensile forces is influenced by the distribution of fibroblasts and its vascularity. The vascularity and distribution of fibroblasts influence the tendons ability to repair microtears. Microtears of the PT result in patellar tendinopathy. There is however, paucity of data on the regional distribution of vascular and cellular elements in the PT which might explain why microtears occur in the posterior-proximal third. One hundred and two pairs of patellar tendons were obtained from postmortem specimens. Sections from the proximal, middle and distal third from the anterior and posterior lamina of 20 pairs of the patellar tendon (10 male, 10 female) were processed for microscopy to demonstrate the cellularity and vascularity of the tendon. The vascularity was highest in the middle third of the anterior lamina. The posterior lamina of the tendon was less vascular than the anterior lamina. The posterior lamina was more cellular than the anterior with the proximal third showing the highest number of nuclei. These findings indicate that the pre-patellar genicular anastomosis contributes significantly to the vascularity of the anterior lamina while the anastomosis located in Hoffa’s fat pad may be less rich and thus resulting in lower vascularity for the posterior lamina. Lower vascularity implies less healing ability after microtears. Therefore, orthopedic surgeons should be aware of this precarious pattern of vascularity to the posterior lamina. The posterior lamina’s high cellularity especially in the proximal third indicates that it may experience greater stress and via durotaxis more fibroblasts migrate to that region to produce more collagen fibers for resilience. The greater tensile stress experienced by the posterior-proximal third and its lower vascularity may explain why it is most susceptible to microtears.Key words: Patella tendon, regional differences, cellularity, vascularity, patella tendinopathy