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      Association of markers of patellofemoral maltracking to cartilage damage and bone marrow lesions on MRI: Data from the 2016 Olympic Games of Rio De Janeiro

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          Abstract

          Background

          Patellofemoral joint (PFJ) disease is a common ailment in elite athletes. Our aim is to report the frequency of superolateral Hoffa’s fat pad (SHFP) edema, and PFJ cartilage damage and bone marrow lesions (BML), among Olympian athletes, and to study the association between measurements of trochlear morphology and vertical patellar position and a) PFJ cartilage damage or BML, and b) SHFP edema.

          Methods

          All knee MRI, performed in the Olympic Village and polyclinics, of participating athletes in the 2016 Olympic Games of Rio de Janeiro were included. MRI were scored for PFJ cartilage damage and BML, and SHFP edema. Trochlear morphology measurements included sulcus angle, trochlear angle, lateral trochlear inclination, and medial trochlear inclination. Insall-Salvati ratio was also assessed.

          Results

          One hundred twenty-one knee MRIs were included (62 female, 51.2 %). The highest frequencies of PFJ cartilage damage, combination of PFJ cartilage damage and BML, and SHFP edema were found among Beach Volleyball and Volleyball athletes. SHFP edema was more common among female compared to male Olympian athletes. We found no statistically significant associations between different measurements of trochlear morphology/vertical patellar position, and 1. SHFP edema, and 2. PFJ cartilage damage/BML.

          Conclusion

          SHFP edema and the combination of PFJ cartilage damage and BML are highly frequent among Olympic athletes especially those competing in Beach volleyball and Volleyball. SHFP edema is more common among female athletes. Further studies are needed to determine whether PFJ cartilage damage has a stronger association to sports disciplines rather than trochlear morphology.

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          Most cited references15

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          Analysis of the load on the knee joint and vertebral column with changes in squatting depth and weight load.

          It has been suggested that deep squats could cause an increased injury risk of the lumbar spine and the knee joints. Avoiding deep flexion has been recommended to minimize the magnitude of knee-joint forces. Unfortunately this suggestion has not taken the influence of the wrapping effect, functional adaptations and soft tissue contact between the back of thigh and calf into account. The aim of this literature review is to assess whether squats with less knee flexion (half/quarter squats) are safer on the musculoskeletal system than deep squats. A search of relevant scientific publications was conducted between March 2011 and January 2013 using PubMed. Over 164 articles were included in the review. There are no realistic estimations of knee-joint forces for knee-flexion angles beyond 50° in the deep squat. Based on biomechanical calculations and measurements of cadaver knee joints, the highest retropatellar compressive forces and stresses can be seen at 90°. With increasing flexion, the wrapping effect contributes to an enhanced load distribution and enhanced force transfer with lower retropatellar compressive forces. Additionally, with further flexion of the knee joint a cranial displacement of facet contact areas with continuous enlargement of the retropatellar articulating surface occurs. Both lead to lower retropatellar compressive stresses. Menisci and cartilage, ligaments and bones are susceptible to anabolic metabolic processes and functional structural adaptations in response to increased activity and mechanical influences. Concerns about degenerative changes of the tendofemoral complex and the apparent higher risk for chondromalacia, osteoarthritis, and osteochondritis in deep squats are unfounded. With the same load configuration as in the deep squat, half and quarter squat training with comparatively supra-maximal loads will favour degenerative changes in the knee joints and spinal joints in the long term. Provided that technique is learned accurately under expert supervision and with progressive training loads, the deep squat presents an effective training exercise for protection against injuries and strengthening of the lower extremity. Contrary to commonly voiced concern, deep squats do not contribute increased risk of injury to passive tissues.
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            MRI criteria for patella alta and baja.

