Your Health - Patellar Tendinopathy

Patellar Tendinopathy

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

Definition

Tendinopathy is an injury to the tendon. It can cause pain, swelling, and limit movement. The injuries can include:

Tendinitis—an inflammation of the tendon (Although this term is used often, most cases of tendinopathy are not associated with significant inflammation.)
Tendinosis—microtears (tiny breaks) in the tendon tissue with no significant inflammation

The patellar tendon connects the patella (kneecap) to the lower leg bone (tibia). Tendinopathy and the associated pain may take months to resolve.

Patellar Tendinitis

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 itself.

Patellar tendinopathy occurs from overuse of the knee tendon. Overuse may be caused by any activity that requires:

Intense running
Jumping
Frequent stops and starts
Frequent impact to the knee

Patellar tendinopathy is most common in the following sports:

Basketball
Soccer
Volleyball
Running

Risk Factors

Factors that increase your chance of patellar tendonopathy include:

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

Symptoms

Symptoms include:

Pain and tenderness in the patellar tendon below the knee
Pain or tightness in the knee when bending, squatting, or straightening the leg
Discomfort in the knee when jumping, running, or walking

Diagnosis

The doctor will ask about your symptoms, physical activity, and how the injury occurred. The doctor will also examine your knee, and may ask you to perform certain movements.

In some cases your doctor may order:

X-ray —a test that uses radiation to take a picture of structures inside the body, used to rule out other conditions that may be causing your symptoms
MRI scan —a test that uses magnetic waves to make pictures of structures inside the body, used to check the severity of your condition

Treatment

Treatment includes:

Ice and Rest

Apply ice or a cold pack to the knee for 15-20 minutes, every four hours, for 2-3 days. Wrap the ice or cold pack in a towel. Do not apply the ice directly to your skin.

Avoid the activity that caused the pain. Reduce shock or vibrations to the knee.

Medication

Over-the-counter medicines that are commonly used to reduce pain include:

Ibuprofen (Motrin, Advil)
Naproxen (Aleve, Naprosyn)
Acetaminophen (Tylenol)
Aspirin

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

Cortisone Injections

If the treatments above do not reduce inflammation, some doctors may recommend that you consider a cortisone injection. (This should be used only for chronic tendonitis that has not responded to other treatments that have been used for at least two months.) Check with your doctor to find out what is best for you. Avoid repeated cortisone injections.

Resuming Exercise

Return to high-impact physical activity gradually. Healing has occurred when:

The knee can bend and straighten without pain.
You are able to jump on the injured leg without pain.
You are able to jog in a straight line without pain.
Swelling is gone.
Normal strength of the quadriceps muscles has returned.

Surgery

You may need surgery if there is:

Advanced damage to the tendon
Little or no response to other treatments over a 6-12 month period

Prevention

You may prevent patellar tendinopathy by:

Avoiding activities and sports that repeatedly stress the kneecaps
Gradually increasing the frequency and intensity of exercise
Regularly doing quadriceps muscle stretching and strengthening exercises

RESOURCES:

American Academy of Orthopaedic Surgeons
http://www.aaos.org/

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

National Institute of Arthritis and Musculoskeletal and Skin Diseases
http://www.niams.nih.gov/

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_Info/Bursitis/default.asp#3_3 . Updated April 2007. Accessed June 13, 2008.

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

Orthopedics hyperguide tutorial. Orthopedics Hyperguide website. Available at: http://www.ortho.hyperguides.com/faq.asp . Accessed October 11, 2005.

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

Last reviewed November 2009 by Robert E. Leach, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.