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Patellar tendinopathy (PT) is an overuse injury associated with loading activities, and popular among basketball and volleyball players. Although altered biomechanical characteristics during landing has been suggested as one of the risk factors for the development of PT, previous evidence failed to show the link between the sagittal plane biomechanics of the hip and knee joint and PT; and little was known about the frontal and horizontal plane biomechanics in athletes with PT. While other factors such as motor control or muscle activation also have not been explored fully. The purpose of this study is to compare hip motor control and biomechanical characteristics of the hip and knee joint during landing in athletes with and without symptomatic PT.
Background: Patellar tendinopathy is an overuse injury associated with loading activities, and it is thought to be caused by repetitive force applied to the patellar tendon. Patellar tendinopathy is popular among basketball and volleyball players, particularly in men. Although altered biomechanical characteristics during landing has been suggested as one of the risk factors for the development of patellar tendinopathy, previous evidence failed to show the link between the sagittal plane biomechanics of the hip and knee joint and patellar tendinopathy; and little was known about the frontal and horizontal plane biomechanics in athletes with patellar tendinopathy. Among those factors contributing to the biomechanical characteristics, hip and quadriceps strength were shown linked with the presence of patellar tendinopathy, while other factors such as motor control or muscle activation have not been explored fully. The purpose of this study is to compare hip motor control and biomechanical characteristics of the hip and knee joint during landing in athletes with and without symptomatic patellar tendinopathy. The investigators hypothesize that the athletes with symptomatic patellar tendinopathy have poorer motor control and different landing biomechanics as compared with asymptomatic athletes.
Method: the investigators plan to recruit seventeen symptomatic patellar tendinopathy athletes for the experimental group, using demographic data (sex, age, height, weight, exercise type) of experimental group to match seventeen non-symptomatic athletes as control group. The assessment included hip motor control in various directions, and measurement of kinetics, kinematics and muscle activation during the step-down task, drop vertical jump and countermovement jump using the computer-aided video motion analysis system (Vicon) and the surface EMG (Noraxon). The group difference will be tested using t-test for the motor control ability and biomechanical characteristics. The significant level was set at 0.05.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| symptomatic group | Individuals with patellar tendon pain last for 3 months Individuals age between 18-40 years old Individuals had trained in volleyball or basketball for more than two years Individuals still played volleyball or basketball for at least 90 minutes a week Victorian Institute of Sport Assessment (VISA) Questionnaire score ≦80 | ||
| asymptomatic group | Individuals without any lower extremity pain(NRS>3/10) in past 3 months Individuals age between 18-40 years old Individuals had trained in volleyball or basketball for more than two years Individuals still played volleyball or basketball for at least 90 minutes a week Victorian Institute of Sport Assessment (VISA) Questionnaire score >80 |
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| Measure | Description | Time Frame |
|---|---|---|
| Hip Flexion Angles | Measure the hip joint angle when the knee reaches the maximum flexion angle during the landing phase of the countermovement jump | In the experiment, the maximum knee flexion during the landing phase of the countermovement jump |
| Maximal Knee Flexion Angle | In the countermovement jump test, the force received by the force plate changes from 0 to a positive value during the landing phase. Measure the maximal knee flexion angle during this phase. | The landing phase of the countermovement jump in the experiment |
| Hip Abduction Angle | Measure the hip abduction angle when the knee reaches the maximum flexion angle during the landing phase of the countermovement jump | In the experiment, the maximum knee flexion during the landing phase of the countermovement jump |
| Knee Joint Flexion Angle | Perform the step-down test on a 15 cm high table to measure the knee flexion angle of the foot on the table when the side foot is at the lowest point. | the contralateral foot is at its lowest point in step-down test in the experiment |
| Motor Control Ability | Having 4 motor control tests: Hip Flexion Control: Maintain an upright posture in a single-leg small knee bend. The knee aligns with the 2nd toe in the sagittal plane and >5 cm beyond the toes. Internal/External Rotation Control:Perform a single-leg small knee bend while rotating the pelvis and upper body toward the opposite/same side. Rotate 35°/30° without excessive L/E compensation. Hip Adduction Control:Maintain a single-leg stance with symmetrical shoulders and pelvis. Pelvic lateral displacement <10 cm, left-right displacement difference <2 cm. Scoring Criteria: Avoid uncontrolled movements, perform isolated movements correctly, achieve adequate ROM, maintain normal breathing, control movements in eccentric/concentric phases, execute smoothly, stay relaxed and aware, ensure fluid transitions, avoid compensations, complete without feedback/support, and show no fatigue. Total score range: 0-52, converted to a percentage for comparison(0-100%). |
| Measure | Description | Time Frame |
|---|---|---|
