Types and epidemiology of tendinopathy
Section snippets
Basic pathology of overuse tendon conditions
The most common tendon injuries in sports are presented in Table 1. Any tendon and its surrounding tissues can undergo a tendinopathic process, however. The intrinsic and extrinsic factors have varying significance in the background of different tendon problems in sports, but some can be discussed in general.
Lack of consistent nomenclature for histopathological findings has limited progress in understanding the pathological basis of tendon conditions [4], [5]. The understanding that the
Tendinopathies: new definitions
We have recently advocated the use of the term tendinopathy as a general clinical descriptor of tendon injuries in sport [21]. In overuse clinical conditions in and around tendons, frank inflammation is infrequent, and, if seen, is associated mostly with tendon ruptures [24], [25], [26]. Tendinosis implies tendon degeneration without clinical or histological signs of intratendinous inflammation, and is not necessarily symptomatic [21]. When the term tendinitis is used in a clinical context, it
Epidemiologic approach to sports injuries
Many studies on sports injuries are based on reports from outpatient or accident and emergency departments, whereas others have been based on reports from specialist sports centers. Often studies cannot be compared, due to lack of uniformity in definitions of injuries, level of sports participation, insufficient information on the population at risk and on the exposure time to the sport, and variability in study design and data collection [27], [28], [29].
The epidemiological approach in sports
Injury risk factors
An important part of sports injury epidemiology is the identification of factors that contribute to the occurrence of athletic injuries [41]. This process is complicated by many risk factors that play a role before the actual occurrence of injury events. These have been classically divided into two types—intrinsic and extrinsic [36], [41], which interact to make the athlete more susceptible to injury [42].
Intrinsic risk factors:
Malalignment (ie, excessive pronation, femoral neck anteversion,
Injury prevention
Most of the preventive measures suggested in the literature have arisen from descriptive research, and have not been derived from risk factors that have been substantiated as defensible injury predictors through correlational or experimental research [28]. Once the analytical evidence points to an association between certain risk factors and injury, thereby establishing a degree of predictability for those participants who are likely to sustain injury, a method of intervention can be devised to
Age
In children, tendons and ligaments are relatively stronger than the epiphyseal plate, and considerably more elastic. Therefore, in severe trauma, the epiphyseal plate, being weaker than the tendons and ligaments, gives way. As a result, growth plate damage is more common than ligamentous and tendon injuries [43], [44].
Injuries to the insertions of tendons onto bone are more frequent than injuries to the main body of the tendon [45]. The Osgood-Schlatter lesion is by far the most common tendon
Gender
Most tendon injuries occur in males. Male predominance in tears of the Achilles tendon varies between 7 to 1 and 4 to 1 [47]. Although 60% of overuse injuries sustained in running occur in men, women under the age of 30 are at the greatest risk for overuse injuries. The proportion of female participants in sports injury surveys has increased dramatically during the past few decades [48]. The reasons for the increased female proportion are probably the increased female participation in physical
Blood group distribution
Josza et al [50] reported a significant association between the increased risk of tendon ruptures and the blood group O in Hungary, where they found that in over 800 patients with tendon rupture, 53% had blood group O. The distribution in the normal Hungarian population was 31%. The ratio of blood groups A to O (A/O ratio) was 0.51 (1.36 in the normal population). Of the patients with multiple tendon ruptures or rerupture, 68% had blood group O, and the A/O ratio was 0.25.
In Finland, a similar
Achilles tendinopathy
The etiology of Achilles tendon overuse injuries is multifactorial [53]. Training errors have been reported in 60% to 70% of the running injuries [54]. Rapid increase in mileage, increased interval training, and running on sloping and slippery roads are associated with Achilles paratendinopathy [55]. In a report on 698 patients with Achilles tendon injuries, 66% had paratenonitis and 23% had Achilles tendon insertional problems. In 8% of the patients, the injury was located at the myotendineal
Summary
During the last few decades, the role of sports and physical activity has become more and more important in all modern communities. The risk of tendon injury has thus increased, and prevention has become important. Epidemiologic studies are important when planning prevention programs for tendon injuries. Because of individual sport cultures and different sport habits in different countries, national epidemiologic studies are of importance in each individual country.
References (91)
Cell-matrix response in tendon injury
Clin Sports Med
(1992)- et al.
Pathology of failure of the rotator cuff tendon
Orthop Clin North Am
(1997) - et al.
