Patellar Tendinopathy

Patellar Tendinopathy

Patellar Tendinopathy is a common musculoskeletal injury that affects recreational and elite athletes.  It leads to pain and disability lasting weeks to several months.  It is described as an overuse injury caused by microtraumas from extreme acceleration and deceleration during running jumping and cutting. 

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Acute tendonitis involves an active inflammatory response and may heal within 3-6 weeks if treated appropriately.  Chronic tendonitis is referred to as jumper's knee and is considered a tendinosis with no active inflammatory cells.  It is a degenerative condition and may take 6 weeks to 3 months to resolve.  Overuse and repetitive strain during acute patellar tendonitis leads to the development of chronic patellar tendonitis.

Extrinsic versus Intrinsic Risk factors:

Intrinsic: Strength imbalance, alignment, foot structure, muscle length
Extrinsic: Physical load, repetition, intensity, frequency, fatigue on the muscle
Extrinsic factors appear to be the primary cause of patellar tendinopathy

 

 

Additional Extrinsic risk factors associated with patellar tendonitis:

-Foot wear, playing surface, and poor training techniques

At risk demographics

-Repetitive ballistic loading

 -Basketball, soccer, dance, military recruits
 -Jumping/landing, running

 

-Deep Squatting

  -Weightlifters

-16-40 years old

-Equal occurrence among genders

 

Clinical Presentation:

Tenderness upon palpation noted at the inferior pole of the patella and or tendon.  Swelling is rare upon observation.  Pain/symptoms are present or provoked with resisted knee extension, ascending descending stairs, squatting, lunges, or hopping.  General pain and stiffness complaints after activity with a feeling of "giving way" or "buckling".

Evaluation of chronic patella tendonitis should include:

-Blazina's Knee Scale
-Kennedy's Scale
-Stage 1: Pain only after activity
-Stage 2: Pain during and after activity
-Stage 3: Pain during and after activity that affects performance

Differential diagnosis should include:

 -Patella Fracture
 -Patella femoral disorder
  -Osgood Schlatter's disease
  -Sinding-Larsen-Johnson Syndrome

 

Rehabilitation

Multiple Treatment Protocols:

REST

  -Refrain from overuse activity
  -Practice controlled exercise without load (pain free activity)
  -Four to eight weeks removal from painful activity

Cryotherapy/ICE

Stretching

  -Hip flexors, quads, hamstring, gastroc

STM

  -Deep transverse friction massage

Strengthening

-Controlled pain free eccentric quad strengthening (progress from low knee flexion to high)
-Hip and knee musculature