0363-5465/103/3131-0408$02.

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THE AMERICAN JOURNAL OF SPORTS MEDICINE, Vol. 31, No. 3
© 2003 American Orthopaedic Society for Sports Medicine

Performance Characteristics of Volleyball

Players with Patellar Tendinopathy
Øystein Lian,*† MD, Per-Egil Refsnes,‡ MSc, Lars Engebretsen,†§ MD, PhD, and
Roald Bahr,†储 MD, PhD

From the *Kristiansund Hospital, Kristiansund, †Oslo Sport Trauma Research Center,
University of Sport and Physical Education, ‡National Sports Center, and §Oslo Orthopedic
University Clinic, Oslo, Norway

Background: Patellar tendinopathy is assumed to result from chronic tendon overload. There may be a relationship between
tendon pain and jumping ability.
Hypothesis: There is no difference in performance characteristics between volleyball players with patellar tendinopathy and
those without.
Study Design: Prospective cohort study.
Method: We examined the performance of the leg extensor apparatus in high-level male volleyball players with patellar
tendinopathy (N ⫽ 24) compared with a control group (N ⫽ 23) without knee symptoms. The testing program consisted of
different jump tests with and without added load, and a composite jump score was calculated to reflect overall performance.
Results: The groups were similar in age, height, and playing experience, but the patellar tendinopathy group did more specific
strength training and had greater body weight. They scored significantly higher than the control group on the composite jump
score (50.3 versus 39.2), and significant differences were also observed for work done in the drop-jump and average force and
power in the standing jumps with half- and full-body weight loads.
Conclusions: Greater body weight, more weight training, and better jumping performance may increase susceptibility to patellar
tendinopathy in volleyball players.
© 2003 American Orthopaedic Society for Sports Medicine

Epidemiologic studies have shown a prevalence of patellar ing and mostly related to static biomechanical parame-
tendinopathy of 40% to 50% among high-level volleyball ters.8, 16, 17, 19 In a previous case-control study, we evaluated
players.6, 8, 19 No epidemiologic data are available on the some dynamic characteristics of the leg extensor apparatus,
prevalence in other sports, but results of clinical studies and the results suggest that players who have patellar ten-
among patients undergoing surgical treatment for patel- dinopathy perform better on jump tests than do healthy
lar tendinopathy suggest that there is a high prevalence control subjects, especially on tests involving eccentric
among soccer players and in sprinters and jumpers as work.18 The purpose of the present study was to examine the
well.13, 20, 23, 24 Evidence from histologic and imaging stud- leg extensor characteristics in a larger cohort of players by
ies suggests that the pathologic process involved consists using a more comprehensive jump- and strength-testing
of unhealed or incompletely healed microtears in the ten- program.
don substance, usually in the proximal part of the patellar
tendon. The histologic changes are compatible with a
MATERIALS AND METHODS
degenerative condition without signs of inflamma-
tion.5, 7, 9 –12, 14, 21–25 Training volume and floor hardness Study Design
are extrinsic factors that correlate with the prevalence of
patellar tendinopathy.8 Data on intrinsic factors are conflict- This study was performed during an international volley-
ball tournament in Oslo, Norway, with approval from the
ethics committee of the Norwegian Research Council. The
储 Address correspondence to Roald Bahr, MD, PhD, Oslo Sport Trauma tournament was played 2 months after the end of the
Research Center, Norwegian University of Sport and Physical Education, POB ordinary competitive season, with teams competing in
4014 Ullevål Stadion, 0806 Oslo, Norway.
No author or related institution has received any financial benefit from classes according to their level of play. The six Norwegian
research in this study. See “Acknowledgments” for funding information. teams that participated in the men’s elite class were invited

408
Vol. 31, No. 3, 2003 Performance Characteristics of Volleyball Players with Patellar Tendinopathy 409

to take part in the study. These were amateur teams that

otherwise compete in the top division of the Norwegian Vol-
leyball Federation (NVBF) leagues. The teams consisted of
53 players, and 47 of these (89%) consented to take part in an
interview, clinical examination, and a series of standardized
jump and power tests. Their patellar tendons were also ex-
amined ultrasonographically, and the results of this investi-
gation have been presented in a separate article.19

