Efectos del ejercicio excntrico

Br J Sports Med. 2005 Jul;39(7):458-61; discussion 458-61.

Vascularity and pain in the patellar tendon of adult jumping athletes:
a 5 month longitudinal study.
Cook JL, Malliaras P, De Luca J, Ptasznik R, Morris M.
La Trobe University, Musculoskeletal Research Centre, School of
Physiotherapy, Bundoora, Victoria 3083, Australia.
j.cook@latrobe.edu.au
BACKGROUND: This study investigated changes in tendon vascularity in
102 (67 men and 35 women) volleyball players over a 6 month
competitive season. METHODS: Athletes were examined with both grey
scale ultrasound and standardised colour Doppler settings. Vessel
length and pain were measured each month on five separate occasions.
Vascular tendons were divided into (i) those that were vascular on
all occasions (persistent vascularity) and (ii) those that were
vascular on more than two but less than five occasions (intermittent
vascularity). RESULTS: A total of 41 of the 133 abnormal tendons were
vascular on two or more occasions. Of these, 16 had persistent
vascularity and 25 hadintermittent vascularity. There was no
significant difference in the prevalence of vascularity between men
and women. None of the tendons had a pattern of vascularity over the
season that could be clearly interpreted as the onset or resolution of
vascularity. Subjects with changes in both tendons were more likely
to have persistent vascularity (p = 0.045). Vessels were longer in
tendons with persistent vascularity (p<0.000) and pain was
significantly greater(p = 0.043) than in tendons with intermittent
vascularity. Tendons with intermittent vascularity had similar pain
scores on all days, whether or not they had detectable blood flow.
CONCLUSIONS: These data suggest that the presence of blood vessels is
more likely to be the source of pain than the blood flow in them.
3: Br J Sports Med. 2005 Feb;39(2):102-5.
Erratum in:
Br J Sports Med. 2005 Apr;39(4):246.
Eccentric decline squat protocol offers superior results at 12 months
compared with traditional eccentric protocol for patellar tendinopathy
in volleyball players.
Young MA, Cook JL, Purdam CR, Kiss ZS, Alfredson H.
Musculoskeletal Research Centre, La Trobe University, Bundoora,
Victoria 3086,
Australia. mark.young@latrobe.edu.au
BACKGROUND: Conservative treatment of patellar tendinopathy has been
minimally investigated. Effective validated treatment protocols are
required. OBJECTIVES: To investigate the immediate (12 weeks) and long
term (12 months) efficacy of two eccentric exercise programmes for the
treatment of patellar tendinopathy. METHODS: This was a prospective
randomised controlled trial of 17 elite volleyball players with
clinically diagnosed and imaging confirmed patellar tendinopathy.
Participants were randomly assigned to one of two treatment groups: a
decline group and a step group. The decline group were required to

