Patellar tendinitis
| Patellar tendinitis | |
|---|---|
| Other names | Patellar tendinopathy, jumper's knee, patellar tendinosis, patellar tendinitis |
 | |
| Location of the pain in patellar tendinitis | |
| Specialty | Orthopedics |
| Differential diagnosis | Runner's knee, Sinding-Larsen and Johansson syndrome, Osgood-Schlatter disease |
Patellar tendinitis, also known as jumper's knee, is a common cause of knee pain among athletes. It is a repetitive strain injury to the tendon connecting the patella, or kneecap, with the shinbone.[1] Jumper's knee commonly occurs in athletes who are involved in jumping sports such as basketball and volleyball, but can affect any athlete.
Evidence for treatment is poor.[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.[3]
Studies have shown it may be associated with stiff ankle movement and ankle sprains.[4][5]
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.[2] 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.[6] 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.
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] New research shows that knee operations in most cases have no better effects than exercise programs, and that most knee operations thus can be avoided.[citation needed]
See also
References
- ^ "Patellar tendinitis". Mayo Clinic. Retrieved 14 December 2018.
- ^ 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