Interview and Clinical Examination

Information requested from each player included age,

height, weight, number of years participating in organized
volleyball training, years of participation at the senior
level and in the top division of the NVBF league system,
number of training hours per week (volleyball training,
weight training, and jump training), and stretching habits
during the previous season.
Each player underwent a standard knee examination
and clinical interview on present and former knee injuries
and complaints. The following diagnostic criteria for pa-
tellar tendinopathy were used: history of pain localized to
the lower patellar pole or insertion of the quadriceps ten-
don in connection with volleyball play and distinct palpa-
tion tenderness corresponding to the painful area.1 A di-
agnosis of previous patellar tendinopathy was based on
history alone. The subjects were classified according to
criteria modified by Lian et al.,19 based on Roels et al.25
and Blazina et al.1 (Table 1 ), and divided into two groups:
those with current patellar tendinopathy and those with
no history of patellar tendinopathy. Figure 1. Schematic of the experimental setup for the jump
tests. During all tests the players jumped on a contact mat
Jump and Power Testing connected to a computer, making it possible to compute
jumping height.4 Also, during jumps with an added load, the
The players went through a standardized jump- and pow- barbell was mechanically linked with the Ergojump system
er-testing program. The testing program was performed connected to a shuttle, making it possible to calculate force,
by using a contact mat connected to a computer (Intervall velocity, and power.2
A/S, Oslo, Norway) (Fig. 1). The equipment measures the
flight time of each jump, and from this the height of rise of
the center of gravity is calculated.3, 26 In addition, power of 45 cm (DJ45 cm), standing jump with a 20-kg load (SJ20 kg),
can be calculated from flight and contact times during standing jump with loads corresponding to one-half body
rebound jumps.4 weight (SJ1/2 bw) and full body weight (SJ1/1 bw), and a
The jumps performed were standing jump (SJ), counter- 15-second maximal rebound jump test (RJ). Standing
movement jump (CMJ), drop-jump from a dropping height jumps were performed with the subject starting from a
stationary semisquatting position with 90° of knee flexion
TABLE 1 and with both hands kept fixed on the hips. No counter
Classification of Patellar Tendinopathy According to movement was allowed with any body segment. In the
Symptomsa counter-movement jump the subject started the move-
Grade Symptoms ment from a stationary erect position with knees fully
extended, and was allowed to bend down to approximately
I Pain at the infrapatellar or suprapatellar region
after practice or after an event 90° of knee flexion before starting the upward motion of
II Pain at the beginning of the activity, disappearing the jump. Standing jumps with loads were performed with
after warm-up and reappearing after completion barbells on the shoulders of the players. The drop-jump
of activity was performed as a counter-movement jump, except that
IIIa Pain during and after activity, but the patient is
the player dropped from a height of 45 cm. In the 15-
able to participate in sports at the same level
IIIb Pain during and after activity, and the patient is second maximal rebound jump test, the subjects were
unable to participate in sports at the same level encouraged to jump as high and as fast as possible during
IV Complete rupture of the tendon 15 seconds (Fig. 1).15
a
Symptoms as outlined by Roels et al.,25 Blazina et al.,1 and The players were encouraged vocally during the jumps
Lian et al.19 and were watched carefully to ensure that the proper
410 Lian et al. American Journal of Sports Medicine