Overuse tendon conditions: time to change a confusing terminology
Arthroscopy
(1998) - et al.
Lower limb injuries in children in sports
Clin Sports Med
(2000) Epidemiology of tendon injuries in sports
Clin Sports Med
(1992)- et al.
ABO blood groups and musculoskeletal injuries
Injury
(1992) - et al.
Jumper's knee
Orthop Clin North Am
(1973) - et al.
Overuse injuries of the extensor mechanism in athletes
Clin Sports Med
(2002) - et al.
Stress injuries of the adolescent extensor mechanism
Clin Sports Med
(1989) - et al.
Ulnar nerve injury at the elbow after steroid injection for medial epicondylitis
J Hand Surg
(1997)
De Quervain's disease: surgical or nonsurgical treatment
J Hand Surg
Acute sports injuries: a clinical and epidemiological study [thesis]
Occurrence and epidemiology of sports injuries in Finland
Ann Chir Gynaecol
Basic sciences of tendons
Sports Medicine and Arthroscopy Review
Histopathology of common tendinopathies. Update and implications for clinical management
Sports Med
Time to abandon the “tendinitis” myth
BMJ
Tendon trauma and overuse injuries
A classification of Achilles tendon disease
Am J Sports Med
Histopathological findings in chronic tendon disorders
Scand J Med Sci Sports
Tendon pathology in long-standing achillodynia. Biopsy findings in 40 patients
Acta Orthop Scand
Intratendinous alterations as imaged by ultrasound and contrast medium enhanced magnetic resonance in chronic achillodynia
Foot Ankle Int
Asymptomatic hypoechoic regions on patellar tendon ultrasound: a 4-year clinical and ultrasound followup of 46 tendons
Scand J Med Sci Sports
Prospective imaging study of asymptomatic patellar tendinopathy in elite junior basketball players
J Ultrasound Med
Patellar tendinopathy in junior basketball players: a controlled clinical and ultrasonographic study of 268 patellar tendons in players aged 14–18 years
Scand J Med Sci Sports
Victorian Institute of Sport Tendon Study Group. Patellar tendon ultrasonography in asymptomatic active athletes reveals hypoechoic regions: a study of 320 tendons
Clin J Sport Med
Long-term ultrasonographic features of the Achilles tendon after rupture
Clin J Sport Med
Patellar tendinitis: a review of current concepts and treatment
Clin J Sport Med
Tendinitis and other chronic tendinopathies
J Am Acad Orthop Surg
Vascular changes in the ruptured Achilles tendon and its paratenon
Int Orthop
Rupture of the Achilles tendon
J Bone Joint Surg Am
Light microscopic histology of achilles tendon ruptures. A comparison with unruptured tendons
Am J Sports Med
Ruptured Achilles tendons are significantly more degenerated than tendinopathic tendons
Med Sci Sports Exerc
Sports related injuries in children. A study of their characteristics, frequency and severity, with comparison to other types of accidental injuries
Am J Sports Med
The epidemiological approach to sports injuries
An epidemiological perspective on the causes of running injuries
The Physician and Sports Medicine
Gymnastic injuries: the Virginia experience, 1982–83
Am J Sports Med
Injuries in persons and high risk sports; a longitudinal study in 1818 school children
Am J Sports Med
Training in elite young athletes (the training of young athletes (TOYA) study): injuries, flexibility and isometric strength
Br J Sports Med
Intensive training in young athletes. The orthopaedic surgeon's view point
Sports Med
Incidence, severity, aetiology and prevention of sports injuries. A review of concepts
Sports Med
Soccer injuries and their mechanisms: a prospective study
Med Sci Sports Exerc
Cited by (490)
Evaluation of Anti-Nociceptive, Anti-Inflammatory, and Anti-Fibrotic effects of noscapine against a rat model of Achilles tendinopathy
2024, International ImmunopharmacologyRehabilitation exercise program after surgical treatment of patellar tendon rupture: A case report
2024, Physical Therapy in SportAn Evidence-Based Approach to Orthobiologics for Tendon Disorders
2023, Physical Medicine and Rehabilitation Clinics of North AmericaCross-country/track and field
2023, The Youth Athlete: A Practitioner's Guide to Providing Comprehensive Sports Medicine CareA novel and efficient murine model for investigating tendon-to-bone healing
2024, Journal of Orthopaedic Surgery and Research