Patellar Tendinopathy
In most cases, patients respond to exercise therapy and progressive return to sport
What is patellar tendinopathy?
Patellar tendinopathy, also known as “jumper’s knee,” is a common injury to the patellar tendon. The patellar tendon attaches the tibia to the patella. Generally, we see this injury in younger athletes who participate in jumping or explosive sports, such as volleyball, track and field athletics, rugby, and football. However, runners can also be affected.
What are the typical features of Patellar tendonitis?
Typically, patients report pain at the patellar tendon insertion site. Most cases occur at the top end of the tendon near the patellar bone insertion, but some present at the bottom end near the insertion to the tibia. Pain is usually inflammatory, i.e. warms up and improves during activity, but worsens and remains sore for hours after exercise. Usually, there is tenderness at the site of the tendon swelling and knee pain when performing a single-leg squat or hop. Additionally, it is crucial to identify factors that may contribute to tendonitis. Dr Masci has co-authored studies on aspects related to good outcomes. Factors include low tendon stiffness, thigh muscle weakness, or stiffness in the ankle joint.
Imaging in patellar tendinopathy is essential to confirm the diagnosis and rule out other conditions, such as pain from kneecap arthritis, fat pad impingement and patellofemoral syndrome. Both ultrasound and MRI reveal the typical tendon changes, including thickening and breakdown of collagen proteins. However, ultrasound has the advantage of being less expensive and can be performed at the time of the initial consultation.
What is the treatment for patellar tendinopathy?
Once we confirm a diagnosis, patients perform a rehab program. Generally, rehabilitation aims to increase muscle strength in the lower leg gradually. We believe that an increase in strength reduces the forces on the patellar tendon, thereby facilitating collagen healing. These programs have greater success if supervised by a physiotherapist.
In most cases, patients respond to exercise therapy and return to sport. However, some patients fail to respond, so they are offered other treatments, such as Shockwave therapy, GTN patches or tendon injections. The choice of treatment depends mainly on the patient’s preference. For example, some patients prefer less invasive treatments, so they opt for GTN patches or Shockwave therapy. Other patients prefer a faster response, so they opt for an injection. Dr Masci has co-authored a review of injections in patellar tendinopathy and can advise on the most appropriate injection for you.
Finally, surgery for patellar tendonitis may be appropriate for complex cases that fail to respond to rehab. Traditionally, surgery involved cutting out the diseased tendon. However, the results of this type of surgery are poor, with 50% of patients unable to return to sport. However, a new surgical technique using ultrasound pioneered by Professor Hakan Alfredson allows a faster recovery. A recent paper demonstrates superior results compared to traditional surgery. Also, new injection and minimally invasive techniques, known as ‘needle scraping‘ or TENEX, are used by Dr Masci in some cases of Patellar tendonitis.
Final word from Sportdoctorlondon about Patellar Tendonitis
Patellar tendinopathy is common in young athletes in jumping or explosive sports. Pain is reported at the site of tendon disease, usually at the top end of the tendon. Imaging such as ultrasound can confirm the typical changes of tendon thickening and breakdown of collagen proteins. In general, treatment consists of exercises to increase muscle strength supervised by a physiotherapist. Other treatments, such as GTN patches, Shockwave therapy, or injections, help improve outcomes in cases that fail to respond to exercise. Pioneering surgery, which yields better results than traditional surgery, should be reserved for stubborn cases.