Sonografische Dimensionen der Patellasehne von Hochleistungssportlern

 

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Zusammenfassung

Hintergrund: Die sonografische Wertigkeit der Sehnenverdickung als morphologisches Korrelat der patellaren Tendinopathie gilt zumindest an der proximalen Insertion des Lig. patellae als unumstritten. Es fehlen jedoch verbindliche Grenzwerte für Leistungssportler und Normalpersonen. Darüber hinaus herrscht in der Literatur nach wie vor Uneinigkeit über die klinische Relevanz von qualitativen Veränderungen wie z. B. der Hypoechogenität der Sehnenbinnenstruktur. Probanden: 202 Kaderathleten des Deutschen Leichtathletik-Verbandes und 199 altersgematchte Normalpersonen wurden sonografisch untersucht. Methoden: 404 Patellasehnen von Leistungssportlern wurden mittels des tragbaren Ultraschallgeräts „Just Vision“ mit 398 Patellasehnen von Normalpersonen bezüglich der Sehnendicke an der (i) proximalen Insertion, der (ii) Taille und der (iii) distalen Insertion verglichen. Zusätzlich wurden qualitative pathologische Veränderungen und klinische Beschwerden erfasst. Ergebnisse: Die Athleten berichteten über mehr klinische Beschwerden und ihre Patellasehnen waren an allen 3 Messpositionen dicker als die der Normalpersonen (alle p-Werte < 0,01). Ab einer proximalen Insertionsdicke von 6,0 mm war bei den Sportlern mit hoher Sicherheit von klinischen Beschwerden auszugehen. Bei den Athleten war an allen 3 Messpositionen ein Zusammenhang zwischen Dicke und Symptomatik zu verzeichnen, in der Kontrollgruppe war dies nur an der proximalen Insertion der Fall. Qualitativ zeigten sich wenig konsistente Unterschiede zwischen Kader- und Kontrollgruppe. Schlussfolgerung: Das Ergebnismuster bestätigt die klinische Relevanz der proximalen Insertionsdicke für die patellare Tendinopathie und liefert kritische Grenzwerte, die zukünftig hinsichtlich ihrer Prognosefunktion im Leistungssport weiter untersucht werden sollten. Die Bedeutung von qualitativ-pathologischen Veränderungen wie Hypoechogenität konnte nicht sicher belegt werden.

Abstract

Background: The sonographic validity of a thickened tendon as a morphological correlate of patellar tendinopathy is beyond dispute, regarding the proximal insertion at the very least. There is, however, a lack of mandatory standard values for competitive athletes and normal individuals. In addition, research findings concerning the clinical relevance of qualitative changes such as hypoechogenic regions are still inconclusive. Participants: 202 national squad athletes from the German track and field federation and 199 age-matched normal individuals were examined sonographically. Method: 404 patellar tendons of athletes were compared as to tendon diameter at the (i) proximal insertion, (ii) waist, and (iii) distal insertion with 398 patellar tendons of normal individuals using the portable ultrasound scanner “Just Vision”. Furthermore, qualitative pathologies and clinical symptoms were assessed. Results: Athletes reported more clinical symptoms and their tendons were thicker than normal tendons at all three positions (all pʼs < 0.01). In athletes, proximal diameters above 6.0 mm were very likely to go along with clinical symptoms. There was an association between tendon diameter and symptoms at all three positions among the athletes, whereas in controls, this was only true for the proximal insertion. Only few consistent qualitative differences were found between athletes and normal individuals. Conclusion: The pattern of results confirms the clinical relevance of the proximal tendon diameter for patellar tendinopathy and provides standard values which should be evaluated in future research with regard to their prognostic utility in competitive sports. The importance of qualitative pathologies such as hypoechogenic regions could not be firmly asserted.

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