Achilles tendon structure improves on UTC imaging over a 5‐month pre‐season in elite Australian football players

Pre‐season injuries are common and may be due to a reintroduction of training loads. Tendons are sensitive to changes in load, making them vulnerable to injury in the pre‐season. This study investigated changes in Achilles tendon structure on ultrasound tissue characterization (UTC) over the course of a 5‐month pre‐season in elite male Australian football players. Eighteen elite male Australian football players with no history of Achilles tendinopathy and normal Achilles tendons were recruited. The left Achilles tendon was scanned with UTC to quantify the stability of the echopattern. Participants were scanned at the start and completion of a 5‐month pre‐season. Fifteen players remained asymptomatic over the course of the pre‐season. All four echo‐types were significantly different at the end of the pre‐season, with the overall echopattern suggesting an improvement in Achilles tendon structure. Three of the 18 participants developed Achilles tendon pain that coincided with a change in the UTC echopattern. This study demonstrates that the UTC echopattern of the Achilles tendon improves over a 5‐month pre‐season training period, representing increased fibrillar alignment. However, further investigation is needed to elucidate with this alteration in the UTC echopattern results in improved tendon resilience and load capacity.     

Quantification of Achilles and patellar tendon structure on imaging does not enhance ability to predict self-reported symptoms beyond grey-scale ultrasound and previous history

Background

Tendon pathology on imaging has been associated with an increased risk of developing symptoms. This evidence is based on classifying the tendon as normal or pathological. It is unclear whether the extent of tendon pathology is associated with the development or severity of symptoms.

A one‐season prospective study of injuries and illness in elite junior tennis

The objective of this study was to estimate the incidence and prevalence of injury and illness among elite junior tennis players. A cohort of 73 players (11–14 years) in the 2012–2013 Dutch national high‐performance program was followed for 32 weeks; all participants completed the study. The OSTRC Questionnaire on Health Problems was used to record self‐reported injuries and illnesses and to record training and match exposure. Main outcome measures were average prevalence of overuse injury and illness and incidence density of acute injury. On average, players practiced 9.1 h/week (SD 0.6; range 2.3–12.0) and had 2.2 h of match play (SD 0.6; range 2.3–12.0). During the course of the study, 67 players reported a total of 187 health problems. The average weekly prevalence of all health problems was 21.3% (95% CI: 19.2–22.9), of which 12.1% (95% CI: 10.9–13.3) constituted overuse injuries and 5.8% (95% CI: 4.6–6.9) illnesses. The incidence of acute injuries was 1.2/1000 h of tennis play (95% CI: 0.7–1.7). The high occurrence of overuse injuries among elite junior tennis players suggests that an early focus on preventative measures is warranted, with a particular focus on the monitoring and management of workload.     

Variations in jump height explain the between‐sex difference in patellar tendon loading during landing

Patellar tendinopathy is the most common overuse knee injury in volleyball, with men reporting more than twice the injury prevalence than women. Although high patellar tendon loading is thought to be a causative factor of patellar tendinopathy, it is unknown whether between‐sex variations in landing technique account for differences in patellar tendon loading. It was hypothesized that male volleyball players would display differences in landing technique and would generate higher patellar tendon loading than their female counterparts. The landing technique and patellar tendon loading of 20 male and 20 female volleyball players performing a lateral stop‐jump block movement were collected. Independent t‐tests were used to identify any between‐sex differences in landing technique with the data grouped to account for differences in jump height and in anthropometry. Male volleyball players were taller and heavier, landed from a higher height, displayed differences in landing kinematics, generated a significantly greater knee extensor moment, and experienced higher patellar tendon loading than female players when all 40 participants were compared. However, when participants were matched on jump height, they generated similar patellar tendon loading, irrespective of their sex. These results imply that jump height is a more important determinant of patellar tendon loading than sex.     

The impact of playing in matches while injured on injury surveillance findings in professional football

This study aimed to analyze the frequency, nature, and consequences of footballers playing matches while injured, and to examine the impact on injury surveillance findings. High levels of inter‐rater reliability and content validity were established for a tool designed to document players who were already injured at the start of a match. The tool was implemented in three English football teams (a Championship, League 1, and League 2 team) for one season, using a “time loss” definition of injury. One hundred forty‐three matches were surveyed, revealing 102 match appearances by players who were already injured. Almost half of all games featured at least one injured player, with episodes of playing with injury occurring more frequently and lasting longer in League 2 players compared with higher level players. No association was observed between the number of injured players starting matches and match outcome [χ²(4, N = 143) = 3.27, P = 0.514]. Fifteen percent of all injury episodes captured were only through prospective documentation of playing while injured. The findings show that both traumatic and overuse injuries are managed by footballers through competitive matches, and have important implications for aiding understanding of the epidemiology of injury in professional football.     

