Tendons in Ten Minutes

Hold onto your hats……

Dr. Richard CollinsMSK Physician

Why tendons?

Sobrino et al. Orthop J Sports Med 2015Overuse injuries in Professional Ballet

• Anterior Knee Pain (likely included PT) 16%

• Patellar Tendinopathy 10.5%• Achilles Tendinopathy 8% Ramkumar et al. J Dance Med Sci

2016Injuries in a Professional Ballet Dance Company

• Foot & Ankle 38%• Sprain 10%• Achilles Tendinopathy 3%

• Back related 20% (most costly)

‘Many American ballet companies have taken to retaining in-house medical and training staff that, in one company of 70 dancers, demonstrated a $1.2 million savings over a 5-year period while simultaneously decreasing the injury incidence from 94% to 75%’

Ramkumar et alLower limb tendon care is a core need in Dance

Medicine

History in 30 seconds!

18 years ago….

7 years ago….

Now…

Tendinopathy

Causes

TreatmentDetection

Causes Collagen health• Systemic health• Pubertal development

Disordered Loading

• Biomechanics• Periodisation

Causes Collagen health• Systemic health• Pubertal

developmentDisordered

Loading• Biomechanics• Periodisation

Pubertal factors on overuse injuries J Dance Med Sci

2015The questions are being asked

Where does Collagen come into this?

Collagen synthesis in puberty

• Life-time tendon collagen is synthesised by age 17• Puberty is a critical period of collagen synthesis• Lower Limb tendon development connected to growth• Tendon collagen is potentially as susceptible to RED-S as

bone collagen

Collagen synthesis in puberty

• Life-time tendon collagen is synthesised by age 17• Puberty is a critical period of collagen synthesis• Lower Limb tendon development connected to growth• Tendon collagen is potentially as susceptible to RED-S as

bone collagen

Collagen synthesis in puberty

• Life-time tendon collagen is synthesised by age 17• Puberty is a critical period of collagen synthesis• Lower Limb tendon development connected to growth• Tendon collagen is potentially as susceptible to RED-S as

bone collagen

Collagen synthesis in puberty

• Life-time tendon collagen is synthesised by age 17• Puberty is a critical period of collagen synthesis• Lower Limb tendon development connected to growth• Tendon collagen is potentially as susceptible to RED-S as

bone collagen

Collagen synthesis in pubertyThe Australians are on to this!

Detection Symptom screening

• Too subjective• Late presentation

UTC – new US technology

• Objective data• Good interobserver reproducibility (once

trained)• Links to developing research base

Detection Symptom screening

• Too subjective• Late presentation

UTC – new US technology

• Objective data• Good interobserver reproducibility (once

trained)• Links to developing research base

UTC – Ultrasound Tissue Characterisation

Dr. Lorenzo Masci hard at work

UTC – Ultrasound Tissue Characterisation

UTC – Ultrasound Tissue Characterisation

Adapted from JL Cook, C PurdumBr J Sports Med 2008

UTC – Ultrasound Tissue Characterisation

L Masci, H AlfredsonBr J Sports Med 2014

Treatment Intelligent

Loading• better models• activity specificInvasive

adjuncts• Injections• Surgery

Treatment Intelligent

Loading• better models• activity specificInvasive

adjuncts• Injections• Surgery

Intelligent Loading

JL Cook, SI DockingBr J Sports Med August 2015

Thank you!