Proposal Final

Fall 2009 ORCA Mentoring Grant Application A Preliminary Analysis of a Novel Patellar Tendon Strap: the Effect on Insertion Angle First applicant name: First applicant email and RouteY login:

Macsen Viehweg & Jason Longhurst [email protected], mviehweg

Mentor name and department:

Matthew K. Seeley, Exercise Science

Importance of Project Knee pain affects a remarkable number of Figure 1 Figure 2 Americans. Twenty percent of the general population suffers from Anterior Knee Pain, also known as Patellar Tendonitis; i.e., pain on the front side of the knee (Coetsee, 2007). Patellar Tendonitis accounts for up to 40 percent of all sports related knee injuries (Coetsee, 2007). tibial Patellar tendon straps reduce pain associated with tuberosity Patellar Tendonitis by an average of 33% (Kemp, 2002); however, the mechanisms that decrease pain are unclear. One proposed mechanism is The angle of insertion we will The white arrows in this MRI study originates at the tibial an altered angle of insertion for the patellar are pointing to the patellar tuberosity, which serves as tendon which is the primary tendon, relative to the tibia. See Figure 1. It has the patellar tendon’s region of pain associated with been proposed that an altered angle of insertion attachment point to the tibia. Patellar Tendonitis. for the patellar tendon may alter the stress that is applied to the tibial tuberosity thus causing a decrease in pain. However, it is presently unknown how the patellar tendon strap affects the aforementioned angle of insertion. Main Proposal Body Purpose and Hypotheses: The purpose of this study is to quantify how the patellar tendon strap affects the patellar tendon’s angle of insertion at the tibial tuberosity. This knowledge may lead to an increased understanding of mechanisms that can potentially decrease anterior knee pain, as well as an improved design for patellar tendon straps. An improved patellar tendon strap may reduce pain caused by Patellar Tendonitis. We hypothesize that the use of a patellar tendon strap will cause the angle of insertion The Patellar tendon strap is applied between the patellar tendon and tibia to decrease across all directly over the Patellar Tendon. We measured conditions. However, we expect that the strap will have hypothesize that the pressure of the strap will change the insertion angle. the greatest effect on insertion angle when the knee is fully extended, or at 0° of flexion. Additionally, we hypothesize that the more the knee is flexed (the greater the degree of flexion), the less the strap will affect the angle of insertion. We feel this will be the case because as the knee is flexed, greater tension is observed in the patellar tendon which will hinder its ability to be deformed by the patellar tendon strap. Data Collection: As this study is preliminary in nature, we only plan to recruit 6 healthy female and 6 healthy male subjects. Each subject will visit the Biomechanics Laboratory at Brigham Young University one time for a single data collection session. There will be one dependent variable: angle of insertion of the patellar tendon relative to the tibia. This will be measured using Rehabilitative Ultrasound Imaging throughout a combination of three independent variables; (1) strap vs. no strap, (2) closed chain vs. open chain motion and (3) degree of flexion of the knee. The following table will be used for each subject.

Degree of Flexion 0° 30° 60° 90°

Closed Chain Motion Without Strap With Strap

Open Chain Motion Without Strap With Strap

Statistical Analysis: The analysis for the three independent variables will be a repeated measures ANOVA, or Analysis of Variance. We will block on subjects which makes each subject their own control across the different variables. Insertion angles without the strap will be compared to insertion angles with the strap on each subject. Anticipated Academic Outcome We plan to present the results of this study at Brown University, in Providence, Rhode Island, USA, during the Annual Meeting for the American Society of Biomechanics to be held in August 2010. Furthermore, if these preliminary data indicate the expected results, we plan to use these data to pursue additional, external funding that will support a larger-scale study related to the present research question. Importantly, this national presentation and the potential grant that may accompany this project will also strengthen our resumes and help us in our pursuit of post-graduate degrees in Medicin and Physical Therapy. Qualifications Matthew Seeley earned a PhD in Biomechanics in 2006. His dissertation, A Test of the Functional Asymmetry Hypothesis in Walking, considered some of the involved mechanics during human locomotion, and his present research emphasis concerns human locomotion. He has extensive experience in collecting data that describes forces and motions during human locomotion. Additionally, as a certified athletic trainer, he has knowledge concerning various facets of the rehabilitation of human gait. Project Timetable Data Collection

Jan -Feb 2010

Data Analysis

Jan-Feb 2010

Final Report to ORCA

April 30, 2010

Abstract Submitted to American Society of Biomechanics Annual Meeting

March 1, 2010

Presentation at the Annual Meeting for the American Society of Biomechanics

August 18-21, 2010

Manuscript Completed and Submitted for Publication

October 1, 2010

Fit With BYU’s Mission On January 13, 2000, the World Health Organization declared that this decade was to be the Bone and Joint Decade. The purpose of this Bone and Joint Decade was to improve the health-related quality of life for people with musculoskeletal disorders throughout the world. The present project would allow BYU to, in part, assist the World Health Organization with the aforementioned purpose. Additionally, BYU has a mission to help further technology that will benefit humankind. The present study has the potential to benefit all who suffer from patellar tendonitis. Sources Bojanić, I., Pećina, M. (2004) Overuse injuries of the musculoskeletal system. Boca Raton, Florida: CCR Press LLC. Cambier, D., Danneels, L., Roget, P., Van Tiggelen, D., Verdonk, R., Witvrouw, E. (2004). Effect of bracing on the prevention of anterior knee pain—a prospective randomized study. Knee Surgery, Sports Traumatology, Arthroscopy. 12(5), p. 434-439. Coetsee, M. F., Phillips, J. (2007). Incidence of Non-Traumatic Anterior Knee Pain Among 11-17 YearOlds. South African Journal of Sports Medicine. 19(2), p. 60-64. Kempe, C. (2002). Patellar Tendonitis Pain Is Decreased With Acute Use Of A Patellar tendon strap. Microform Publications Bulletin: Health, Physical Education and Recreation Exercise and Sport Sciences. 15(2), p. 79.

Fall 2005 ORCA Mentoring Grant Application

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