Tendinopathy is an damage to the muscle. It can cause discomfort, inflammation, and restrict activity. The patella muscle is situated just below the patella (knee cap). It has accessories on the patella and the tibial tuberosity on the leg (shin bone). There have been advances in understanding the histopathology, imaging and surgical outcomes in this condition in the past decade. Nevertheless, successful management of the jumping athlete with patellar tendinopathy remains a major challenge for the practitioner and patient.
Nomenclature (Classification of Patellar Tendinopathy)
Patellar tendinopathy was first referred to as 'jumper's knee' due to its frequency in jumping sports (e.g. basketball, volleyball, high, long, and triple jumps). However, the condition also occurs in sportspeople who change direction and may occur in sportspeople who do not perform either jumping or change of direction. The term 'patellar tendinitis" is a misnomer as the pathology underlying this condition is degenerative tendinosis rather than inflammatory 'tendinitis' fortunately, the term patellar tendinitis is falling out of favor. On balance, patellar tendinopathy is probably the most appropriate general label for this condition.
Clinical Features
The patient complains of anterior knee pain aggravated by activities such as jumping, hopping, and bounding. The most common site of tendinopathy is the deep attachment of the tendon to the inferior pole of the patella. Distal lesions are less common and midsubstance lesions have been reported. The tendon is tender on palpation either at the inferior pole or in the body of the tendon. There is frequently associated thickening of the tendon. Expert clinicians also assess possible precipitating factors, such as muscle tightness of the quadriceps and hamstring muscles, increased neural tension or abnormal biomechanics of the pelvis, PFJ, or lower leg. Calf weakness is common in patients with patellar tendinopathy.
- It is important to reproduce the patients pain on examination.
- In less severe cases it may be necessary to perform a functional activity, such as a squat or hop, to reproduce the pain.
- As these activities also load the PFJ, taping to correct the PFJ followed by reassessment may help to differentiate between the two conditions or at least indicate if the PFJ should also be treated.
Investigations
Ultrasound examination and MRI are the investigations of choice in patellar tendinopathy, although clinicians must appreciate that these imaging modalities do not have 100% sensitivity and specificity for the condition. Ultrasound examination with Doppler will assess the vascularity present in the tendon. This is important as increased vascularity has been associated with pain.
Treatment
- Treatment of patellar tendinopathy requires patience and a multifaceted approach.
- It is essential that the practitioner and patient recognize that tendinopathy that has been present for months may require a considerable period of treatment associated with rehabilitation before symptoms disappear.
- Conservative management of patellar tendinopathy requires appropriate strengthening exercises, load reduction, correcting biomechanical errors, and soft tissue therapy.
- An innovation has been the use of sclerotherapy of neovessels with polidocanol.
- Surgery is indicated after a considered and lengthy conservative program has failed.
- This section outlines the physical therapy approach of correction of biomechanics that might be contributing to excessive load on the tendon, targeted exercise therapy, and soft tissue treatment before outlining medical treatments including medication, sclerotherapy, and surgery.
Patellar tendonitis is a situation recognized by injury and swelling to the patellar muscle resulting in pain in the top side of the joint. Accessible Physical Therapy Services provide fast recovery from injuries. Call us at: (301) 885-2500
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