perform single leg squats on a 25 degrees decline board, exercising

into tendon pain and progressing their exercises with load. The step
group performed single leg squats on a 10 cm step, exercising without
tendon pain and progressing their exercises with speed then load. All
participants completed a 12 week intervention programme during their
preseason. Outcome measures used were the Victorian Institute of Sport
Assessment (VISA) score for knee function and 100 mm visual analogue
scale (VAS) for tendon pain with activity. Measures were taken
throughout the intervention period and at 12 months. RESULTS: Both
groups had improved significantly from baseline at 12 weeks and 12
months. Analysis of the likelihood of a 20 point improvement in VISA
score at 12 months revealed a greater likelihood of clinical
improvements in the decline group than the step group. VAS scores at
12 months did not differ between the groups. CONCLUSIONS:
Both exercise protocols improved pain and sporting function in
volleyball players over 12 months. This study indicates that the
decline squat protocol offers greater clinical gains during a
rehabilitation programme for patellar tendinopathy in athletes who
continue to train and play with pain.
6: Br J Sports Med. 2004 Aug;38(4):395-7.
A pilot study of the eccentric decline squat in the management of
painful chronic patellar tendinopathy.
Purdam CR, Jonsson P, Alfredson H, Lorentzon R, Cook JL, Khan KM.
Department of Physical Therapies, Australian Institute of Sport, PO
Box 176, Belconnen 2616, ACT, Australia.
OBJECTIVES: This non-randomised pilot study investigated the effect of
eccentric quadriceps training on 17 patients (22 tendons) with painful
chronic patellar tendinopathy. METHODS: Two different eccentric
exercise regimens were used by subjects with a long duration of pain
with activity (more than six months). (a) Nine consecutive patients
(10 tendons; eight men, one woman; mean age 22 years) performed
eccentric exercise with the ankle joint in a standard (foot flat)
position. (b) Eight patients (12 tendons; five men, three women; mean
age 28 years) performed eccentric training standing on a 25 degrees
decline board, designed to increase load on the knee extensor
mechanism. The eccentric training was performed twice daily, with
three sets of 15 repetitions, for 12 weeks. Primary outcome measures
were (a) 100 mm visual analogue scale (VAS), where the subject
recorded the amount of pain during activity, and (b) return to
previous activity. Follow up was at 12 weeks, with a further limited
follow up at 15 months. RESULTS: Good clinical results were obtained
in the group who trained on the decline board, with six patients (nine
tendons) returning to sport and showing a significantly reduced amount
of pain over the 12 week period. Mean VAS scores fell from 74.2 to
28.5 (p = 0.004). At 15 months, four patients (five tendons) reported
satisfactory results (mean VAS 26.2). In the standard squat
group the results were poor, with only one athlete returning to
previous activity. Mean VAS scores in this group were 79.0 at baseline
and 72.3 at 12 weeks (p = 0.144). CONCLUSION: In a small group of
patients with patellar tendinopathy, eccentric squats on a decline
board produced encouraging results in terms of pain reduction and
return to function in the short term. Eccentric exercise using
standard single leg squats in a similar sized group appeared to
be a less effective form of rehabilitation in reducing pain and
returning subjects to previous levels of activity.

Medidas antropomricas
4: Br J Sports Med. 2004 Oct;38(5):581-5.
Are unilateral and bilateral patellar tendinopathy distinguished by
differences in anthropometry, body composition, or muscle strength in
elite female basketball players?
Gaida JE, Cook JL, Bass SL, Austen S, Kiss ZS.
Musculoskeletal Research Centre, School of Physiotherapy, La Trobe
University, Bundoora, 3086, Australia.
BACKGROUND: Overuse injury to the patellar tendon (patellar
tendinopathy) is a major reason for interrupted training and
competition for elite athletes. In both sexes, the prevalence of
unilateral and bilateral tendinopathy has been shown to differ. It has
been proposed that bilateral pathology may have a different aetiology
from unilateral pathology. Investigation of risk factors that may be
unique to unilateral and bilateral patellar tendinopathy in female
athletes may reveal insights into the aetiology of this condition.
OBJECTIVES: To examine whether anthropometry, body composition, or
muscle strength distinguished elite female basketball players with
unilateral or bilateral patellar tendinopathy. METHODS: Body
composition, anthropometry, and muscle strength were compared in elite
female basketball players with unilateral (n = 8), bilateral (n = 7),
or no (n = 24) patellar tendinopathy. Body composition was analysed
using a dual energy x ray absorptiometer. Anthropometric measures were
assessed using standard techniques. Knee extensor strength was
measured at 180 degrees /s using an isokinetic dynamometer. z scores
were calculated for the unilateral and bilateral groups (using the no
tendinopathy group as controls). Z scores were tested against zero.
RESULTS: The tibia length to stature ratio was approximately 1.3 (1.3)
SDs above zero in both the affected and non-affected legs in the
unilateral group (p<0.05). The waist to hip ratio was 0.66 (0.78) SD
above zero in the unilateral group (p<0.05). In the unilateral group,
leg lean to total lean ratio was 0.42 (0.55) SD above zero (p<0.07),
the trunk lean to total lean ratio was 0.63 (0.68) SD below zero
(p<0.05), and leg fat relative to total fat was 0.47 (0.65) SD below
zero (p<0.09). In the unilateral group, the leg with pathology was
0.78 (1.03) SD weaker during eccentric contractions (p<0.07).
CONCLUSIONS: Unilateral patellar tendinopathy has identifiable risk
factors whereas bilateral patellar tendinopathy may not. This suggests
that the aetiology of these conditions may be different. However,
interpretation must respect the limitation of small subject numbers.
7: Br J Sports Med. 2004 Apr;38(2):206-9.
Anthropometry, physical performance, and ultrasound patellar tendon
abnormality in elite junior basketball players: a cross-sectional
study.
Cook JL, Kiss ZS, Khan KM, Purdam CR, Webster KE.
Musculoskeletal Research Centre, La Trobe University, Bundoora, Vic.
3083, Australia. j.cook@latrobe.edu.au
OBJECTIVE: Patellar tendinopathy has been reported to be associated
with many intrinsic risk factors. Few have been fully investigated.
This cross-sectional study examined the anthropometric and physical

