Patellar tendinitis: Difference between revisions
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Revision as of 23:43, 10 July 2019
| Patellar tendinitis | |
|---|---|
| Other names | Quadriceps tendinopathy, patellar tendinopathy, jumper's knee, patellar tendinosis, patellar tendinitis |
 | |
| Location of the pain in patellar tendinitis | |
| Specialty | Orthopedics |
| Symptoms | Pain at the front of the knee[1] |
| Risk factors | Jumping sports, being overweight[1] |
| Diagnostic method | Based on symptoms and examination[2] |
| Differential diagnosis | Chondromalacia patella, patellofemoral syndrome[1] |
| Treatment | Rest, physical therapy[2] |
| Frequency | 14% of athletes[1] |
Patellar tendinitis, also known as jumper's knee, is an overuse injury of the ligaments that straighten the knee.[1] Symptoms include pain in the front of the knee.[1] Typically the pain and tenderness is at the lower part of the kneecap, though the upper part may also be affected.[2] Generally there is not pain when the person is resting.[2]
Risk factors include being involved in athletics and being overweight.[1] It is particularly common in athletes who are involved in jumping sports such as basketball and volleyball.[1][2] The underlying mechanism involves small tears in the the tendon connecting the kneecap with the shinbone.[2] Diagnosis is generally based on symptoms and examination.[2] Other conditions that can appear similar include chondromalacia patella and patellofemoral syndrome.[1]
Treatment generally involves resting the knee followed by physical therapy.[2] Evidence for treatment, however, is poor.[3] It is relatively common with about 14% of athletes currently affected.[1] Males are more commonly affected than females.[2]
Signs and symptoms
People report anterior knee pain, often with an aching quality. The symptom onset is insidious. Rarely is a discrete injury described. Usually, the problem is below the kneecap but it may also be above. Depending on the duration of symptoms, jumper's knee can be classified into 1 of 4 stages, as follows:
Stage 1 – Pain only after activity, without functional impairment
Stage 2 – Pain during and after activity, although the person is still able to perform satisfactorily in his or her sport
Stage 3 – Prolonged pain during and after activity, with increasing difficulty in performing at a satisfactory level
Stage 4 – Complete tendon tear requiring surgical repair
It begins as inflammation in the patellar tendon where it attaches to the patella and may progress by tearing or degenerating the tendon. People present with an ache over the patella tendon. Most people are between 10 and 16 years old. Magnetic resonance imaging can reveal edema (increased T2 signal intensity) in the proximal aspect of the patellar tendon.
Causes
It is an overuse injury from repetitive overloading of the extensor mechanism of the knee. The microtears exceed the body's healing mechanism unless the activity is stopped.
Among the risk factors for patellar tendonitis are low ankle dorsiflexion, weak gluteal muscles, and muscle tightness, particularly in the calves, quadriceps muscle, and hamstrings.[4]
Studies have shown it may be associated with stiff ankle movement and ankle sprains.[5][6]
Diagnosis
A physiotherapist performs a physical examination. If the symptoms are severe, further tests may be done, such as magnetic resonance imaging, or ultrasound.
Treatment
Evidence for treatment is poor.[3] In the early rest, ice, compression, and elevation may be tried. Tentative evidence supports exercises involving eccentric muscle contractions of the quadriceps on a decline board.[7] A physical therapist may also recommend specific exercises and stretches to strengthen the muscles and tendons, eg. cycling or swimming. Use of a strap for jumper's knee and suspension inlays for shoes may also reduce the problems.
Procedures
Dry needling, sclerosing injections, platelet-rich plasma, extracorporeal shock wave treatment, and heat therapy have been tried.[2]
Surgery
Uncommonly it may require surgery to remove myxoid degeneration in the tendon. This is reserved for people with severe pain for 6–12 months despite conservative measures. Novel treatment modalities targeting the abnormal blood vessel growth which occurs in the condition are currently being investigated.[citation needed] Knee operations in most cases have no better effects than exercise programs.[citation needed]
See also
References
- ^ a b c d e f g h i j King, D; Yakubek, G; Chughtai, M; Khlopas, A; Saluan, P; Mont, MA; Genin, J (February 2019). "Quadriceps tendinopathy: a review-part 1: epidemiology and diagnosis". Annals of translational medicine. 7 (4): 71. doi:10.21037/atm.2019.01.58. PMID 30963066.
{{cite journal}}: CS1 maint: unflagged free DOI (link) - ^ a b c d e f g h i j Santana, JA; Sherman, Al (January 2019). "Jumpers Knee". PMID 30422564.
{{cite journal}}: Cite journal requires|journal=(help) - ^ a b Mendonça, LM; Leite, HR; Zwerver, J; Henschke, N; Branco, G; Oliveira, VC (6 June 2019). "How strong is the evidence that conservative treatment reduces pain and improves function in individuals with patellar tendinopathy? A systematic review of randomised controlled trials including GRADE recommendations". British journal of sports medicine. doi:10.1136/bjsports-2018-099747. PMID 31171514.
- ^ Koban, Martin (2013). Beating Patellar Tendonitis. pp. 20–25. ISBN 978-1491049730.
{{cite book}}: Unknown parameter|name-list-format=ignored (|name-list-style=suggested) (help) - ^ Marcus, Adam (7 October 2011). "Stiff ankles tied to young athletes' painful knees". Reuters.
{{cite web}}: Unknown parameter|name-list-format=ignored (|name-list-style=suggested) (help) - ^ Backman LJ, Danielson P (December 2011). "Low range of ankle dorsiflexion predisposes for patellar tendinopathy in junior elite basketball players: a 1-year prospective study". The American Journal of Sports Medicine. 39 (12): 2626–33. doi:10.1177/0363546511420552. PMID 21917610.
- ^ Visnes H, Bahr R (April 2007). "The evolution of eccentric training as treatment for patellar tendinopathy (jumper's knee): a critical review of exercise programmes". British Journal of Sports Medicine. 41 (4): 217–23. doi:10.1136/bjsm.2006.032417. PMC 2658948. PMID 17261559.
External links