technique was used. In particular, care was taken to en- RESULTS

sure that there was no counter movement in the standing
jumps and that the subjects landed with straight legs. The Prevalence of Jumper’s Knee
best of three technically correctly performed jumps was
Of the 47 players participating in the study, 24 (51.0%)
used for the final calculations.
were given a diagnosis of current patellar tendinopathy
In addition, during the execution of the standing jumps
affecting at least one side, based on the clinical examina-
with loads, the average velocity, force, and power during
tion (typical history and clinical findings). Twenty players
the jump were measured with the Ergopower system (Er-
(42.6%) had never experienced problems in either knee,
gotest Technology AS, Langesund, Norway) (Fig. 1). The
whereas three players (6.4%) reported having had previ-
equipment measured the displacement of gravitational
ous knee problems identified as patellar tendinopathy.
loads (in this case, barbells) as external resistance.2 The
The severity of symptoms among those with current pa-
vertical displacements of the loads were monitored with
tellar tendinopathy (33 knees) was classified as grade I
mechanical and sensor arrangements. The loads were me- in 6 knees, grade II in 18 knees, and grade IIIa in 9
chanically linked to a shuttle gliding on a track bar. The knees (Table 1). The onset of symptoms was gradual in
movement of this shuttle was recorded by the sensor, which 31 knees (94%) and acute in 2 knees, and the duration of
was interfaced to an electronic device that included a micro- symptoms reported by the players who had patellar
processor and software. The microprocessor worked inter- tendinopathy was 3.5 ⫾ 2.4 years (range, 0.1 to 10). The
nally with a 10-␮m time resolution. When the subject moved age at symptom onset was 18.8 ⫾ 2.8 years (range, 13.5
the loads, the signal from the sensor interrupted the micro- to 25.9).
processor every 3 mm of displacement. Thus, it was possible
to calculate velocity, acceleration, force, power, and work
corresponding to the load displacements. This system has
Player Characteristics
been shown to be accurate and reproducible.2
The characteristics of the players and their training back-
grounds are shown in Table 2. Players with a diagnosis of
Data Analysis patellar tendinopathy had a significantly greater body
weight than the control subjects and trained more with
For each player, a composite jump score to evaluate the weights. The prevalence of current patellar tendinopathy
performance ability of the leg extensor apparatus was was significantly higher among outside hitters (12 of 18,
calculated by rating each player’s result on a scale from 0 67%) and middle blockers (9 of 14, 64%), compared with
to 100 on each of the jump tests, where 0 represents the utility players (1 of 6, 17%) or setters (2 of 9, 22%).
lowest test score among all the players tested and 100, the Thirty-seven players (79%) reported using a right-left
best score. The overall score was computed as the average step-close takeoff technique in the spike jump, whereas 10
of the results from each of these eight scores. Results are players (21%) used a left-right takeoff. Only 1 player re-
given as means ⫾ SD unless otherwise noted. ported preferring the right leg when landing after the
Prevalence was compared between the two groups by attack, whereas 31 players (66%) reported a balanced
using chi-square tests. Comparisons of the jump and landing technique, and 15 players (32%) reported favoring
strength test results between the patellar tendinopathy their left leg when landing. The takeoff and landing tech-
group and the control group were made with unpaired niques among the players with current symptoms of jump-
t-tests. An alpha level of 0.05 was used. er’s knee are shown in Table 3.

TABLE 2
Characteristics of Players with Current Symptoms of Patellar Tendinopathy and Players with
No History of Patellar Tendinopathy (Means ⫾ SD)
Current symptoms No history Significance
Variable
(N ⫽ 24) (N ⫽ 20) level (P)

Age (years) 22.4 ⫾ 2.5 22.0 ⫾ 4.0 0.65

Height (cm) 191.1 ⫾ 7.0 189.5 ⫾ 6.2 0.43
Weight (kg) 86.7 ⫾ 7.9a 81.9 ⫾ 8.1 0.05
Organized volleyball training (years) 8.0 ⫾ 2.8 7.5 ⫾ 3.6 0.55
Training at senior level (years) 6.8 ⫾ 2.5 5.7 ⫾ 3.6 0.28
Training at elite level (years) 2.5 ⫾ 2.6 2.2 ⫾ 3.2 0.70
Volleyball training (hours/week) 7.7 ⫾ 2.1 7.4 ⫾ 1.6 0.53
Weight training (hours/week) 4.5 ⫾ 2.8a 2.3 ⫾ 2.3 0.009
Jump training (hours/week) 0.4 ⫾ 0.9 0.6 ⫾ 1.1 0.53
Total training (hours/week) 12.6 ⫾ 4.2 10.3 ⫾ 3.9 0.06
Stretching during warm-up (minutes) 3.4 ⫾ 3.0 3.1 ⫾ 2.7 0.71
Stretching after training (minutes) 6.2 ⫾ 5.8 7.1 ⫾ 3.9 0.55
a
Significantly different from players with no history of patellar tendinopathy (unpaired t-tests).
Vol. 31, No. 3, 2003 Performance Characteristics of Volleyball Players with Patellar Tendinopathy 411

