Dr Suzi Edwards's research examines the mechanics of lower limb landing strategies associated with knee joint injuries, particular patellar tendinopathy. Patellar tendinopathy is an insidious overuse knee injury with a reported prevalence ranging from 10% to 45% in sports involving repetitive jumping and landing, such as volleyball, basketball and soccer. This is a complex condition that is difficult to treat, rest does not alleviate pain, and it can severely limit or potentially end an athletic career. One of the major extrinsic risk factors in the development of patellar tendinopathy is thought to be repetitive landing. As the structure, composition, and mechanical properties of tendons can be altered in response to mechanical loading, the patellar tendon will display histological adaptation in reaction to loading. Nevertheless, such adaptations may reduce the ability of the tendon to withstand higher loads. Therefore, repetitive loading is the most frequently reported causative factor associated with patellar tendinopathy and rehabilitation strategies have frequently focused on altering patellar tendon loading. As loading the patellar tendon at higher knee flexion angles increases stress-shielding and also potentially increases the compressive strain, lower limb landing techniques displayed by athletes may influence the development of patellar tendinopathy. In order to identify factors that might contribute to high loading of the knee during repetitive landing tasks, Dr Edwards’s research focuses on the biomechanics of lower limb landing techniques displayed by athletes with and without patellar tendinopathy while they perform dynamic landing movements.
One risk factor that could provide insight into the development of patellar tendinopathy, in terms of potentially altering an athlete’s lower limb landing technique and loading pattern of the patellar tendon, is the presence of a patellar tendon ultrasound abnormality on diagnostic imaging (PTA). A PTA is a hypoechoic region within the patellar tendon, which indicates structural changes within the patellar tendon. Although a PTA and tendon pain are diagnostic criteria for patellar tendinopathy, a PTA can also be evident in athletes without tendon pain, with a prevalence of 22% to 32%. The likelihood of an asymptomatic athlete with a PTA developing patellar tendinopathy increases four times in basketball players and 17% in elite soccer players compared to asymptomatic athletes with no evidence of a PTA. Despite being confirmed as a risk factor, a PTA can resolve, remain unchanged or worsen in athletes without predicting symptoms of patellar tendinopathy. Nevertheless, although altered lower limb landing strategies have been associated with patellar tendinopathy, Dr Edwards’s research has also observed different lower limb strategies in asymptomatic athletes with PTA.
Fatigue is also thought to be a major risk factor in the development of knee joint injuries, particularly overuse injuries such as patellar tendinopathy, as a higher incidence of injuries occur towards the end of both halves or in the later part of competitive team games. Lower limb fatigue may also contribute to patellar tendinopathy by altering the way an individual lands and, in turn, the magnitude and/or pattern of patellar tendon loading.
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