Ultrasound imaging of the patellar tendon attachment to the tibia during puberty: a 12‐month follow‐up in tennis players

This longitudinal study investigated the ultrasound appearance of the patellar tendon attachment to the tibia throughout puberty in young tennis players with and without Osgood‐Schlatter disease (OSD). Twenty‐eight competitive players (17 boys), aged 10.6–15.3 years, had bilateral ultrasound imaging of the patellar tendon attachment to the tibia at baseline and 1 year later. On each occasion, anthropometric measurements, pubertal status and injury history were recorded. Ultrasound appearance of the patellar tendon attachment was categorized into three stages: cartilage attachment, insertional cartilage and mature attachment. Stage 1 appearance, a large anechoic region with or without ossicles and irregularity of the apophysis that are classically associated with OSD, was found in eight players, seven of them were pain free. A majority (62%) of the patellar tendons in stage 1 at baseline progressed toward stage 2 or stage 3 1 year later. Likewise the patellar tendon attachment in most athletes with cartilage insertion showed progression to a mature enthesis over 1 year. The imaging appearance that is classically interpreted as OSD was common in asymptomatic knees. This ultrasonographic description of the patellar tendon attachment to the tibia during growth provides a reference for the assessment of bone tendon attachments in adolescents.

[1]  W. Grechenig,et al.  Sonoanatomy of the Achilles tendon insertion in children , 2004, Journal of clinical ultrasound : JCU.

[2]  G. Beunen,et al.  An assessment of maturity from anthropometric measurements. , 2002, Medicine and science in sports and exercise.

[3]  L. Micheli,et al.  Prevention and Management of Calcaneal Apophysitis in Children: An Overuse Syndrome , 1987, Journal of pediatric orthopedics.

[4]  J. Ralphs,et al.  The cell and developmental biology of tendons and ligaments. , 2000, International review of cytology.

[5]  T. Ishii,et al.  Magnetic resonance imaging of Osgood-Schlatter disease: the course of the disease , 2002, Skeletal Radiology.

[6]  J. Ralphs,et al.  Where tendons and ligaments meet bone: attachment sites (‘entheses’) in relation to exercise and/or mechanical load , 2006, Journal of anatomy.

[7]  M. Salai,et al.  Ultrasonography as a diagnostic modality in Osgood-Schlatter disease , 2001, Archives of Orthopaedic and Trauma Surgery.

[8]  D. A. Sholl,et al.  Growth at Adolescence , 1962 .

[9]  C. Benhamou,et al.  Short-term and long-term site-specific effects of tennis playing on trabecular and cortical bone at the distal radius , 2006, Journal of Bone and Mineral Metabolism.

[10]  N. Maffulli,et al.  Growth and maturation of adolescent female gymnasts, swimmers, and tennis players. , 2008, Medicine and science in sports and exercise.

[11]  A. Robling,et al.  The Effect of Mechanical Loading on the Size and Shape of Bone in Pre‐, Peri‐, and Postpubertal Girls: A Study in Tennis Players , 2002, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[12]  G. Dilmen,et al.  Ultrasonography of the calcaneus in Sever's disease. , 2005, Indian pediatrics.

[13]  J. Eisenmann,et al.  Controlling for Maturation in Pediatric Exercise Science , 2005 .

[14]  A. Pytel,et al.  [Osgood-Schlatter syndrome]. , 1969, Polski tygodnik lekarski.

[15]  P. Lanning,et al.  Ultrasonic Features of the Osgood–Schlatter Lesion , 1991, Journal of pediatric orthopedics.

[16]  David Pontell,et al.  Sports injuries in the pediatric and adolescent foot and ankle: common overuse and acute presentations. , 2006, Clinics in podiatric medicine and surgery.

[17]  Z. Rosenberg,et al.  Osgood-Schlatter lesion: fracture or tendinitis? Scintigraphic, CT, and MR imaging features. , 1992, Radiology.

[18]  J. Volpon,et al.  Calcaneal apophysitis: a quantitative radiographic evaluation of the secondary ossification center , 2002, Archives of Orthopaedic and Trauma Surgery.

[19]  Isabelle Rogowski,et al.  Asymmetry in volume between dominant and nondominant upper limbs in young tennis players. , 2008, Pediatric exercise science.

[20]  G. Balconi,et al.  Ultrasonic diagnosis of Osgood-Schlatter and Sinding-Larsen-Johansson diseases of the knee , 2004, Skeletal Radiology.

[21]  B. Demirağ,et al.  The pathophysiology of Osgood–Schlatter disease: a magnetic resonance investigation , 2004, Journal of pediatric orthopedics. Part B.

[22]  N Maffulli,et al.  Growth and development of male gymnasts, swimmers, soccer and tennis players: a longitudinal study. , 1995, Annals of human biology.

[23]  C. Milgrom,et al.  Ossicles anterior to the proximal tibia. , 1993, Clinical imaging.

[24]  Michael D Ross,et al.  Disability Levels of College‐Aged Men With a History of Osgood‐Schlatter Disease , 2003, Journal of strength and conditioning research.

[25]  Griffin Ly.  Common sports injuries of the foot and ankle seen in children and adolescents , 1994 .

[26]  A. D. Martin,et al.  Bone mineral and calcium accretion during puberty. , 1997, The American journal of clinical nutrition.

[27]  I. Litt,et al.  Adolescents' self-assessment of sexual maturation. , 1980, Pediatrics.