performance results of elite junior basketball players with normal or

abnormal patellar tendons to see if any measures were associated with
changes in tendon morphology. METHODS: Agility, leg strength,
endurance, and flexibility were measured in 71 male and 64 female
players. A blinded radiologist ultrasonographically examined their
patellar tendons and athletes were grouped as having normal or
abnormal tendons. One-way ANOVA was used to test for differences in
anthropometric and physical performance data for athletes whose
tendons were normal or abnormal (unilateral or bilateral tendinopathy)
on ultrasound. RESULTS: Results show that females with abnormalities
in their tendons had a significantly better vertical jump (50.9+/-6.8
cm) than those with normal tendons (46.1+/-5.4 cm) (p = 0.02). This
was not found in males. In males, the mean sit and reach in those with
normal tendons (13.2+/-6.7 cm) was greater (p<0.03) than in unilateral
tendinopathy (10.3+/-6.2 cm) or in bilateral tendinopathy (7.8+/-8.3
cm). In females, those with normal tendons (13.3+/-4.8 cm) and
bilateral tendinopathy (15.8+/-6.2 cm) were distinctly different from
those with unilateral tendinopathy (7.9+/-6.6 cm). CONCLUSION:
Flexibility and vertical jump ability are associated with patellar
tendinopathy and the findings warrant consideration when managing
young, jumping athletes.
Instrumentos de medida
8: Br J Sports Med. 2001 Oct;35(5):335-41.
The VISA-A questionnaire: a valid and reliable index of the clinical
severity of Achilles tendinopathy.
Robinson JM, Cook JL, Purdam C, Visentini PJ, Ross J, Maffulli N,
Taunton JE, Khan KM; Victorian Institute Of Sport Tendon Study Group.
Department of Family Practice, University of British Columbia,
Vancouver, Canada.
BACKGROUND: There is no disease specific, reliable, and valid clinical
measure of Achilles tendinopathy. OBJECTIVE: To develop and test a
questionnaire based instrument that would serve as an index of
severity of Achilles tendinopathy. METHODS: Item generation, item
reduction, item scaling, and pretesting were used to develop a
questionnaire to assess the severity of Achilles tendinopathy. The
final version consisted of eight questions that measured the domains
of pain, function in daily living, and sporting activity. Results
range from 0 to 100, where 100 represents the perfect score. Its
validity and reliability were then tested in a population of nonsurgical patients with Achilles tendinopathy (n = 45), presurgical
patients with Achilles tendinopathy (n = 14), and two normal control
populations (total n = 87). RESULTS: The VISA-A questionnaire had good
test-retest (r = 0.93), intrarater (three tests, r = 0.90), and
interrater (r = 0.90) reliability as well as good stability when
compared one week apart (r = 0.81). The mean (95% confidence interval)
VISA-A score in the non-surgical patients was 64 (59-69), in
presurgical patients 44 (28-60), and in control subjects it exceeded
96 (94-99). Thus the VISA-A score was higher in non-surgical than
presurgical patients (p = 0.02) and higher in control subjects than in
both patient populations (p<0.001). CONCLUSIONS: The VISA-A
questionnaire is reliable and displayed construct validity when means
were compared in patients with a range of severity of Achilles
tendinopathy and control subjects. The continuous numerical result of
the VISA-A questionnaire has the potential to provide utility in both