Pathological tendons maintain sufficient aligned fibrillar structure on ultrasound tissue characterization (UTC)

Structural disorganization in the tendon is associated with tendinopathy, with little research investigating whether disorganization overwhelms the overall structural integrity of the tendon. This study investigated the mean cross‐sectional area (CSA) of aligned fibrillar structure as detected by ultrasound tissue characterization (UTC) in the pathological and normal Achilles and patellar tendons. Ninety‐one participants had their Achilles and/or patellar tendons scanned using UTC to capture a three‐dimensional image of the tendon and allow a semi‐quantification of the echopattern. The mean CSA of aligned fibrillar structure (echo type I + II) and disorganized structure (echo type III + IV) was calculated based on UTC algorithms. Each tendon was classified as either pathological or normal based solely on gray‐scale ultrasound. The mean CSA of aligned fibrillar structure was significantly greater (P ≤ 0.001) in the pathological tendon compared with the normal tendon, despite the pathological tendon containing greater amounts of disorganized structure (P ≤ 0.001). A significant relationship was observed between the mean CSA of disorganized structure and anteroposterior diameter of the Achilles (R² = 0.587) and patellar (R² = 0.559) tendons. This study is the first to show that pathological tendons have sufficient levels of aligned fibrillar structure. Pathological tendons may compensate for areas of disorganization by increasing in tendon thickness.     

Low prevalence of patellar tendon abnormality and low incidence of patellar tendinopathy in female collegiate volleyball players

ABSTRACT

The prevalence of patellar tendinopathy has been reported to be as high as 50% in elite male volleyball (VB) players; however, the rate of injury in female collegiate VB athletes is unknown. The purpose of this study was to 1) identify the prevalence of ultrasonographic evidence of patellar tendon abnormality at the start of the preseason in female collegiate VB players; 2) report the incidence of tendinopathy during the season; and 3) determine if the preseason presence of tendon abnormality is associated with onset of disease. One hundred and six female collegiate VB players had both patellar tendons imaged. Incidence of patellar tendinopathy was tracked during the course of the 4-month season. Twenty-two athletes presented with ultrasonographic evidence of patellar tendon abnormality in at least one knee at the start of the preseason. The incidence of time-loss patellar tendinopathy was 0.26 (95% CI: 0.04, 0.85) per 1000 athletic exposures. This study was unable to determine if preseason presence of tendon abnormality was associated with a greater risk of tendinopathy due to power. The prevalence of tendon abnormality in the preseason and the incidence of patellar tendinopathy in female collegiate VB players are lower than that observed in other populations.     

Etiology and pathophysiology of tendon ruptures in sports

Of all spontaneous tendon ruptures, complete Achilles tendon tears are most closely associated with sports activities (1–3). Schönbauer (3) reported that 75% of all ruptures of the Achilles tendon are related to sports. In Plecko & Passl (2) the number was 60%. In our material of 430 cases, the number of sports-related Achilles ruptures was very similar (62%), while only 2% of ruptures of other tendons were sports-related (P<0.001) (1). Also, the majority of Achilles reruptures occurred in sports. The ruptures occurred most often in soccer (34%), track and field (16%) and basketball (14%). The distribution of Achilles ruptures according to different sports varies considerably from country to country, according to the national sport traditions. For example, in northern and middle Europe, soccer, tennis, track and field, indoor ball games, downhill skiing, and gymnastics are the most common; and in North America, football, basketball, baseball, tennis and downhill skiing dominate the statistics (1, 2, 4). In sports, some Achilles ruptures are not spontaneous or degeneration-induced but may occur as a consequence of the remarkably high forces that are involved in the performance (2). Ruptures in the high jump or triple jump are good examples. In such cases, failure in the neuromuscular protective mechanisms due to fatigue or disturbed co-ordination can frequently be found. The spontaneous complete rupture of the supraspinatus tendon of the rotator cuff does not occur very frequently in sports. Those sports that include high-energy throwing movements, such as American and Finnish baseball, American football, rugby and discus and javelin throwing, may, however, produce this injury. Partial tears and inflammations of the rotator cuff complex are much more frequent in throwing sports. The complete rupture of the proximal long head of the biceps brachii tendon is rare among competitive and recreational athletes. In our material, under 2% of these ruptures were associated with sports activities (5). The rupture (avulsion) of the distal tendon of the biceps muscle is rare. In sports, gymnastics, body building and weight lifting have been said to be able to produce this injury (6). In general, complete ruptures of the quadriceps tendon and the patellar tendon occur most often in older individuals. In our study, the mean age of these patients was 65 years (5). However, these injuries do also occur in younger age groups, especially in athletes. In athletes, the rupture most frequently occurs in high-power sports events, such as high jump, basketball and weight lifting, at the age of 15-30 years. A chronic patellar apicitis (jumper's knee) may predispose rupture of the tendon (7). As is the case with the rotator cuff complex, overuse inflammation and partial tears of the quadriceps and patellar tendons are one of the most characteristic athletic injuries. Complete spontaneous ruptures of other tendons in sports are rare, although the literature does provide case studies from almost every tendon the human body possesses (8–18).     

