A randomised clinical trial of the efficacy of drop squats or leg extension/leg curl exercises to treat clinically diagnosed jumper's knee in athletes: pilot study

Objectives—To compare the therapeutic effect of two different exercise protocols in athletes with jumper's knee. Methods—Randomised clinical trial comparing a 12 week programme of either drop squat exercises or leg extension/leg curl exercises. Measurement was performed at baseline and after six and 12 weeks. Primary outcome measures were pain (visual analogue scale 1–10) and return to sport. Secondary outcome measures included quadriceps and hamstring moment of force using a Cybex II isokinetic dynamometer at 30°/second. Differences in pain response between the drop squat and leg extension/curl treatment groups were assessed by 2 (group) × 3 (time) analysis of variance. Two by two contingency tables were used to test differences in rates of return to sport. Analysis of variance (2 (injured versus non-injured leg) × 2 (group) × 3 (time)) was also used to determine differences for secondary outcome measures. Results—Over the 12 week intervention, pain diminished by 2.3 points (36%) in the leg extension/curl group and 3.2 points (57%) in the squat group. There was a significant main effect of both exercise protocols on pain (p<0.01) with no interaction effect. Nine of 10 subjects in the drop squat group returned to sporting activity by 12 weeks, but five of those subjects still had low level pain. Six of nine of the leg extension/curl group returned to sporting activity by 12 weeks and four patients had low level pain. There was no significant difference between groups in numbers returning to sporting activity. There were no differences in the change in quadriceps or hamstring muscle moment of force between groups. Conclusions—Progressive drop squats and leg extension/curl exercises can reduce the pain of jumper's knee in a 12 week period and permit a high proportion of patients to return to sport. Not all patients, however, return to sport by that time.

[1]  J. Taunton,et al.  THE EFFECT OF ECCENTRIC VERSUS CONCENTRIC EXERCISE IN THE MANAGEMENT OF ACHILLES TENDONITIS , 1992 .

[2]  D. Fritschy,et al.  Jumper's knee and ultrasonography , 1988, The American journal of sports medicine.

[3]  A. Gad,et al.  Tendon pathology in long-standing achillodynia. Biopsy findings in 40 patients. , 1997, Acta orthopaedica Scandinavica.

[4]  J. Léonard Pathologie tendineuse et terminologie , 1999 .

[5]  K. Khan,et al.  Postoperative patellar tendon healing: An ultrasound study , 1998 .

[6]  L. Almekinders,et al.  Patellar Tendinitis: The Significance of Magnetic Resonance Imaging Findings , 1999, The American journal of sports medicine.

[7]  K M Khan,et al.  A cross sectional study of 100 athletes with jumper's knee managed conservatively and surgically. The Victorian Institute of Sport Tendon Study Group. , 1997, British journal of sports medicine.

[8]  W. Hagner,et al.  [Jumper's knee]. , 1993, Chirurgia narzadow ruchu i ortopedia polska.

[9]  K M Khan,et al.  Prospective imaging study of asymptomatic patellar tendinopathy in elite junior basketball players. , 2000, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[10]  P. Croft,et al.  Pragmatic randomised controlled trial of local corticosteroid injection and naproxen for treatment of lateral epicondylitis of elbow in primary care , 1999, BMJ.

[11]  J. Wark,et al.  Open and Arthroscopic Patellar Tenotomy for Chronic Patellar Tendinopathy , 2000, The American journal of sports medicine.

[12]  R. Lorentzon,et al.  Heavy-Load Eccentric Calf Muscle Training For the Treatment of Chronic Achilles Tendinosis , 1998, The American journal of sports medicine.

[13]  P. Hölmich,et al.  Effectiveness of active physical training as treatment for long-standing adductor-related groin pain in athletes: randomised trial , 1999, The Lancet.

[14]  K. Khan,et al.  Patellar tendinopathy in junior basketball players: a controlled clinical and ultrasonographic study of 268 patellar tendons in players aged 14–18 years , 2000, Scandinavian journal of medicine & science in sports.

[15]  K. Khan,et al.  Tendinopathy: an Achilles' heel for athletes and clinicians. , 1998 .

[16]  J. Wark,et al.  Studies of surgical outcome after patellar tendinopathy: clinical significance of methodological deficiencies and guidelines for future studies , 2000, Scandinavian journal of medicine & science in sports.

[17]  K. Khan,et al.  Overuse tendon conditions: time to change a confusing terminology. , 1998, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[18]  R. P. Di Fabio,et al.  Evaluation of eccentric exercise in treatment of patellar tendinitis. , 1989, Physical therapy.

[19]  N Maffulli,et al.  Where is the pain coming from in tendinopathy? It may be biochemical, not only structural, in origin , 2000, British journal of sports medicine.

[20]  K. Khan,et al.  Overuse Tendon Injuries: Where does the Pain Come From? , 2000 .

[21]  Karim M. Khan,et al.  Histopathology of Common Tendinopathies , 1999, Sports medicine.

[22]  I. Suramo,et al.  Ultrasonography of Jumper's Knee , 1990, Acta radiologica.

[23]  J. Zuckerman,et al.  Efficacy of Injections of Corticosteroids for Subacromial Impingement Syndrome* , 1996, The Journal of bone and joint surgery. American volume.

[24]  L. Engebretsen,et al.  Relationship between symptoms of jumper's knee and the ultrasound characteristics of the patellar tendon among high level male volleyball players , 1996, Scandinavian journal of medicine & science in sports.

[25]  J. Wark,et al.  Patellar Tendon Ultrasonography in Asymptomatic Active Athletes Reveals Hypoechoic Regions: A Study of 320 Tendons , 1998, Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine.

[26]  K. Khan,et al.  Patellar tendinitis: the significance of magnetic resonance imaging findings. , 1999, The American journal of sports medicine.

[27]  R P Nirschl,et al.  Tendinosis of the elbow (tennis elbow). Clinical features and findings of histological, immunohistochemical, and electron microscopy studies. , 1999, The Journal of bone and joint surgery. American volume.

[28]  R. Lorentzon,et al.  In situ microdialysis in tendon tissue: high levels of glutamate, but not prostaglandin E2 in chronic Achilles tendon pain , 1999, Knee Surgery, Sports Traumatology, Arthroscopy.

[29]  B. Forster,et al.  Correlation of ultrasound and magnetic resonance imaging with clinical outcome after patellar tenotomy: prospective and retrospective studies. Victorian Institute of Sport Tendon Study Group. , 1999, Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine.

[30]  J. Karlsson,et al.  Partial rupture of the patellar ligament , 1991, The American journal of sports medicine.