| Maximum Muscle Activity of Biceps Femoris | Before the task, the subjects were asked to prone on the bed with their hips at 0 degrees and tested knee at 45 degrees of flexion, and to do isometric contractions with the utmost strength. The muscle contraction signals were recorded by EMG, and the average value of five measurements was taken as maximal voluntary contraction (MVC) of biceps femoris. The countermovement jump test requires the participant to cross their arms over the chest, squat down, and then jump as high as possible before landing. The landing phase is identified when the ground reaction force recorded by the force plate transitions from zero to a positive value. Using a trigger, the force plate data is synchronized with EMG data to determine the peak activation of the biceps femoris muscle during the landing phase. The biceps femoris contraction signals collected during the task were divided by the maximum biceps femoris contraction signal, and the results were standardized for comparison between individuals. |
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Inclusion Criteria:
symptomatic group:
asymptomatic group:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Yi-Fen Shih, Ph.D | Department of Physical Therapy and Assistive Technology, National Yang-Ming Chiao-Tung University | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| National Yang-Ming Chiao-Tung University | Taipei | 11221 | Taiwan |
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Participants were recruited from Taipei and New Taipei City via social media between February 2023 and June 2023. The first participant was enrolled on February 13, 2023 and the last participant was enrolled in June 2023
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| ID | Title | Description |
|---|---|---|
| FG000 | Symptomatic Group | Individuals with patellar tendon pain last for 3 months Individuals age between 18-40 years old Individuals had trained in volleyball or basketball for more than two years Individuals still played volleyball or basketball for at least 90 minutes a week Victorian Institute of Sport Assessment (VISA) Questionnaire score ≦80 |
| FG001 | Asymptomatic Group | Individuals without any lower extremity pain(NRS>3/10) in past 3 months Individuals age between 18-40 years old Individuals had trained in volleyball or basketball for more than two years Individuals still played volleyball or basketball for at least 90 minutes a week Victorian Institute of Sport Assessment (VISA) Questionnaire score >80 |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
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| ID | Title | Description |
|---|---|---|
| BG000 | Symptomatic Group | Individuals with patellar tendon pain last for 3 months Individuals age between 18-40 years old Individuals had trained in volleyball or basketball for more than two years Individuals still played volleyball or basketball for at least 90 minutes a week Victorian Institute of Sport Assessment (VISA) Questionnaire score ≦80 |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Categorical | Count of Participants |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Hip Flexion Angles | Measure the hip joint angle when the knee reaches the maximum flexion angle during the landing phase of the countermovement jump | Posted | Mean | Standard Deviation | degrees | In the experiment, the maximum knee flexion during the landing phase of the countermovement jump |
|
during the experiment, up to 4 hours
no any adverse event
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Symptomatic Group | Individuals with patellar tendon pain last for 3 months Individuals age between 18-40 years old Individuals had trained in volleyball or basketball for more than two years Individuals still played volleyball or basketball for at least 90 minutes a week Victorian Institute of Sport Assessment (VISA) Questionnaire score ≦80 |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Yi-Fen Shih, Ph.D Department of Physical Therapy and Assistive Technology | National Yang-Ming Chiao-Tung University | +886-2-28267340 | yfshih@nycu.edu.tw |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Apr 14, 2024 | Mar 23, 2025 | Prot_SAP_000.pdf |
| ICF | No | No | Yes | Informed Consent Form | Dec 1, 2022 | Mar 23, 2025 | ICF_001.pdf |
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| during the experiment, up to 4 hours |
| Immediately during the experiment |
| Muscle Activity of Biceps Femoris | Before the task, the subjects were asked to prone on the bed with their hips at 0 degrees and tested knee at 45 degrees of flexion, and to do isometric contractions with the utmost strength. The muscle contraction signals were recorded by EMG, and the average value of five measurements was taken as maximal voluntary contraction (MVC) of biceps femoris. The countermovement jump test requires the participant to cross their arms over the chest, squat down, and then jump as high as possible before landing. The landing phase is identified when the GRF recorded by the force plate transitions from zero to a positive value. Using a trigger, the force plate data and kinematics data is synchronized with EMG data to determine the activation of the biceps femoris muscle during maximal knee flexion in the landing phase. The signals collected during the task were divided by the maximum biceps femoris contraction signal, and the results were standardized for comparison between individuals. | Immediately during the experiment |
| BG001 |
| Asymptomatic Group |
Individuals without any lower extremity pain(NRS>3/10) in past 3 months Individuals age between 18-40 years old Individuals had trained in volleyball or basketball for more than two years Individuals still played volleyball or basketball for at least 90 minutes a week Victorian Institute of Sport Assessment (VISA) Questionnaire score >80 |
| BG002 | Total | Total of all reporting groups |
| Participants |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Race (NIH/OMB) | Count of Participants | Participants |
|
| Height | Mean | Standard Deviation | cm |
|