the clinical setting and research. The test is not designed to be

diagnostic. Further studies are needed to determine whether the VISA-A
score predicts prognosis.
9: Br J Sports Med. 2001 Feb;35(1):65-9.
Reproducibility and clinical utility of tendon palpation to detect
patellar tendinopathy in young basketball players. Victorian Institute
of Sport tendon study group.
Cook JL, Khan KM, Kiss ZS, Purdam CR, Griffiths L.
School of Physiotherapy, Latrobe University, Bundoora, Australia.
cook.evans@bigpond.com
BACKGROUND: Palpation is an important clinical test for jumper's knee.
OBJECTIVES: To (a) test the reproducibility of palpation tenderness,
(b) evaluate the sensitivity and specificity of palpation in subjects
with clinical symptoms of jumper's knee, and (c) determine whether
tenderness to palpation may serve as a useful screening test for
patellar tendinopathy. The yardstick for diagnosis of patellar
tendinopathy was ultrasonographic abnormality. METHODS: In
326 junior symptomatic and asymptomatic athletes' tendons, palpation
was performed by a single examiner before ultrasonographic examination
by a certified ultrasound radiologist. In 58 tendons, palpation was
performed twice to test reliability. Tenderness to palpation was
scored on a scale from 0 to 3 where 0 represented no pain, and 1, 2,
and 3 represented mild, moderate, and severe tenderness respectively.
RESULTS: Patellar tendon palpation was a reliable examination for a
single examiner (Pearson r = 0.82). In symptomatic tendons, the
positive predictive value of palpation was 68%. As a screening
examination in asymptomatic subjects, the positive predictive value of
tendon palpation was 36-38%. Moderate and severe palpation tenderness
were better predictors of ultrasonographic tendon pathology than
absent or mild tenderness (p<0.001). Tender and symptomatic tendons
were more likely to have ultrasound abnormality than tenderness alone
(p<0.01). CONCLUSIONS: In this age group, palpation is a reliable test
but it is not cost effective in detecting patellar tendinopathy in a
preparticipation examination. In symptomatic tendons, palpation is a
moderately sensitive but not specific test. Mild tenderness in
the patellar tendons in asymptomatic jumping athletes should be
considered normal.
15: J Sci Med Sport. 1998 Jan;1(1):22-8.
The VISA score: an index of severity of symptoms in patients with
jumper's knee (patellar tendinosis). Victorian Institute of Sport
Tendon Study Group.
Visentini PJ, Khan KM, Cook JL, Kiss ZS, Harcourt PR, Wark JD.
The University of Melbourne (Department of Medicine-RMH), Parkville,
Victoria, Australia.
Symptoms of jumper's knee (patellar tendinosis) are not easily
quantified andthis may explain why there are no evidence-based
guidelines for managing the condition. A simple, practical
questionnaire-based index of severity would facilitate jumper's knee
research and subsequently, clinical management. Thus we devised and
tested the Victorian Institute of Sport Assessment (VISA)

questionnaire. The brief questionnaire assesses (i) symptoms, (ii)

simple tests of function and (iii) ability to play sport. Six of the
eight questions are scored on a visual analogue scale from 0-10 with
10 representing optimal health. The maximal VISA score for an
asymptomatic, fully performing individual is 100 points and the
theoretical minimum is 0 points. We found the VISA scale to have
excellent short-term test-retest, and inter-tester reliability (both,
r>0.95) as well as good short-term (one week) stability (r=0.87).
Mean (SD) of the VISA scores ranged from 95 (8) points in asymptomatic
control subjects to 55 (12) points in patients who presented to a
sports medicine clinic with jumper's knee
and 22 (17) points in patients before surgery for chronic jumper's
knee. Six- and twelve-months after surgery VISA scores returned to 49
(15) and 75 (17) points respectively, mirroring clinical recovery. We
conclude that the VISA score is a reliable index of the severity of
jumper's knee that has potential to aid clinicians and researchers.
Estudios de imagen
11: Scand J Med Sci Sports. 2000 Aug;10(4):216-20.
Patellar tendinopathy in junior basketball players: a controlled
clinical and ultrasonographic study of 268 patellar tendons in players
aged 14-18 years.
Cook JL, Khan KM, Kiss ZS, Griffiths L.
Victorian Institute of Sport, South Melbourne, Australia.
Anterior knee pain is a common presenting complaint amongst adolescent
athletes. We hypothesised that patellar tendinopathy may occur at a
younger age than is generally recognised. Thus, we studied the
patellar tendons in 134 elite 14- to 18-year-old female (n=64) and
male (n=70) basketball players and 29 control swimmers (17 female, 12
male) clinically and with ultrasonography. We found that of 268
tendons, 19 (7%) had current patellar tendinopathy on clinical grounds
(11% in males, 2% in females). Twenty-six percent of the basketball
players' patellar tendons contained an ultrasonographic hypoechoic
region. Ultrasonographic abnormality was more prevalent in the oldest
tertile of players (17-18 years) than the youngest tertile (14-15.9
years). Of tendons categorised clinically as 'Never patellar
tendinopathy', 22% had an ultrasonographic hypoechoic region
nevertheless. This study indicates that patellar tendinopathy
can occur in 14- to 18-year-old basketball players. Ultrasonographic
tendon abnormality is 3 times as common as clinical symptoms.
16: Clin J Sport Med. 1998 Apr;8(2):73-7.
Patellar tendon ultrasonography in asymptomatic active athletes
reveals hypoechoic regions: a study of 320 tendons. Victorian
Institute of Sport Tendon Study Group.
Cook JL, Khan KM, Harcourt PR, Kiss ZS, Fehrmann MW, Griffiths L, Wark
JD.
Department of Medicine, Royal Melbourne Hospital, The University of
Melbourne, Parkville, Australia.
OBJECTIVE: To compare patellar tendon sonographic findings in active,
currently asymptomatic, elite athletes with those in nonathletic