            To determine the range of the patellar tendon length to patellar length ratio on magnetic resonance imaging (MRI) of the knee in order to aid in the establishment of MRI criteria for patella alta and baja. Two hundred and forty-five patients ages 6-85 (mean 44) years who went through 262 consecutive 1.5 MRI studies of the knee performed during November 2000 through February 2001 were evaluated, regardless of their clinical symptoms. Patellar length (PL) and patellar tendon length (TL) were measured by a single musculoskeletal radiologist on sagittal images by a line connecting the superior and inferior patellar poles and the shortest length of the inner margin of the tendon respectively. TL/PL ratio was subsequently calculated. The distribution of ratios was evaluated; the extreme 2.5% at each end of the distribution was defined as patella alta and baja. The TL/PL ratio ranged between 0.56 and 1.71 (mean 1.05). After plotting the ratios, we noted an asymmetric curve skewed to the left. Based upon calculation of the extreme 2.5% of the ratio at each end of the plot, we determined that the MRI definition of patella alta and baja is a ratio of TL/PL of more than 1.50 and less than 0.74 respectively. We found that females had significantly higher TL/PL ratio than males (1.0878 and 1.0032 respectively). Ratios defined for patella alta and baja were 1.52 and 0.79 respectively in females and 1.32 and 0.74 respectively in males ( p<0.0001). Patella alta and baja are determined as TL/PL of more than 1.50 and less than 0.74 respectively, somewhat different than traditionally quoted radiographic and previously described MRI criteria.
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              Injuries and preventive actions in elite Swedish volleyball.

              The purpose of this study was to examine the prevalence of injury and the extent of preventive actions in elite Swedish volleyball players. Injuries to players in the elite male and female Swedish division, during the 2002-2003 season, were registered by using a questionnaire. Of the 158 volleyball players (70% response rate), a total of 82 players (52%) reported 121 injuries, during a total exposure time of 24 632 h, representing an overall incidence of 0.77 injuries per player. The majority of the injuries were located in the ankle (23%), followed by the knee (18%) and the back (15%). Most injuries (62%) were classified as being of minor severity. Most injuries occurred during training (47%), and 41% of the injuries had a gradual onset. Fifty-four percent of the injuries that could be related to a specific court situation occurred during blocking, and 30% during spiking. Most players (96%) participated in injury prevention training of some kind, generally performed without supervision (58%). Although most players took part in some kind of preventive action, one out of two players incurred an injury during the season, which indicates that the risk of suffering an injury in elite volleyball is relatively high.
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                Author and article information

                Contributors
                Journal
                Eur J Radiol Open
                Eur J Radiol Open
                European Journal of Radiology Open
                Elsevier
                2352-0477
                04 October 2021
                2021
                04 October 2021
                : 8
                : 100381
                Affiliations
                [a ]Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
                [b ]Department of Radiology, Boston University School of Medicine, Boston, MA, United States
                [c ]Department of Radiology, Friedrich Alexander University Erlangen-Nürnberg (FAU) & Universitätsklinikum Erlangen, Erlangen, Germany
                [d ]Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
                [e ]Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
                [f ]Department of Orthopedic Surgery, Oslo University Hospital, University of Oslo, Norway
                [g ]Department of Radiology, Brigham and Women’s Hospital, Boston, MA, United States
                [h ]Department of Radiology, VA Boston Health System, Boston, MA, United States
                Author notes
                [* ]Corresponding author at: Department of Radiology, Massachusetts General Hospital, 32 Fruit Street, YAW 6044, Boston, MA, 02114, United States. mjarraya@ 123456mgh.harvard.edu
                Article
                S2352-0477(21)00061-7 100381
                10.1016/j.ejro.2021.100381
                8502704
                34660850
                47ea413e-15e8-4f2b-8b1d-58a3d423686b

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 18 July 2021
                : 20 September 2021
                : 27 September 2021
                Categories
                Article

                bml, bone marrow lesion,ioc, international olympic committee,lti, lateral trochlear inclination,mti, medial trochlear inclination,oa, osteoarthritis,pfj, patellofemoral joint,ta, trochlear angle,sa, sulcus angle,shfp, superolateral hoffa’s fat pad,knee,athletes,maltracking,cartilage,bone marrow lesion,superolateral hoffa’s fat pad edema

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