Association of Hip and Foot Factors With Patellar Tendinopathy (Jumper's Knee) in Athletes

BACKGROUND: Investigations on the causes of patellar tendinopathy should consider impairments at the hip and foot/ankle because they are known to influence movement patterns and affect patellar tendon loading. OBJECTIVES: To investigate hip and foot/ankle impairments associated with patellar tendinopathy in volleyball and basketball athletes using classification and regression tree analysis. METHODS: In this clinical measurement, cross-sectional study, 192 athletes were assessed for impairments of the hip and foot/ankle, including shank-forefoot alignment, dorsiflexion range of motion (ROM), iliotibial band flexibility, passive hip internal rotation ROM, and hip external rotator and hip abductor isometric strength. Athletes with tenderness and/or pain at the inferior pole of the patella were considered to have patellar tendinopathy. Athletes with scores higher than 95 points on the Victorian Institute of Sport Assessment-patella (VISA-P), no pain during the single-leg decline squat, and no history of patellar tendon pain were considered not to have patellar tendinopathy. Classification and regression tree analyses were performed to identify interacting factors associated with patellar tendinopathy. RESULTS: Interactions among passive hip internal rotation ROM, shank-forefoot alignment, and hip external rotator and abductor strength identified athletes with and without patellar tendinopathy. The model achieved 71.2% sensitivity and 74.4% specificity. The area under the receiver operating characteristic curve was 0.77 (95% confidence interval: 0.70, 0.84; P<.001). CONCLUSION: Impairments of the hip and foot/ankle are associated with the presence of patellar tendinopathy in volleyball and basketball athletes. Future studies should evaluate the role of these impairments in the etiology of patellar tendinopathy.