Mersmann Falk, Domroes Theresa, Tsai Meng-Shiuan, Pentidis Nikolaos, Schroll Arno, Bohm Sebastian, Arampatzis Adamantios
Department of Training and Movement Sciences, Humboldt-Universität Zu Berlin, Unter Den Linden 6, 10099, Berlin, Germany.
Berlin School of Movement Science, Berlin, Germany.
Sports Med Open. 2023 Sep 7;9(1):83. doi: 10.1186/s40798-023-00627-y.
High tendon strain leads to sub-rupture fatigue damage and net-catabolic signaling upon repetitive loading. While high levels of tendon strain occur in adolescent athletes at risk for tendinopathy, a direct association has not yet been established. Therefore, in this prospective longitudinal study, we examined the hypothesis that adolescent athletes who develop patellar tendon pain have shown increased levels of strain in advance.
In 44 adolescent athletes (12-17 years old), patellar tendon mechanical properties were measured using ultrasonography and inverse dynamics at four time points during a season. Fourteen athletes developed clinically relevant tendon pain (SYM; i.e., reduction of the VISA-P score of at least 13 points), while 23 remained asymptomatic (ASYM; VISA-P score of > 87 points). Seven cases did not fall into one of these categories and were excluded. Tendon mechanical properties of SYM in the session before the development of symptoms were compared to a randomly selected session in ASYM.
Tendon strain was significantly higher in SYM compared to ASYM (p = 0.03). The risk ratio for developing symptoms was 2.3-fold higher in athletes with tendon strain ≥9% (p = 0.026). While there was no clear evidence for systematic differences of the force applied to the tendon or tendon stiffness between SYM and ASYM (p > 0.05), subgroup analysis indicated that tendon force increased prior to the development of symptoms only in SYM (p = 0.034).
The study provides novel longitudinal evidence that high tendon strain could be an important risk factor for patellar tendinopathy in adolescent athletes. We suggest that inadequate adaptation of tendon stiffness to increases in muscle strength may occur if adolescent athletes are subject to mechanical loading which does not provide effective tendon stimulation.
高肌腱应变会导致重复性负荷下的亚破裂疲劳损伤和净分解代谢信号传导。虽然在有肌腱病风险的青少年运动员中会出现高水平的肌腱应变，但尚未建立直接关联。因此，在这项前瞻性纵向研究中，我们检验了这样一个假设，即出现髌腱疼痛的青少年运动员此前已表现出应变水平升高。
在44名青少年运动员（12 - 17岁）中，在一个赛季的四个时间点使用超声检查和逆动力学测量髌腱力学性能。14名运动员出现了临床相关的肌腱疼痛（SYM组，即VISA - P评分至少降低13分），而23名运动员保持无症状（ASYM组，VISA - P评分>87分）。7例不属于这两类，被排除。将SYM组症状出现前一次检查时的肌腱力学性能与ASYM组随机选择的一次检查进行比较。
与ASYM组相比，SYM组的肌腱应变显著更高（p = 0.03）。肌腱应变≥9%的运动员出现症状的风险比高2.3倍（p = 0.026）。虽然没有明确证据表明SYM组和ASYM组在施加于肌腱的力或肌腱刚度方面存在系统性差异（p>0.05），但亚组分析表明，仅在SYM组中，症状出现前肌腱力增加（p = 0.034）。
该研究提供了新的纵向证据，表明高肌腱应变可能是青少年运动员髌腱病的一个重要危险因素。我们认为，如果青少年运动员受到不能提供有效肌腱刺激的机械负荷，可能会出现肌腱刚度对肌肉力量增加的适应不足。
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