TABLE 3 than did players without patellar tendinopathy. The

Takeoff and Landing Technique in Spike Jump for each of the symptomatic group had a greater body weight and did
Knees with Patellar Tendinopathy (N ⫽ 33)
more specific weight training than did those in the control
Right knee Left knee group.
Technique
(N ⫽ 22) (N ⫽ 11)
Patellar tendinopathy is a condition characterized by
Right-left takeoff 20 11 histologic7, 10, 12, 22–25 and soft tissue imaging findings5, 9 –
Left-right takeoff 2 0 12, 14, 21, 22
compatible with an unhealed or insufficiently
Right-left landing 0 0
Left-right landing 6 4 healed partial patellar tendon tear. These partial tears
Simultaneous landing 16 7 probably occur when the strength of the tendon is insuf-
ficient in relation to the applied forces.29 The tendon may
be subject to fatigue under the high chronic repetitive
Jump and Power Testing loading, despite the fact that the cyclical loads may be well
within the ultimate failure stress range of the tendon,28
The test results for players with current symptoms of which is in the range of 56.7 ⫾ 4.4 MPa. This view is
patellar tendinopathy and players without a history of supported by the fact that most of the players with patel-
patellar tendinopathy are shown in Table 4. The patellar lar tendinopathy reported a gradual onset of their symp-
tendinopathy group scored significantly higher than the toms. Because eccentric force production in certain cir-
control group on the composite jump score (50.3 versus cumstances may be three times the concentric force, it is
39.2, P ⫽ 0.02), and significant differences were also ob- believed to be a primary cause of the microruptures.29 It
served for work done in the drop-jump and average force has been suggested that tendon overload may result from
and power in the standing jumps with half- and full-body a combination of extrinsic (such as floor type)6, 8 and in-
weight loads. trinsic (such as malalignment) factors,16, 17 with the sum
of these factors determining whether a player develops
DISCUSSION patellar tendinopathy.
In this study, we evaluated intrinsic factors with the
The main findings of the present study were that players jump-testing program. The composite jump score was de-
with a clinical diagnosis of patellar tendinopathy gener- signed as an overall indicator of a player’s ability to load
ally performed better on the dynamic testing program the extensor apparatus during conditions ranging from
slow-speed concentric (standing jump with added load) to
TABLE 4 high-speed ballistic (rebound jumps) movements. The dy-
Results of Jump and Power Tests in Players with Current namic testing program was selected to resemble the var-
Symptoms of Patellar Tendinopathy and Players with No ious loading conditions imposed on the leg extensors dur-
History of Patellar Tendinopathy (Means ⫾ SD)
ing different jumping and cutting movements used in the
Current game of volleyball. The significant difference in the com-
No history Significance
Measurement and jumpa symptoms
(N ⫽ 20) level (P) posite jump score observed between the groups may be
(N ⫽ 24)
taken as an indication that the leg extensor apparatus in
Jump height (cm)
the group of players with patellar tendinopathy may be
SJ 36.2 ⫾ 5.8 36.0 ⫾ 4.0 0.88
CMJ 41.3 ⫾ 6.5 40.3 ⫾ 4.1 0.54 subjected to higher loads during volleyball play as well.
CMJ–SJ 5.1 ⫾ 2.1 4.3 ⫾ 1.8 0.19 There were significant differences between the players
DJ45cm 53.1 ⫾ 7.1 50.5 ⫾ 6.0 0.20 with current patellar tendinopathy and those without,
SJ20kg 27.3 ⫾ 5.1 26.6 ⫾ 3.7 0.60 both in average force and average power in standing
SJ1/2bw 19.5 ⫾ 4.4 18.3 ⫾ 3.4 0.33
SJ1/1bw 10.0 ⫾ 2.3 9.5 ⫾ 2.4 0.55 jumps with added loads corresponding to one-half and
Work (J) whole body weight. Consequently, the forces acting on the
SJ 306 ⫾ 46 286 ⫾ 34 0.14 tendon or the rate of force development during jumping
CMJ 349 ⫾ 56 322 ⫾ 35 0.06 may surpass the adaptive abilities of the tendon, and, in
DJ45cm 449 ⫾ 67b 404 ⫾ 53 0.02
that way, cause microtears in the tendon substance among
Average power (W)
Rebound jumps 15 s 67.4 ⫾ 13.4 60.3 ⫾ 11.5 0.07 players with high performance ability.
SJ1/2bw 705 ⫾ 133b 621 ⫾ 104 0.04 In a previous case-control study, we found significant
SJ1/1bw 1048 ⫾ 161b 865 ⫾ 147 0.003 differences between two smaller groups of players in the
Average force (N) results of a counter-movement jump, in the difference in
SJ1/2bw 528 ⫾ 47b 485 ⫾ 49 0.01
SJ1/1bw 1011 ⫾ 83b 908 ⫾ 70 0.001 jumping height between a counter-movement jump and a
Average velocity (m/s) standing jump, and in a rebound test.18 In this previous
SJ1/2bw 1.33 ⫾ 0.17 1.27 ⫾ 0.14 0.28 study the jumps were performed in the same manner as
SJ1/1bw 1.03 ⫾ 0.12 0.95 ⫾ 0.14 0.10 described in detail in the methods for the present study.
a
SJ, standing jump; CMJ, counter-movement jump; DJ45cm, However, we could not reproduce these results. The pre-
drop-jump from 45 cm height; SJ20kg, standing jump with 20 kg vious study included a smaller number of players, and in
weight; SJ1/2bw, standing jump with loads corresponding to one- a case-control study it is possible that a selection bias may
half body weight; SJ1/1bw, standing jump with loads correspond-
ing to full body weight.
have occurred. However, the performance of the players
b
Significantly different from players with no history of patellar with patellar tendinopathy in the first study in the
tendinopathy (unpaired t-tests). counter-movement jump test and the rebound jump test
412 Lian et al. American Journal of Sports Medicine

