Fall 2009 ORCA Mentoring Grant Application

A Preliminary Analysis of a Novel Patellar Tendon Strap:

the Effect on Insertion Angle
First applicant name: Macsen Viehweg & Jason Longhurst
First applicant email and RouteY login: macsenviehweg@gmail.com, 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
an altered angle of insertion for the patellar study originates at the tibial are pointing to the patellar
tendon, relative to the tibia. See Figure 1. It has tuberosity, which serves as tendon which is the primary
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
directly over the Patellar Tendon. We between the patellar tendon and tibia to decrease across all
hypothesize that the pressure of the measured conditions. However, we expect that the strap will have
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.

Closed Chain Motion Open Chain Motion

Degree of Flexion Without Strap With Strap Without Strap With Strap
0°
30°
60°
90°
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 Year-
Olds. 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 page 2