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Evidence of accumulated stress in Achilles and anterior knee tendons in elite badminton players

  • Sports Medicine
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Tendon-related injuries are a major problem, but the aetiology of tendinopathies is unknown. In tendinopathies as well as during unaccustomed loading, intra-tendinous flow can be detected indicating that extensive loading can provoke intra-tendinous flow. The aim of present study is to evaluate the vascular response as indicated by colour Doppler (CD) activity in both the Achilles and patella tendon after loading during high-level badminton matches. The Achilles tendon was subdivided into a mid-tendon, pre-insertional, and insertional region and the anterior knee tendons into a quadriceps-, patella- and tuberositas region. Intra-tendinous flow was measured using both a semi-quantitative grading system (CD grading) and a quantitative scoring system (CF) on colour Doppler. Intra-tendinous flow in the Achilles and anterior knee tendons was examined in fourteen single players before tournament and after 1st and 2nd match, respectively on both the dominant and non-dominant side. All players had abnormal intra-tendinous flow (Colour Doppler ≥ grade 2) in at least one tendon in at least one scan during the tournament. At baseline, only two of the 14 players had normal flow in all the tendons examined. After 1st match, tendencies to higher intra-tendinous flow were observed in both the dominant patella tendon and non-dominant quadriceps tendon (P-values n.s.). After 2nd match, intra-tendinous flow was significant increased in the dominant patella tendon (P = 0.009). In all other locations, there was a trend towards a stepwise increase in intra-tendinous flow. The preliminary results indicate that high amount of intra-tendinous flow was found in elite badminton players at baseline and was increased after repetitive loading, especially in the patella tendon (dominant leg). The colour Doppler measurement can be used to determine changes in intra-tendinous flow after repetitive loading.

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References

  1. Alfredson H, Forsgren S, Thorsen K, Lorentzon R (2001) In vivo microdialysis and immunohistochemical analyses of tendon tissue demonstrated high amounts of free glutamate and glutamate NMDAR1 receptors, but no signs of inflammation, in Jumper’s knee. J Orthop Res 195:881–886

    Article  Google Scholar 

  2. Alfredson H, Ohberg L, Forsgren S (2003) Is vasculo-neural ingrowth the cause of pain in chronic Achilles tendinosis? An investigation using ultrasonography and colour Doppler, immunohistochemistry, and diagnostic injections. Knee Surg Sports Traumatol Arthrosc 115:334–338

    Article  Google Scholar 

  3. Aström M, Gentz CF, Nilsson P, Rausing A, Sjöberg S, Westlin N (1996) Imaging in chronic achilles tendinopathy: a comparison of ultrasonography, magnetic resonance imaging and surgical findings in 27 histologically verified cases. Skeletal Radiol 257:615–620

    Google Scholar 

  4. Boesen MI, Boesen M, Langberg H et al (2010) Musculoskeletal colour/power Doppler in sports medicine: image parameters, artefacts, image interpretation and therapy. Clin Exp Rheumatol 28:103–113

    CAS  PubMed  Google Scholar 

  5. Boesen MI, Boesen A, Koenig MJ, Bliddal H, Torp-Pedersen S (2006) Ultrasonographic investigation of the Achilles tendon in elite badminton players using color Doppler. Am J Sports Med 3412:2013–2021

    Article  Google Scholar 

  6. Boesen MI, Koenig MJ, Torp-Pedersen S, Bliddal H, Langberg H (2006) Tendinopathy and Doppler activity: the vascular response of the Achilles tendon to exercise. Scand J Med Sci Sports 166:463–469

    Article  Google Scholar 

  7. Chard MD, Lachmann SM (1987) Racquet sports–patterns of injury presenting to a sports injury clinic. Br J Sports Med 214:150–153

    Article  Google Scholar 

  8. Clain MR, Baxter DE (1992) Achilles tendinitis. Foot Ankle 138:482–487

    Google Scholar 

  9. Cook JL, Kiss ZS, Ptasznik R, Malliaras P (2005) Is vascularity more evident after exercise? Implications for tendon imaging. AJR Am J Roentgenol 1855:1138–1140

    Article  Google Scholar 

  10. Cook JL, Malliaras P, De LJ, Ptasznik R, Morris M (2005) Vascularity and pain in the patellar tendon of adult jumping athletes: a 5 month longitudinal study. Br J Sports Med 39(7):458–461