was significantly better than the results of the players in effect of this training would also increase muscle mass and
the present study. This suggests that the injured players jumping ability. This indication is supported by the fact
in the first study had a highly developed leg extensor that the players with patellar tendinopathy had a greater
apparatus, which may indicate a stronger disposition to body weight than those without patellar tendinopathy. We
patellar tendinopathy. did not examine body composition, but it is unlikely that
Data from previous studies concerning other potentially the body weight difference observed was due to differences
important intrinsic factors are conflicting; these studies in body fat in such a well-trained population of players.
have mostly evaluated static biomechanical parameters. The right knee was affected twice as often as the left
Ferretti6 found no differences in sex, alignment of the knee in the patients in the present study. The majority of
knee, alignment of the extensor mechanism, position of the players used a right-left step-close takeoff technique,
the patella, characteristics of the tibial tuberosity, rota- and only one player reportedly preferred the right leg
tion of the femur, rotation of the tibia, degree of constitu- when landing after the attack. In fact, 20 of the 22 players
tional instability, characteristics of the foot, or morpho- with current jumper’s knee on the right side used a right-
type between subjects with and without jumper’s knee. On left takeoff technique. This finding suggests that a rela-
the other hand, Kujala et al.16, 17 found more leg-length tionship may exist between the takeoff technique and
inequality and patella alta in patients with patellar ten- patellar tendinopathy and that the forces sustained dur-
dinopathy compared with controls, on the basis of stand- ing takeoff may be of considerable importance. For a right-
ing radiographs. With use of the same group of subjects as handed player to obtain proper alignment of the upper
in the present study, we found no difference in the length body for an effective spike, the preferred technique in-
of the patellar tendon or the Insall-Salvati index when we volves placing the right foot first in a position of about 45°
compared patients with patellar tendinopathy and control of external rotation27 (Fig. 2). When using this takeoff
subjects.19 technique, the deceleration work is done mostly with the
Epidemiologic studies on extrinsic risk factors have right leg, subjecting it to higher eccentric-concentric load-
shown that the hardness of the playing surface and an ing than the left leg. Also, when these high loads are
increased frequency of training sessions correlate posi- imposed, the right leg may be in a state of functional
tively with the prevalence of patellar tendinopathy.6, 8 As malalignment. The preferred takeoff technique results in
expected, we found no difference between the groups in
the total amount of specific volleyball training because all
of the players were selected from the same teams—a well-
trained group with a similar training history. However,
we do not have detailed information on the training his-
tory of the players at the time they were first injured. At
that time there may have been differences in training
volume or intensity that we were unable to detect in a
cross-sectional study. Longitudinal studies are necessary
to examine in detail how training programs may lead to
tendon overload.
It can be argued that the additional weight room train-
ing and better jumping characteristics were a consequence
of the symptoms because the athlete with tendinopathy
could be expected to spend more time in the training room,
strengthening and stretching the aching muscle-tendon
group. We find it highly unlikely that a painful condition
regarded as a chronic overuse injury should improve the
jumping capacity of these athletes. None of the teams had
a physical therapist or athletic trainer working systemat-
ically with them, and at the time there was no tradition of
systematic weight training (eccentric strength training) to
treat patellar tendinopathy. In fact, most of the players
had received no treatment for their symptoms. We did find
that the prevalence of patellar tendinopathy was signifi-
cantly higher among outside hitters and middle blockers
compared with utility players and setters. This is not
surprising because outside hitters and middle blockers
perform a much higher number of maximal jumps than do
setters as a result of their function on the team.
The players with patellar tendinopathy reportedly Figure 2. Takeoff technique during spike jumps in volleyball.
trained more with weights than the others did. This ad- Note how the typical foot placement pattern results in exter-
ditional weight training by itself indicates a higher total nal rotation of the tibia in relation to the femur, increased
loading of the extensor apparatus, and the anticipated knee flexion, and valgus stress on the right side.
Vol. 31, No. 3, 2003 Performance Characteristics of Volleyball Players with Patellar Tendinopathy 413