The Football Association Medical Research Programme: an audit of injuries in professional football-analysis of preseason injuries

OBJECTIVES: To conduct a detailed analysis of preseason football injuries sustained in English professional football over two competitive seasons. METHODS: Club medical staff at 91 professional football clubs annotated player injuries. A specific injury audit questionnaire was used together with a weekly form that documented each club's current injury status. RESULTS: 17% (1025) of the total number of injuries over the two seasons were sustained during the preseason, the mean number of days absent per injury was 22.3 days. Younger age groups (17-25 yrs) were more likely to sustain a preseason injury than more experienced players (26-35+) (p<0.01). There were relatively more "slight" and "minor" injuries (as defined in the methodology), overuse, and tendon related injuries sustained during preseason compared to the in season (p<0.01). The thigh (23%), knee (17%), and ankle (17%) were the most common locations for injuries during the preseason, there was a relatively greater number of lower leg injuries (15%) during the preseason (p<0.05). Achilles tendonitis was most prevalent in the preseason, with 33% of all Achilles related injuries sustained during this period (p<0.01). Muscle strains were the most common injury during preseason (37%). Rectus femoris muscle strains were observed twice as frequently during the preseason relative to the in season (p<0.01). Ligament sprains were the second most common injury during preseason (19%). Non-contact mechanisms were the cause of significantly more injuries during the preseason (p<0.01), with relatively more preseason injuries sustained while running or shooting (p<0.01). For 70% of the injuries reported during the preseason, the ground condition was described as dry. CONCLUSIONS: Players are at a greater risk of slight and minor injuries, overuse injuries, lower leg injuries (especially the Achilles tendon) and rectus femoris strains during the preseason period. Prevention of preseason injury is important to ensure availability of players for the commencement of the season and to decrease the risk of injury later in the season, we recommend the implementation of a risk management policy for this purpose. Areas requiring further investigation include methods of prevention for the common preseason injuries that have been identified, a detailed analysis of preseason and closed season training programmes, and a smaller study involving exposure data.     

Can Achilles and patellar tendon structures predict musculoskeletal injuries in combat soldiers?

Aiming to investigate whether Achilles tendon (AT) structure and patellar tendon (PT) structure are risk factors for musculoskeletal injuries in combat soldiers, 168 participants were recruited from an infantry commander's course. The AT and PT were examined pre‐course using UTC to capture the structure of four echo‐type fibers (I–IV). All injuries were assessed by military physicians pre‐course and throughout the 14‐week course. Soldiers who were injured during the course had a significantly higher pre‐course prevalence of AT and PT echo‐type III and echo‐type IV compared to soldiers that were not injured during the course. Variables that were found to be associated with injured/non‐injured participants were echo‐type III + IV of the PT (OR = 1.44, 95% CI = 1.24‐1.68) and echo‐type III of the AT (OR = 1.69, 95% CI = 1.35‐2.12). ROC analyses showed that the best model, exhibiting both high sensitivity and low specificity, was that participants with PT echo‐type III + IV > 10% or AT echo‐type III >8.5% had the highest risk of being injured during the course. In conclusions, the tendon structure at the beginning of high‐intensity activity or physical training program might be a risk factor for subsequent injury during the course. Soldiers and high‐level athletes should be aware of the cutoff points for fiber types in tendon structure that might put them at high risk for future injury. At‐risk soldiers/athletes should be provided with an intervention program before they start their training program, with the aim of improving the tendon structure and preventing subsequent injury.     

