Patellar Tendinopathy

In most cases, patients respond to exercise therapy and progressive return to sport

What is patellar tendinopathy?

Patellar tendinopathy also called ‘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 in jumping or explosive sports such as volleyball, track 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. Most cases occur at the top end of the tendon near the patellar bone insertion, but some cases present at the bottom end near the insertion to the tibia. Pain is usually inflammatory ie warms up and improves during activity but worsens and remains sore for hours after activity. Usually, there is tenderness at the site of tendon swelling, and knee pain when performing a single-leg squat or hop. Also, it is important to detect factors that may cause tendonitis. Dr Masci has co-authored studies on factors related to good outcomes. Factors include include low tendon stiffness, thigh muscle weakness, or stiffness in the ankle joint.

Imaging in patellar tendinopathy is important to confirm the diagnosis and rule out other conditions such as pain from kneecap arthritis. Both ultrasound and MRI show the typical tendon changes of thickening and breakdown in collagen proteins. However, ultrasound has the advantage of being cheaper and able to be performed at the time of the first consultation.

What is the treatment for patellar tendinopathy?

Once we confirm a diagnosis, patients perform a rehab program. Generally, the aim of rehab is to gradually increase muscle strength in the lower leg. We think that an increase in strength reduces forces on the patellar tendon allowing for the healing of collagen. 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 are offered other treatments such as Shockwave therapy, GTN patches or tendon injections. The choice of treatment depends largely on the patients’ preference. For example, some patients want less invasive treatment so choose GTN patches or Shockwave therapy. Other patients want a faster response so choose 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 difficult 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 and pioneered by Professor Hakan Alfredson, allows a faster recovery. A recent paper demonstrates superior results compared to traditional surgery. Also a new injection technique, known as ‘needle scraping‘, is used by Dr Masci in some cases of Patellar tendonitis.

Final word from Sportdoctorlondon

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. In cases that fail to respond to exercise, other treatments such as GTN patches, Shockwave therapy or injections are helpful to improve outcomes. Pioneering surgery with better results than traditional surgery should only be reserved for stubborn cases.

Dr. Masci is a specialist sport doctor in London. 

He specialises in muscle, tendon and joint injuries.

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