a valgus position of the right leg, a greater flexion angle of 2. Bosco C, Belli A, Astrua M, et al: A dynamometer for evaluation of
dynamic muscle work. Eur J Appl Physiol Occup Physiol 70: 379 –386,
the knee, and greater external rotation of the tibia relative 1995
to the femur (Fig. 2). It is possible that these factors result 3. Bosco C, Komi PV: Mechanical characteristics and fiber composition of
in a more unfavorable loading pattern of the right knee human leg extensor muscles. Eur J Appl Physiol Occup Physiol 41:
275–284, 1979
with respect to development of patellar tendinopathy. Mo- 4. Bosco C, Luhtanen P, Komi PV: A simple method for measurement of
tion analysis and direct force measurements are necessary mechanical power in jumping. Eur J Appl Physiol Occup Physiol 50:
273–282, 1983
to study this phenomenon in more detail. 5. Davies SG, Baudouin CJ, King JB, et al: Ultrasound, computed tomogra-
It is tempting to speculate that the particular takeoff phy and magnetic resonance imaging in patellar tendinitis. Clin Radiol 43:
technique used in volleyball may cause loading patterns 52–56, 1991
6. Ferretti A: Epidemiology of jumper’s knee. Sports Med 3: 289 –295, 1986
that are more likely to cause jumper’s knee than those 7. Ferretti A, Puddu G, Mariani PP, et al: The natural history of jumper’s
observed in many other sports. An exception may be high knee. Patellar and quadriceps tendonitis. Int Orthop 8: 239 –242, 1985
jumping, where the takeoff leg is loaded in valgus and 8. Ferretti A, Puddu G, Mariani PP, et al: Jumper’s knee: An epidemiological
study of volleyball players. Physician Sportsmed 12(10): 97–106, 1984
external rotation, similar to the position in volleyball. 9. Fornage BD, Rifkin MD, Touche DH, et al: Sonography of the patellar
However, the prevalence of jumper’s knee in other sports tendon: Preliminary observations. AJR Am J Roentgenol 143: 179 –182,
1984
is not known, although clinical studies indicate that jump- 10. Fritschy D, de Gautard R: Jumper’s knee and ultrasonography.
er’s knee may also be a problem among athletes in soccer Am J Sports Med 16: 637– 640, 1988
and athletics.13, 20, 23, 24 The high prevalence of jumper’s 11. Jerosch J, Schröder M: Ergebnisse der diagnostischen Sonographie bei
Verletzungen des Kniegelenkes. Sportverletz Sportschaden 4: 139 –146,
knee among high-level volleyball players detected in the 1990
present study is similar to that reported by others,6, 8, 18 12. Kälebo P, Swärd L, Karlsson J, et al: Ultrasonography in the detection of
but further epidemiologic studies are necessary to com- partial patellar ligament ruptures (jumper’s knee). Skeletal Radiol 20:
285–289, 1991
pare the prevalence in other sports. 13. Karlsson J, Lundin O, Lossing IW, et al: Partial rupture of the patellar
ligament. Results after operative treatment. Am J Sports Med 19: 403–
408, 1991
CONCLUSIONS 14. King JB, Perry DJ, Mourad K, et al: Lesions of the patellar ligament.
J Bone Joint Surg 72B: 46 – 48, 1990
The overall results from the jump-testing program showed 15. Komi PV, Bosco C: Utilization of stored elastic energy in leg extensor
muscles by men and women. Med Sci Sports 10: 261–265, 1978