| Specializing in | Count of Participants | Participants |
|
| Dominal leg | Count of Participants | Participants |
|
| Body weight | Mean | Standard Deviation | kg |
|
| BMI | Mean | Standard Deviation | kg/m^2 |
|
| Training time per week | Mean | Standard Deviation | min/wk |
|
| VISA-PCh | The VISA-PCh scale is a validated Chinese version questionnaire designed to assess the severity of patellar tendinopathy, commonly known as jumper's knee. Questionnaire consists of eight questions, covering three key areas: Pain, Function and Sports Participation. Each question is scored, with a total possible score from 0-100. A higher score indicates better tendon health and lower symptom severity, while a lower score suggests more significant impairment due to patellar tendinopathy. | Mean | Standard Deviation | units on a scale |
|
| Jumping height | Mean | Standard Deviation | cm |
|
| Height of spike jump | Mean | Standard Deviation | cm |
|
| Ankle DF ROM in weight bearing | Mean | Standard Deviation | degrees |
|
| Hip extensor power | Mean | Standard Deviation | percentage of body weight |
|
|
|
|
| Primary | Maximal Knee Flexion Angle | In the countermovement jump test, the force received by the force plate changes from 0 to a positive value during the landing phase. Measure the maximal knee flexion angle during this phase. | Posted | Mean | Standard Deviation | degrees | The landing phase of the countermovement jump in the experiment |
|
|
|
|
| Primary | Hip Abduction Angle | Measure the hip abduction angle when the knee reaches the maximum flexion angle during the landing phase of the countermovement jump | Posted | Mean | Standard Deviation | degrees | In the experiment, the maximum knee flexion during the landing phase of the countermovement jump |
|
|
|
|
| Primary | Knee Joint Flexion Angle | Perform the step-down test on a 15 cm high table to measure the knee flexion angle of the foot on the table when the side foot is at the lowest point. | Posted | Mean | Standard Deviation | degrees | the contralateral foot is at its lowest point in step-down test in the experiment |
|
|
|
|
| Primary | Motor Control Ability | Having 4 motor control tests: Hip Flexion Control: Maintain an upright posture in a single-leg small knee bend. The knee aligns with the 2nd toe in the sagittal plane and >5 cm beyond the toes. Internal/External Rotation Control:Perform a single-leg small knee bend while rotating the pelvis and upper body toward the opposite/same side. Rotate 35°/30° without excessive L/E compensation. Hip Adduction Control:Maintain a single-leg stance with symmetrical shoulders and pelvis. Pelvic lateral displacement <10 cm, left-right displacement difference <2 cm. Scoring Criteria: Avoid uncontrolled movements, perform isolated movements correctly, achieve adequate ROM, maintain normal breathing, control movements in eccentric/concentric phases, execute smoothly, stay relaxed and aware, ensure fluid transitions, avoid compensations, complete without feedback/support, and show no fatigue. Total score range: 0-52, converted to a percentage for comparison(0-100%). | Posted | Mean | Standard Deviation | score on a scale | during the experiment, up to 4 hours |
|
|
|
|
| Secondary | Maximum Muscle Activity of Biceps Femoris | Before the task, the subjects were asked to prone on the bed with their hips at 0 degrees and tested knee at 45 degrees of flexion, and to do isometric contractions with the utmost strength. The muscle contraction signals were recorded by EMG, and the average value of five measurements was taken as maximal voluntary contraction (MVC) of biceps femoris. The countermovement jump test requires the participant to cross their arms over the chest, squat down, and then jump as high as possible before landing. The landing phase is identified when the ground reaction force recorded by the force plate transitions from zero to a positive value. Using a trigger, the force plate data is synchronized with EMG data to determine the peak activation of the biceps femoris muscle during the landing phase. The biceps femoris contraction signals collected during the task were divided by the maximum biceps femoris contraction signal, and the results were standardized for comparison between individuals. | Posted | Mean | Standard Deviation | percentage of MVC | Immediately during the experiment |
|
|
|
|
| Secondary | Muscle Activity of Biceps Femoris | Before the task, the subjects were asked to prone on the bed with their hips at 0 degrees and tested knee at 45 degrees of flexion, and to do isometric contractions with the utmost strength. The muscle contraction signals were recorded by EMG, and the average value of five measurements was taken as maximal voluntary contraction (MVC) of biceps femoris. The countermovement jump test requires the participant to cross their arms over the chest, squat down, and then jump as high as possible before landing. The landing phase is identified when the GRF recorded by the force plate transitions from zero to a positive value. Using a trigger, the force plate data and kinematics data is synchronized with EMG data to determine the activation of the biceps femoris muscle during maximal knee flexion in the landing phase. The signals collected during the task were divided by the maximum biceps femoris contraction signal, and the results were standardized for comparison between individuals. | Posted | Mean | Standard Deviation | percentage of MVC | Immediately during the experiment |
|
|
|
|
| 0 |
| 17 |
| 0 |
| 17 |
| 0 |
| 17 |
| EG001 | Asymptomatic Group | Individuals without any lower extremity pain(NRS>3/10) in past 3 months Individuals age between 18-40 years old Individuals had trained in volleyball or basketball for more than two years Individuals still played volleyball or basketball for at least 90 minutes a week Victorian Institute of Sport Assessment (VISA) Questionnaire score >80 | 0 | 17 | 0 | 17 | 0 | 17 |
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