At What Age Do Children and Adolescents Develop Lower Limb Tendon Pathology or Tendinopathy? A Systematic Review and Meta-analysis
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Tendon pathology and tendinopathy have been reported in children and adolescents; however, the age at onset and prevalence of the conditions have not been examined systematically.
To examine the prevalence of lower limb tendon pathology and tendinopathy in children and adolescents, and the factors associated with these conditions in this population.
Six databases were searched (MEDLINE, the Cochrane Central Register of Controlled Trials, Embase, Scopus, the Web of Science and the Allied and Complementary Medicine Database). Studies were included if the prevalence of lower limb tendon pathology and/or tendinopathy were reported in humans under the age of 18 years. Studies were divided according to the method of diagnosis (physical examination, ultrasound or a questionnaire) and further divided into studies that reported prevalence data by tendon [reported two data points (right and left) for each participant] and those that reported prevalence data for each participant [reporting one data point (right or left) per participant].
Seventeen studies met the inclusion criteria. Lower limb tendinopathy prevalence (presence of pain and dysfunction) ranged between 8.2 and 33.3 %, and increased in prevalence as age increased up to 18 years. The odds ratio for studies reporting tendinopathy by tendon was 0.37 (95 % confidence interval 0.20–0.69) in favour of boys presenting with tendinopathy. Study aims and reporting methods were heterogeneous.
The age at onset of lower limb tendinopathy in children and adolescents has not been widely studied. This systematic review found that tendinopathy is present in children and adolescents, and increases in prevalence with age up to 18 years. Male sex is significantly associated with tendinopathy in studies that report tendinopathy by tendon.
KeywordsPatellar Tendon Tendon Injury Basketball Player American Football Achilles Tendinopathy
Mitchell Simpson designed the review, completed the literature search, designed and completed the quality assessment of all studies, drafted the initial manuscript, and approved the final manuscript as submitted. Ebonie Rio assisted with the design of the review and search terms, reviewed and revised the manuscript, and approved the final manuscript as submitted. Jill Cook assisted with the design of the review and search terms, assessed the quality of the studies, supervised the initial draft of the manuscript, critically reviewed the manuscript, and approved the final manuscript as submitted. All authors agree to be accountable for all aspects of the work.
Compliance with Ethical Standards
Jill Cook is supported by the Australian Centre for Research into Sports Injury and Its Prevention, which is one of the International Research Centres for Prevention of Injury and Protection of Athlete Health supported by the International Olympic Committee (IOC). Jill Cook is also a National Health and Medical Research Council practitioner fellow (ID 1058493). All funding for this systematic review was provided in kind by Monash University. No external funding was secured for this review.
Conflicts of interest
Mitchell Simpson, Ebonie Rio and Jill Cook declare that they have no conflicts of interest relevant to the content of this review.
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