controls. DESIGN: Cross-sectional cohort study with convenience

control sample. SETTING: The Victorian Institute of Sport Tendon Study
Group, an institutional elite athlete study group in Australia.
PATIENTS AND PARTICIPANTS: Two hundred elite male and female athletes
from the sports of basketball, cricket, netball, and Australian
rules football. Forty athletes who had current symptoms of jumper's
knee were excluded from analysis, leaving 320 subject tendons in
athletes who were currently asymptomatic. Twenty-seven nonathletic
individuals served as controls. MAIN OUTCOME MEASURE: Sonographic
patellar tendon appearance. We measured the dimensions of subject
tendons and noted the presence or absence of hypoechoic regions and
tendon calcification. Dimensions of hypoechoic regions were measured,
and approximate cross-sectional areas were calculated. Chi-squared
analysis was used to test the prevalence of hypoechoic regions in
subjects and controls and men and women. RESULTS: In currently
asymptomatic subjects, hypoechoic regions were more prevalent in
athlete tendons (22%) than in controls (4%), in male subject tendons
(30%) than in female subjects (14%), and in basketball players (32%)
than in other athletes (9%) (all p < 0.01). Bilateral tendon
abnormalities were equally prevalent in men and women but more
prevalent in basketball players (15%) than in other athletes (3%) (p <
0.05). Sonographic hypoechoic regions were present in 35 of 250 (14%)
patellar tendons in athletes who had never had anterior knee pain.
CONCLUSIONS: Patellar tendon sonographic hypoechoic areas were present
in asymptomatic patellar tendons of a proportion of elite athletes but
rarely present in controls. This has implications for clinicians
managing athletes with anterior knee pain.
10: J Ultrasound Med. 2000 Jul;19(7):473-9.
Prospective imaging study of asymptomatic patellar tendinopathy in
elite junior basketball players.
Cook JL, Khan KM, Kiss ZS, Purdam CR, Griffiths L.
Victorian Institute of Sport and Latrobe University, Melbourne,
Australia.
To evaluate the ability of ultrasonography to predict eventual
symptoms in an at-risk population, 52 elite junior basketball players'
patellar tendons were studied at baseline and again 16 months later.
The group consisted of 10 study tendons (ultrasonographically
hypoechoic at baseline) and 42 control tendons (ultrasonographically
normal at baseline). By design, all tendons were asymptomatic at
baseline. No differences were noted between subjects and controls at
baseline for age, height, weight, training hours, and vertical jump.
Functional (P < 0.01) and symptomatic outcome (P < 0.05) were poorer
for subjects' tendons than for controls. Relative risk for developing
symptoms of jumper's knee was 4.2 times greater in case tendons than
in control tendons. Men were more likely to develop ultrasonographic
changes than women (P < 0.025), and they also had significantly
increased training hours per week (P < 0.01) in the study period. Half
(50%) of abnormal tendons in women became ultrasonographically normal
in the study period. Our data suggest that presence of an
ultrasonographic hypoechoic area is associated with a greater risk of
developing jumper's knee symptoms. Ultrasonographic patellar tendon
changes may resolve, but this is not necessary for an athlete to
become asymptomatic. Qualitative or quantitative analysis of baseline
ultrasonographic images revealed it was not possible to predict which
tendons would develop symptoms or resolve ultrasonographically.

5: Clin J Sport Med. 2004 Sep;14(5):296-299.