Prevalence and severity of groin problems in Spanish football: A prospective study beyond the time-loss approach

The time-loss definition of injury is commonly adopted in epidemiological groin-injury studies in football, with a significant risk of underestimating the impact of these injuries. This study investigated the extent of groin problems, beyond the time-loss approach, over a full Spanish football season. Players from 17 amateur male teams were followed over 39 consecutive weeks. Groin-injury time loss and self-reported groin pain, irrespective of time loss, were combined to calculate the average weekly prevalence of all groin problems with or without time loss. A subscale measuring hip- and groin-related sporting function from the Copenhagen Hip and Groin Outcome Score questionnaire (HAGOS, Sport/Rec) was registered every 4 weeks. In total, 407 players participated in the study. The average (range) weekly prevalence of all groin problems was 11.7% (7.2%-20.8%); 1.3% with time loss (0.0%-3.2%) and 10.4% without time loss (6.3%-17.6%). Players with groin problems reported lower scores (mean difference) on the HAGOS, Sport/Rec subscale compared with players without (−19.5 [95% CI: −20.7 to −18.4]), while there was no difference between players reporting groin problems with and without time loss (4.0 [95% CI: −1.1 to 9.1]). The traditional time-loss measure only captured 10% of all groin problems. Hip- and groin-related sporting function was not different between players reporting groin problems with or without time loss, suggesting the reason for continuing to play is not only related to the severity of symptoms. These findings question the judicious use of the time-loss approach in overuse conditions, such as groin pain in footballers.     

Health problems in youth competitive alpine skiing: A 12-month observation of 155 athletes around the growth spurt

Alpine ski racing is known as a high-risk sport; however, little is known on the health problems occurring at youth level. The purpose of this study was to investigate the prevalence of health problems in youth competitive alpine skiers with respect to sex, age, and season differences, to describe their severity and location and to assess the influence of biological maturation. Over a 12-month period, 155 youth competitive alpine skiers around the growth spurt were prospectively monitored for health problems using the Oslo Sports Trauma Research Centre (OSTRC) questionnaire. These data were verified by supplemental interviews at the end. Biological maturation was estimated by a non-invasive, anthropometric-based assessment method. During competition season, 42.2% of the skiers suffered from health problems and 19.8% reported their problem being substantial. Females had significantly higher rates of acute and overuse injuries compared to males, while there was no sex difference in duration, severity, and time loss. Skiers of the category U15 showed higher prevalence of acute and overuse injuries than U14 skiers. During preparation season, health problem prevalence was substantially lower. The knee was found to be the most affected body part for both acute and overuse injuries. There was a direct association between the offset to the age at peak height velocity (APHV) and the occurrence and severity of acute injuries. In conclusion, youth competitive alpine skiers suffer from a large number of health problems. Since sex, age, and biological maturation are important, effective injury prevention should already start before reaching the APHV.     

Selected physical capacity norms for Australian football players at the non-elite level

Australian football is a popular male team sport that consists mainly of participants competing at the non-elite level. The main purpose of this study was to compare in non-elite Australian football players competing in sub-elite and community leagues, selected physical capacities recognised as predictors of lower extremity injury in Australian football and/or other sports. Participants were 143 adult (mean age of 22.2 years) male Western Australian footballers from the Western Australian Football League (WAFL) (sub-elite) and the Western Australian Amateur Football League (WAAFL) (community). During the 2005 regular playing season participants completed a questionnaire and a physical measurement testing session. The physical testing session involved the following lower extremity measures: generalised joint laxity, leg length discrepancy, presence of Morton's toe, foot arch, hamstring flexibility and static balance. Football players from the sub-elite and community leagues did not differ significantly in any of the physical testing session measures or in the questionnaire items relating to injury number in the past 12 months and lower limb preventative device use. However, they did differ in some measures with players from the sub-elite league significantly more likely to stretch after a match and training, and to have a designated stretching leader at their club. While players from the community league were significantly more likely to smoke and to participate in sports additional to Australian football. Although the selected physical capacities did not differ between the sub-elite and community players in this study, future research should be aimed at identifying differences for a greater number of physical capacities, including skill and endurance, while utilising a larger sample.     