an increased performance ability of the leg extensors 16. Kujala UM, Friberg O, Aalto T, et al: Lower limb asymmetry and patel-
among players with a current diagnosis of jumper’s knee lofemoral joint incongruence in the etiology of knee exertion injuries in
athletes. Int J Sports Med 8: 214 –220, 1987
compared with players without a history of jumper’s knee. 17. Kujala UM, Österman K, Kvist M, et al: Factors predisposing to patellar
The body weight of the players with jumper’s knee was chondropathy and patellar apicitis in athletes. Int Orthop 10: 195–200,
also greater, and they reportedly did more weight training 1986
18. Lian Ø, Engebretsen L, Ovrebo RV, et al: Characteristics of leg extensors
than the group without symptoms. All of these factors will in male volleyball players with jumper’s knee. Am J Sports Med 24:
tend to increase the loading of the extensor apparatus and 380 –385, 1996
thereby increase the susceptibility to partial tendon 19. Lian Ø, Holen KJ, Engebretsen L, et al: Relationship between symptoms
of jumper’s knee and the ultrasound characteristics of the patellar tendon
ruptures. among high level male volleyball players. Scand J Med Sci Sports 6:
291–296, 1996
20. Martens M, Wouters P, Burssens A, et al: Patellar tendinitis: Pathology
ACKNOWLEDGMENTS and results of treatment. Acta Orthop Scand 53: 445– 450, 1982
21. Mourad K, King J, Guggiana P: Computed tomography and ultrasound
This study was financed through a grant from the Norwe- imaging of jumper’s knee—patellar tendinitis. Clin Radiol 39: 162–165,
1988
gian Olympic Committee. We are also indebted to the 22. Myllymäki T, Bondestam S, Suramo I, et al: Ultrasonography of jumper’s
Norwegian Volleyball Federation and Oslo Volleyballkrets knee. Acta Radiol 31: 147–149, 1990
23. Orava S, Österback L, Hurme M: Surgical treatment of patellar tendon
for their assistance. The Oslo Sports Trauma Research pain in athletes. Br J Sports Med 20: 167–169, 1986
Center has been established at the Norwegian University 24. Raatikainen T, Karpakka J, Puranen J, et al: Operative treatment of partial
of Sport and Physical Education through generous grants rupture of the patellar ligament. A study of 138 cases. Int J Sports Med 15:
46 – 49, 1994
from the Royal Norwegian Ministry of Culture, the Nor- 25. Roels J, Martens M, Mulier JC, et al: Patellar tendinitis (jumper’s knee).
wegian Olympic Committee and Confederation of Sport, Am J Sports Med 6: 362–368, 1978
Norsk Tipping AS, and Pfizer AS. We thank Harald Vikne 26. Sale DG: Testing strength and power, in MacDougall JD, Wenger HA,
Green HJ (eds): Physiologic Testing of the High-Performance Athlete.
and Ingrid Aase Bahr for their technical assistance. Second edition. Champaign, IL, Human Kinetics Books, 1991, pp 21–106
27. Selinger A, Ackermann-Blount J: Arie Selinger’s Power Volleyball. New
York, St. Martin’s Press, 1986
REFERENCES 28. Stanish WD, Curwin S, Rubinovich M: Tendinitis: The analysis and treat-
ment for running. Clin Sports Med 4: 593– 609, 1985
1. Blazina ME, Kerlan RK, Jobe FW, et al: Jumper’s knee. Orthop Clin North 29. Stanish WD, Rubinovich RM, Curwin S: Eccentric exercise in chronic
Am 4: 665– 678, 1973 tendinitis. Clin Orthop 208: 65– 68, 1986