Neovascularization and Pain in Abnormal Patellar Tendons of Active
Jumping Athletes.
Cook JL, Malliaras P, De Luca J, Ptasznik R, Morris ME, Goldie P.
*Musculoskeletal Research Centre, School of Physiotherapy, La Trobe
University,Victoria, Australia; and daggerLa Trobe Medical Centre
Medical Imaging, Victoria, Australia.
OBJECTIVE:: The aim of this study was to investigate tendon pain in
abnormal patellar tendons with and without neovascularization. STUDY
DESIGN:: Comparative design. SETTING:: Multidisciplinary tendon study
group at a competitive volleyball venue. PARTICIPANTS:: One hundred
eleven volleyball players volunteered to participate in the study.
MAIN OUTCOME MEASURES:: Subjects' patellar tendons were imaged with
ultrasound, with and without Doppler. Tendons that were imaging
abnormal were categorized according the presence of tendon
neovascularization. Subjects completed 3 pain scales that examined
function (Victorian Institute of Sport Assessment score, 100-point
maximum), pain with tendon load (decline squat, visual analogue scale,
100-mm maximum), and maximum pain for the previous week (visual
analogue scale, 100-mm maximum). A 1-tailed Mann-Whitney U test
compared pain scores in abnormal tendons without neovascularization to
abnormal tendons with neovascularization. RESULTS:: Functional scores
were lower (Victorian Institute of Sport score, median, 78; P
= 0.045) and pain scores under tendon load were greater (decline squat
pain, median, 19; P = 0.048) in subjects with abnormal tendons with
neovascularization than subjects with abnormal tendons without
neovascularization (Victorian Institute of Sport Assessment score,
median, 87; decline squat pain, median, 0). CONCLUSIONS:: This study
indicates that the presence of neovascularization in abnormal patellar
tendons is associated with greater tendon pain compared with abnormal
tendons without neovascularization in active jumping athletes.
18: Clin J Sport Med. 1997 Jul;7(3):199-206.
Patellar tendon ultrasonography and jumper's knee in female basketball
players: a longitudinal study.
Khan KM, Cook JL, Kiss ZS, Visentini PJ, Fehrmann MW, Harcourt PR,
Tress BW, Wark JD.
Department of Medicine, Royal Melbourne Hospital, University of
Melbourne, Parkville, Australia.
OBJECTIVE: To compare patellar tendon sonographic findings at baseline
and at follow-up in active female basketball players with and without
symptoms of jumper's knee. We hypothesized that baseline sonographic
morphology would not reliably predict prognosis and, in particular,
that it would not predict the need for surgery. DESIGN: Prospective
longitudinal study with 12-month minimum follow-up. SETTING:
Institutional elite athlete study group in Australia(Victorian
Institute of Sport Tendon Study Group). PATIENTS AND PARTICIPANTS: A
total of 15 female elite basketball players with 23 sonographically
abnormal tendons and 15 matched control basketball players with 23
sonographically normal tendons. MAIN OUTCOME MEASURES: Sonographic
patellar tendon appearance and clinical assessment of symptoms of
jumper's knee at baseline and follow-up. Dimensions of abnormal
regions were measured. RESULTS: At baseline, the 23

subject tendons contained sonographic hypoechoic regions (six

currently symptomatic, eight previously symptomatic only, and nine
never symptomatic). At follow-up, the hypoechoic areas in seven
tendons had resolved (and caused no symptoms), the hypoechoic areas in
11 tendons had remained essentially the same size (five were
symptomatic), and the hypoechoic areas in five tendons had expanded
(three symptomatic). At baseline, there were no differences between
the mean +/- SD cross-sectional areas of the abnormalities in the
tendons that subsequently resolved (15.9 +/- 10.1 mm2) and those that
remained unchanged(39.3 +/- 25.8) or expanded (25.3 +/- 12.5). The
presence of a baseline sonographic abnormality predicted symptoms of
jumper's knee at follow-up (p <0.05), but the presence of symptoms of
jumper's knee at baseline also predicted symptoms at follow-up (p <
0.05). No subject or control missed any games or underwent surgical
treatment. CONCLUSIONS: Patellar tendon sonographic hypoechoic areas
can resolve, remain unchanged, or expand in active sports-women
without predicting symptoms of jumper's knee. Thus, symptoms were not
directlyrelated to sonographic tendon morphology. Sonographic
hypoechoic regions ought not to constitute per se an indication for
surgery.