Performance-based outcomes following patellar tendon repair in professional athletes

ABSTRACT

Objectives: There are limited data on the impact of a patellar tendon repair to a professional athlete’s career. The purpose of this study was to determine differences return to play (RTP) rate, career length, and performance-based outcomes after a patellar tendon repair in professional athletes of four different sports.

Methods: Participants met inclusion criteria if initial reports of the date and type of surgery were corroborated by at least two independent sources of information through a well-established protocol of public newspaper archives, team injury reports, and player profiles. Players with other concomitant injuries of the knee or treated nonoperatively were excluded. One hundred and three athletes across professional baseball, basketball, American football, and soccer athletes were identified and met inclusion criteria. RTP rate, career length, and sports-specific performance statistics (i.e. player efficiency rating (PER) for professional basketball players) before and after surgery were collected for each athlete.

Results: Seventy-nine (76.7%) professional athletes successfully RTP. American football athletes had the lowest RTP rate and the largest drop in performance in post-operative season 1 (P < 0.001). These athletes also experienced the shortest adjusted career lengths (P = 0.003) compared to players in the other sports. Basketball athletes played significantly less games through post-operative seasons 1 to 3 (P < 0.05). Soccer athletes had less goals and assists per game and played fewer games (P < 0.05) in post-operative season 1 that recovered to baseline by seasons 2 and 3.

Conclusion: A patellar tendon rupture is a potentially devastating injury for the professional athlete. American football players appeared to have the worst postoperative outcome with the lowest RTP rate and a most significant decrease in performance in the first postoperative season. This procedure also had a significant short-term impact on soccer athletes who sustained decreases in short-term game performance. These findings are likely explained by the unique physical demands imposed by each sport.     

Swedish translation and validation of a web‐based questionnaire for registration of overuse problems

The main aim of this study was to translate the Oslo Sport Trauma Research Center (OSTRC) Overuse Injury Questionnaire into Swedish. The validity and applicability of the questionnaire for studying overuse injuries among Swedish handball, volleyball, tennis, and orienteering top athletes were also examined. The back‐translation method was used for translation. An expert committee further developed it for use in a study of injuries in handball, orienteering, tennis, and volleyball. A 10‐week pretest was then conducted on 43 athletes, average age 21 (18–31) from these sports, during which time the athletes completed the modified OSTRC questionnaire on a weekly basis. In the 10th week, four additional questions were added in order to examine the questionnaire's content validity. No major disagreement was found in the translation. The athletes perceived the web‐based questionnaire to be smooth and easy to complete, accurately capturing overuse injuries. However, suggestions were made to add questions relating to the hip for orienteerers and to the hand/fingers for handball players. The average prevalence of overuse injuries for all athletes, in any anatomical area was 22% (95% confidence interval 20–25). Construct validity appeared to be high, and we therefore suggest that the questionnaire may be used when studying overuse injuries in different sports.     

Painful conditions in the Achilles tendon region: a common problem in middle-aged competitive badminton players

Overuse injuries are the most frequent type in badminton, generally localized in the legs. An earlier study found 32% of young Swedish elite badminton players to have experienced disabling pain in the Achilles tendon region during the previous 5 years. The present investigation examined the prevalence and characteristics of painful conditions in the Achilles tendon region in 32 middle-aged competitive badminton players by means of questionnaire and physiotherapist's examination. Pain in the Achilles tendon region was reported by 44%, either presently or during the past 5 years, generally localized in the middle portion of the tendon. Symptoms had lasted 2 weeks-1 year (96 days). On the competition days 22% of the reported pain currently in the region. Age was found to be correlated to Achilles tendon pain, but there was no relationship between symptoms of pain and body mass index, gender, training quantity, or years of playing badminton. In conclusion, Achilles tendon pain seems to be relatively common among Swedish middle-aged competitive badminton players, particularly in the older ones.     

