{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T10:41:50Z","timestamp":1788259310725,"version":"build-2803163510"},"reference-count":51,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2024,6,25]],"date-time":"2024-06-25T00:00:00Z","timestamp":1719273600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001826","name":"ZonMw","doi-asserted-by":"publisher","award":["538001779"],"award-info":[{"award-number":["538001779"]}],"id":[{"id":"10.13039\/501100001826","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>This observational study aimed to evaluate the intra- and inter-operator reliability of a digital palpation device in measuring compressive stiffness of the patellar tendon at different knee angles in talent and elite volleyball players. Second aim was to examine differences in reliability when measuring at different knee angles, between dominant and non-dominant knees, between sexes, and with age. Two operators measured stiffness at the midpoint of the patellar tendon in 45 Dutch volleyball players at 0\u00b0, 45\u00b0 and 90\u00b0 knee flexion, on both the dominant and non-dominant side. We found excellent intra-operator reliability (ICC&gt;0.979). For inter-operator reliability, significant differences were found in stiffness measured between operators (p&lt;0.007). The coefficient of variance significantly decreased with increasing knee flexion (2.27% at 0\u00b0, 1.65% at 45\u00b0 and 1.20% at 90\u00b0, p&lt;0.001). In conclusion, the device appeared to be reliable when measuring compressive stiffness of the patellar tendon in elite volleyball players, especially at 90\u00b0 knee flexion. Inter-operator reliability appeared to be questionable. More standardized positioning and measurement protocols seem necessary.<\/jats:p>","DOI":"10.1371\/journal.pone.0304743","type":"journal-article","created":{"date-parts":[[2024,6,25]],"date-time":"2024-06-25T18:48:04Z","timestamp":1719341284000},"page":"e0304743","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["Intra- and inter-operator reliability of measuring compressive stiffness of the patellar tendon in volleyball players using a handheld digital palpation device"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4088-5985","authenticated-orcid":true,"given":"Lotte","family":"van Dam","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rieneke","family":"Terink","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inge","family":"van den 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Magnusson","year":"2008","journal-title":"The Journal of physiology"},{"key":"pone.0304743.ref048","author":"J. 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