What is jumpers knee?
Jumpers knee also known as patellar tendonitis is an overuse patellar tendon injury. This tendon connects the kneecap (patella) with the lower leg. Together with the kneecap, quadriceps tendon, and quadriceps muscle, these structures allow you to straighten the knee.
Usually, patellar tendonitis occurs when the tendon becomes inflamed from repetitive sprinting or jumping. Generally, we see this condition in sports such as basketball, volleyball, running and football.
In general, most cases of patellar tendonitis result from too much sport. Frequently, excess increase in volume or intensity of sport causes the tendon to swell. This swelling leads to tendon pain and reduced performance.
Unlike Achilles or hamstring tendonitis, we think that patellar tendon changes start as a teenager and set sporting people up for pain as an adult.
Symptoms of Jumpers knee
Commonly, patellar tendonitis causes pain at the site of tendon swelling just below the kneecap. Usually, tendon pain worsens with high-intensity running or jumping. After sport, pain usually settles after 1-2 days. Also, pain can occur with sitting or driving. The tendon is usually swollen and tender to touch.
Usually, a simple ultrasound confirms tendon thickening. There is often a growth of blood vessels in the tendon. We think these blood vessels are a source of pain. Often, MRI is useful to rule out other causes of knee pain such as fat pad impingement or kneecap arthritis.
Patellofemoral pain vs patellar tendonitis
Often, it can be difficult to know whether the pain is related to the patellar tendon or the kneecap (or patellofemoral) joint.
Generally, patellofemoral or kneecap pain is often not as focal as patellar tendonitis pain. Also, pain usually occurs with walking, cycling, and sitting – unlike patellar tendonitis. Sometimes, taping the kneecap can improve pain and point to the patellofemoral joint as the cause of knee pain.
What are the treatments for jumpers knee?
In general, patellar tendinitis is a difficult condition to manage. Usually, we tell sports patients that the road to recovery is long and arduous.
Overall, we use simple treatments first including:
- Modified activity: Often, a period of rest from sport is needed. Cross-training helps maintain fitness.
- Anti-inflammatory tablets: Usually, a short course of anti-inflammatory tablets such as ibuprofen will help reduce pain.
- Exercise therapy: We all agree that exercise is important. You will need to perform a strengthening program with supervision. Recent studies reveal that quadriceps muscle and tendon strengthening improves pain and function. Generally, we recommend a heavy loading program consists of a series of three or four different exercises targeting the various muscle group in the leg. For example, single-leg knee extension, single-leg incline press, and reverse lunges are some of the exercises we recommend to build strength and reduce pain in the patellar tendon. Also, you need to build strength around the knee including the calf and hamstring. Exercises targeting these muscles include seated and standing calf raises and hamstring curls/hip thrusters. Once you achieve good strength, you should add ‘plyometrics’ such as skipping, hopping, and running every 2-3 days.
What are your options for jumpers knee when rehab stalls?
In difficult cases that fail to improve with simple treatments, we try other options:
Recent studies suggest that applying GTN patches to painful tendons reduces pain. These patches contain nitric oxide which is an important catalyst for tendon healing. Generally, we use patches during rehab and training, so it won’t disrupt your sport.
A shockwave machine produces soundwaves that can heal tendons. We think that shockwave helps tendon recovery by reducing pain and remodeling the tendon.
Generally, tendon injections are an option in difficult cases. Firstly, cortisone injections cause worsening pain and should be avoided for patellar tendonitis. Secondly, some doctors are using platelet-rich plasma injections with mixed success. A paper written by Dr Masci shows little effect of PRP in patellar tendonitis in high-level athletes. Overall, injections are not particularly effective for patellar tendinopathy.
However, a new technique called percutaneous tendon scrap shows promise. By using ultrasound, the upper and lower surfaces of the diseased tendon are scraped reducing pain and allowing an early return to sport.
Is surgery an option for jumpers knee?
In general, traditional surgery where the diseased tendon is cut out is not a good option. Studies show the success of tendon excision is only 50%. However, a new procedure involving tendon scraping by keyhole surgery shows more promise with over 80% improvement when combined with rehab.
Final word from Sportdoctorlondon
Overall, patellar tendonitis is a difficult condition to treat. First, we start with simple treatments. Then, we move onto treatments such as patches or shockwave. Injections for patellar tendonitis are unpredictable and should be avoided. However, a tendon scraping procedure using a special blade or keyhole shows more promise. Finally, traditional surgery should be avoided but keyhole tendon scraping shows better results.