Tendinopatia patelar: investigando fatores associados à sobrecarga no tendão patelar em atletas

Abstract

Excessive forces (magnitude and duration) applied to the patellar tendon are related to the mechanisms that lead to patellar tendinopathy (PT) development, as result of tissue inflammation and/or repetitive micro traumas. Factors related to the knee joint (local) and/or to the hip and foot joints (non-local) may contribute to patellar tendon overload. Excessive varus forefoot alignment, muscle weakness and restricted joint range of motion (ROM) could alter the correct movement pattern and overload the patellar tendon. However, research on factors associated with PT is inconsistent and rarely find factors that are strongly associated with PT occurrence. Moreover, non-local factors are not frequently investigated. The purpose of this thesis was to investigate factors associated to patellar tendon overload in athletes. The first study was conducted to explore possible association of factors related to hip, knee and foot joints with the occurrence of patellar tendon morphological abnormalities. The ROC curve showed an association of iliotibial band flexibility, shank-forefoot alignment (SFA) and frontal plane patellar rotation (Arno angle) with patellar tendon morphological abnormalities identified by ultrasonography. The second study was developed to establish diagnostic criteria to identify athletes with patellar tendon morphological abnormalities. The results indicated that the combination of VISA-P questionnaire, single-leg decline squat and patellar tendon pain history, named Patellar Tendon Clinical Test (PTCT), accurately identified athletes with abnormalities identified at ultrasound. The third study was performed to identify the contribution of factors related to the hip and foot joints to the occurrence of patellar tendinopathy (jumper's knee) in volleyball and basketball athletes. Classification and regression tree analysis indicated that no isolated factor could classify PT occurrence and revealed that proximal and distal factors may be involved in mechanisms related to patellar tendon overload. Interactions among hip lateral rotators isometric torque, SFA, hip passive medial rotation ROM and ankle dorsiflexion were found to be related to the occurrence of patellar tendinopathy and should be investigated in future prospective studies. The results of this thesis founded non-local factors participating in patellar tendon overload mechanism in athletes.