    Article  CAS  PubMed  Google Scholar 

  11. Couppe C, Kongsgaard M, Aagaard P et al (2008) Habitual loading results in tendon hypertrophy and increased stiffness of the human patellar tendon. J Appl Physiol 1053:805–810

    Article  Google Scholar 

  12. Ellegaard K, Torp-Pedersen S, Henriksen M, Lund H, Danneskiold-Samsoe B, Bliddal H (2009) Influence of recent exercise and skin temperature on ultrasound Doppler measurements in patients with rheumatoid arthritis–an intervention study. Rheumatology (Oxford) 4812:1520–1523

    Article  Google Scholar 

  13. Fahlström M, Björnstig U, Lorentzon R (1998) Acute Achilles tendon rupture in badminton players. Am J Sports Med 263:467–470

    Google Scholar 

  14. Fahlström M, Björnstig U, Lorentzon R (1998) Acute badminton injuries. Scand J Med Sci Sports 83:145–148

    Google Scholar 

  15. Fahlström M, Lorentzon R, Alfredson H (2002) Painful conditions in the Achilles tendon region in elite badminton players. Am J Sports Med 301:51–54

    Google Scholar 

  16. Fredberg U, Bolvig L, Andersen NT (2008) Prophylactic training in asymptomatic soccer players with ultrasonographic abnormalities in Achilles and patellar tendons: the Danish Super League Study. Am J Sports Med 363:451–460

    Google Scholar 

  17. Fredberg U, Stengaard-Pedersen K (2008) Chronic tendinopathy tissue pathology, pain mechanisms, and etiology with a special focus on inflammation. Scand J Med Sci Sports 181:3–15

    Article  Google Scholar 

  18. Hensley LD, Paup DC (1979) A survey of badminton injuries. Br J Sports Med 134:156–160

    Article  Google Scholar 

  19. Hess GW (2010) Achilles tendon rupture: a review of etiology, population, anatomy, risk factors, and injury prevention. Foot Ankle Spec 31:29–32

    Article  Google Scholar 

  20. Hoksrud A, Ohberg L, Alfredson H, Bahr R (2008) Color Doppler ultrasound findings in patellar tendinopathy (jumper’s knee). Am J Sports Med 369:1813–1820

    Article  Google Scholar 

  21. Höy K, Lindblad BE, Terkelsen CJ, Helleland HE, Terkelsen CJ (1994) Badminton injuries–a prospective epidemiological and socioeconomic study. Br J Sports Med 284:276–279

    Article  Google Scholar 

  22. Järvinen TA, Kannus P, Paavola M, Järvinen TL, Jozsa L, Järvinen M (2001) Achilles tendon injuries. Curr Opin Rheumatol 132:150–155

    Article  Google Scholar 

  23. Jörgensen U, Winge S (1987) Epidemiology of badminton injuries. Int J Sports Med 86:379–382

    Article  Google Scholar 

  24. Jörgensen U, Winge S (1990) Injuries in badminton. Sports Med 101:59–64

    Article  Google Scholar 

  25. Kannus P, Paavola M, Paakkala T, Parkkari J, Järvinen T, Järvinen M (2002) Pathophysiology of overuse tendon injury. Radiologe 4210:766–770

    Article  Google Scholar 

  26. Khan KM, Forster BB, Robinson J et al (2003) Are ultrasound and magnetic resonance imaging of value in assessment of Achilles tendon disorders? A two year prospective study. Br J Sports Med 372:149–153

    Article  Google Scholar 

  27. Koenig MJ, Torp-Pedersen S, Boesen MI, Holm CC, Bliddal H (2010) Doppler ultrasonography of the anterior knee tendons in elite badminton players: colour fraction before and after match. Br J Sports Med 442:134–139

    Article  Google Scholar 

  28. Koenig MJ, Torp-Pedersen S, Qvistgaard E, Terslev L, Bliddal H (2004) Preliminary results of colour Doppler-guided intratendinous glucocorticoid injection for Achilles tendonitis in five patients. Scand J Med Sci Sports 142:100–106

    Article  Google Scholar 

  29. Koenig MJ, Torp-Pedersen ST, Christensen R et al (2007) Effect of knee position on ultrasound Doppler findings in patients with patellar tendon hyperaemia (jumper’s knee). Ultraschall Med 285:479–483