Danish translation and validation of the Oslo Sports Trauma Research Centre questionnaires on overuse injuries and health problems

The Oslo Sports Trauma Research Centre Overuse Injury Questionnaire (OSTRC‐O) and the Oslo Sports Trauma Research Centre questionnaire on Health Problems (The OSTRC‐H) make it possible to monitor illness and injury at regular intervals capturing prevalence and incidence of acute injury, overuse injury, and illnesses. The aim of this study was to translate, culturally adapt, and establish the face validity of the OSTRC‐O and the OSTRC‐H into a Danish context (DK) through cognitive interviews and the assessment of test–retest reliability. The OSTRC‐O.DK was distributed to 57 heterogenous respondents; response rate was 89%. The OSTRC‐H was distributed to 58 heterogenous respondents; response rate was 86%. No major disagreements were observed between the original and translated versions of the questionnaires. The OSTRC‐O had high internal consistency (Cronbach's alpha 0.80–0.93). The primary reliability analyses including all participants, showed reliability ICC: 0.62 (95% CI: 0.42–0.77. The secondary reliability analyses that only included subjects who did not change injury region from the test to the retest showed an ICC of 0.86 (95% CI: 0.77–0.92).The questionnaires were found to be valid, reliable, and acceptable for use in a Danish population.     

Injury surveillance in male professional football; is medical staff reporting complete and accurate?

Since the 2000 season, an injury surveillance system has been established to monitor injury risk and injury patterns in the Norwegian professional football league. The aim of this study was to assess the accuracy of routine injury registration performed by medical staff in professional football. The team medical staff completed injury registration forms on a monthly basis throughout the 2007 season (January–October). Players were interviewed at the end of the season (October/November) about all injuries that occurred from July through September. Thirteen of fourteen teams, 296 of 310 A‐squad players were interviewed. An injury was recorded when a player was unable to take fully part in football training or match the day after injury. A total of 174 injuries were registered, 123 acute injuries and 51 overuse injuries. Of these, 141 were reported by medical staff and 122 by players. Eighty‐nine injuries (51%) were registered using both methods, 52 (30%) by medical staff only and 33 (19%) by player interviews only. Prospective injury surveillance by team medical staff in Norwegian male professional football underestimates the incidence of time‐loss injuries by at least one‐fifth.     

A pilot study of the attitudes of Australian Rules footballers towards protective headgear

Despite a relatively high risk of injury to participants of Australian Rules football, very few players report wearing protective equipment. The aim of this paper is to describe the results of a pilot survey of the attitudes of community-level Australian Rules football players towards protective headgear and the risk of head injury. Seventy players from four purposefully chosen clubs in metropolitan Melbourne completed a self-report questionnaire at the end of the 2000-playing season. Almost all players (91.4%) reported they did not wear protective headgear during the 2000 season. Non-headgear users said that headgear was too uncomfortable (47.4%) and they didn't like it (42.1%). However, 80.0% of non-users said they would wear it if it prevented injury. The major motivation for wearing headgear was to prevent injury. Players considered rugby, boxing and driving a car, to be associated with a higher-risk of head injury than Australian Rules football. As a group, the players perceived the risk of head injury in Australian Rules football to be low to moderate when compared to other sports and activities. This partially explains why so few players wore protective headgear. Repeat surveys on a larger sample should be conducted to further understand the attitudes towards protective headgear and perceptions of risk in community-level Australian football players.     

Self-reported jumpers’ knee is common in elite basketball athletes – But is it all patellar tendinopathy?

ObjectivesTo describe the prevalence and pain location of self-reported patellar tendinopathy and patellar tendon abnormality in a male elite basketball population.DesignCross-sectional.SettingPre-season tournament.ParticipantsSixty male athletes from the Australian National Basketball League.Main outcome measuresSelf-reported patellar tendinopathy (PT) using the Oslo Sports Trauma Research Centre Overuse Questionnaire (OSTRC). Pain location using pain mapping (dichotomised: focal/diffuse) and severity during the single leg decline squat. Ultrasound tissue characterisation scans of both patellar tendons.ResultsThirteen participants (22.7%) self-reported PT. Only 3 who reported PT had localised inferior pole pain. Thirty athletes reported pain during the decline squat, 15 described focal pain; 10 diffuse pain (5 missing data). Those with diffuse pain had greater years played [Md = 21 (13–24), n = 10 than focal pain (Md = 12 (7–26), n = 15), p = 0.042, r = 0.3]. Bilateral tendon abnormality was found in 45% of athletes and 15% had unilateral tendon abnormality.ConclusionElite male basketball athletes self-reporting PT had heterogeneity in pain location. When focal pain with loading was used as a primary definition of PT, ‘jumpers’ knee’ was not common in this cohort. This study found that abnormality of the patellar tendon was common and did not correlate with symptoms.