by Badash M

Patellar Tendinopathy

(Jumper's Knee; Patellar Tendonitis; Patellar Tendinosis; Quadriceps Tendonitis; Infrapatellar Tendinopathy; Patellar Apicitis)

Definition

The patellar tendon connects the kneecap to the lower leg bone. Tendinopathy is an injury to the tendon. It can cause pain, swelling, and limited movement. The injury can include:
  • Tendonitis—inflammation of the tendon
  • Tendinosis—tiny tears in the tendon tissue with no significant inflammation
Treatment depends on the severity of the injury.
Patellar Tendonitis
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Causes

Tendinopathy is generally caused by overuse of a muscle-tendon unit. Over time, the strain on the tendon causes structural changes within the tendon.
Patellar tendinopathy occurs from overuse of the patellar tendon. Overuse may be caused by any activity that requires:
  • Intense running
  • Jumping
  • Frequent stops and starts
  • Frequent impact to the knee
  • Falls
  • Tendon weakness from certain diseases

Risk Factors

Factors that increase your chance of developing patellar tendonopathy include:
  • Being a physically active teenager or young adult
  • An increase in the frequency of training
  • A sudden increase in the intensity of training
  • Changing from one sport to another
  • Training on a hard surface
  • Repeated improper movements while training
  • Muscle weakness or imbalance
  • Involvement in basketball, soccer, volleyball, or running

Symptoms

Symptoms may include:
  • Pain and tenderness in the patellar tendon below the kneecap
  • Pain or tightness in the knee when bending, squatting, or straightening the leg
  • Discomfort in the knee when jumping, squating, or walking up stairs

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done.
Tests may include x-rays or an MRI.

Treatment

Talk with your doctor about the best treatment plan for you. Treatment will depend on the severity of the injury. Options include:

Home Care

To reduce pain and swelling:
  • Avoid activity that causes pain. Reduce shock or vibrations to the knee.
  • Apply an ice pack for 15-20 minutes at a time, several times a day. Place a towel between the ice pack and your skin.
  • Wrap your injured knee in elastic bandaging. Don't wrap the bandage too tight. It may cut off circulation.
  • Elevate your knee above your heart.

Medication

To help manage pain, your doctor may recommend:
  • Over-the-counter pain relievers, such as acetaminophen or non-steroidal anti-inflammatory medication (NSAIDs)
  • Topical pain medications that are applied to the skin
  • Prescription pain relievers

Infra-patellar Strap

This strap, also called a counterforce brace, can help support the tendon and reduce pain. It is worn as a band just below the knee.

Physical Therapy

Physical therapy will help:
  • Stretch and condition the quadriceps muscle, which attaches to the patella
  • Maintain muscle strength, flexibility, and endurance
  • Improve balance and range of motion

Cortisone Injections

If the treatments above do not reduce inflammation, your doctor may recommend that you consider a cortisone injection. Try to avoid repeated cortisone injections.

Surgery

You may need surgery if you have advanced damage to the tendon. Your doctor may also recommend surgery if you have not responded to other treatment methods over a period of several months.

Prevention

To reduce your chances of getting patellar tendinopathy, take these steps:
  • Avoiding activities and sports that repeatedly stress the kneecaps, especially those that involve jumping
  • Regularly doing quadriceps muscle stretching and strengthening exercises
  • Gradually increasing the frequency and intensity of exercise
  • Learn proper sporting technique

RESOURCES

American Academy of Orthopaedic Surgeons Ortho Info http://www.orthoinfo.org

The American Orthopaedic Society for Sports Medicine http://www.sportsmed.org

CANADIAN RESOURCES

Canadian Orthopaedic Association http://www.coa-aco.org

Canadian Orthopaedic Foundation http://www.canorth.org

References

Aronen JG, Garrick JG. Sports-induced inflammation in the lower extremities. Hosp Pract . 1999;34:51.

Bursitis and tendinitis. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/Health%5FInfo/Bursitis/default.asp#3%5F3 . Updated March 2011. Accessed January 7, 2013.

O'Connor FG, Howard TM, Fieseler CM, Nirschl RP. Managing overuse injuries: a systematic approach. Phys Sportsmed . 1997 May;25(5).

Patellar tendinopathy. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed . Updated November 3, 2012. Accessed April 25, 2013.

Patellar tendon knee tear. American Academy of Orthopaedic Surgeons Ortho Info website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00512 . Updated August 2009. Accessed April 25, 2013.

Post WR. Patellofemoral pain: let the physical exam define treatment. Phys Sportsmed .1998;26(1).

Steunebrink M, Zwerver J, Brandsema R, Groenenboom P, Akker-Scheek Iv, Weir A. Topical glyceryl trinitrate treatment of chronic patellar tendinopathy: a randomised, double-blind, placebo-controlled clinical trial. Br J Sports Med . 2013 Jan;47(1):34-9.

10/26/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Massey T, Derry S, Moore R, McQuay H. Topical NSAIDs for acute pain in adults. Cochrane Database Syst Rev . 2010;(6):CD007402.

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