    Article  Google Scholar 

  30. Kroner K, Schmidt SA, Nielsen AB et al (1990) Badminton injuries. Br J Sports Med 243:169–172

    Article  Google Scholar 

  31. Kujala UM, Sarna S, Kaprio J (2005) Cumulative incidence of achilles tendon rupture and tendinopathy in male former elite athletes. Clin J Sport Med 153:133–135

    Article  Google Scholar 

  32. Levi N (1997) The incidence of Achilles tendon rupture in Copenhagen. Injury 284:311–313

    Article  Google Scholar 

  33. Martinoli C, Derchi LE, Rizzatto G, Solbiati L (1998) Power Doppler sonography: general principles, clinical applications, and future prospects. Eur Radiol 87:1224–1235

    Article  Google Scholar 

  34. Mills R (1977) Injuries in badminton. Br J Sports Med 111:51–53

    Article  Google Scholar 

  35. Ohberg L, Lorentzon R, Alfredson H (2001) Neovascularisation in Achilles tendons with painful tendinosis but not in normal tendons: an ultrasonographic investigation. Knee Surg Sports Traumatol Arthrosc 94:233–238

    Google Scholar 

  36. Rasmussen OS (2000) Sonography of tendons. Scand J Med Sci Sports 106:360–364

    Article  Google Scholar 

  37. Reiter M, Ulreich N, Dirisamer A, Tscholakoff D, Bucek RA (2004) Colour and power Doppler sonography in symptomatic Achilles tendon disease. Int J Sports Med 254:301–305

    Google Scholar 

  38. Richards PJ, Dheer AK, McCall IM (2001) Achilles tendon (TA) size and power Doppler ultrasound (PD) changes compared to MRI: a preliminary observational study. Clin Radiol 5610:843–850

    Article  Google Scholar 

  39. Richards PJ, Win T, Jones PW (2005) The distribution of microvascular response in Achilles tendonopathy assessed by colour and power Doppler. Skeletal Radiol 346:336–342

    Article  Google Scholar 

  40. Ristolainen L, Heinonen A, Turunen H et al (2009) Type of sport is related to injury profile: a study on cross country skiers, swimmers, long-distance runners and soccer players. A retrospective 12-month study. Scand J Med Sci Sports 203:384–393

    Article  Google Scholar 

  41. Seynnes OR, Erskine RM, Maganaris CN et al (2009) Training-induced changes in structural and mechanical properties of the patellar tendon are related to muscle hypertrophy but not to strength gains. J Appl Physiol 1072:523–530

    Article  Google Scholar 

  42. Terslev L, Qvistgaard E, Torp-Pedersen S, Laetgaard J, Danneskiold-Samsoe B, Bliddal H (2001) Ultrasound and Power Doppler findings in jumper’s knee—preliminary observations. Eur J Ultrasound 133:183–189

    Article  Google Scholar 

  43. Weinberg EP, Adams MJ, Hollenberg GM (1998) Color Doppler sonography of patellar tendinosis. AJR Am J Roentgenol 1713:743–744

    Google Scholar 

  44. Weir MA, Watson AW (1996) A twelve month study of sports injuries in one Irish school. Ir J Med Sci 1653:165–169

    Article  Google Scholar 

  45. Winge S, Jörgensen U, Lassen NA (1989) Epidemiology of injuries in Danish championship tennis. Int J Sports Med 105:368–371

    Article  Google Scholar 

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Acknowledgment

The study was supported by the OAK foundation.

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Authors and Affiliations

  1. Institute of Sports Medicine, Bispebjerg Hospital and Center for Healthy Aging, Faculty of Health Sciences, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen NV, Denmark

    Anders Ploug Boesen & Henning Langberg

  2. The Parker Institute, Frederiksberg Hospital, Frederiksberg, Denmark

    Morten Ilum Boesen, Merete Juhl Koenig, Henning Bliddal & Soren Torp-Pedersen

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  1. Anders Ploug Boesen
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  2. Morten Ilum Boesen
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  3. Merete Juhl Koenig
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  4. Henning Bliddal
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  5. Soren Torp-Pedersen
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  6. Henning Langberg
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Correspondence to Anders Ploug Boesen.

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Boesen, A.P., Boesen, M.I., Koenig, M.J. et al. Evidence of accumulated stress in Achilles and anterior knee tendons in elite badminton players. Knee Surg Sports Traumatol Arthrosc 19, 30–37 (2011). https://doi.org/10.1007/s00167-010-1208-z

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  • DOI: https://doi.org/10.1007/s00167-010-1208-z

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