What is patellar tendinitis?
Patellar tendinitis is an overuse injury of the patellar tendon which connects the kneecap to the shin bone. The patellar tendon gives us ability to straighten the knee by connecting the quadriceps muscles of the thigh to the top of the shin bone. Knee tendinitis is also called Jumper’s Knee or Patellar tendonitis. It is the most common cause of knee pain, especially in elite athletes such as volleyball players, basketball players, and weight lifters. It is a common condition in teen athletes and people in their 20s and 30s.
What causes patellar tendinitis?
It is caused by repetitive mechanical stress that causes micro- trauma which creates microscopic tears in the tendon and leads to tendon degeneration. The result is pain and disability. In the worse cases, prolonged use progressively weakens the tendon and can result in a rupture of the tendon.
What are the symptoms?
- Aching pain in the front of the knee
- Pain around the kneecap, usually felt below the kneecap but can be felt above as well
- Pain that goes away with rest. The pain resolves with rest because the tendon can heal microscopic tears.
- Pain that recurs with prolonged sitting, squatting, and climbing stairs.
- Pain that is relieved with rest
- Pain that becomes chronic with repetitive stress and can interfere with daily functions and sleep
Who is at risk for developing knee tendinitis?
- Recreational athletes who engage in activities that require strenuous and repetitive jumping, running, or playing sports such as soccer without proper conditioning.
- Elite athletes who play jumping sports like basketball or volleyball, or any sport that involves jumping, landing, and abrupt changes in directions.
- People who are taller and heavier
- Older age and prior injuries
- Misalignment of the foot, heel or shin bone (tibia), leg length differences and foot arch height
- Some metabolic diseases like diabetes
- Athletes who train excessively or and train/play on hard ground
- Men are most often affected
How is it diagnosed?
Patellar tendinitis is a clinical diagnosis based on medical history, physical examination, and symptoms. Ultrasound can often facilitate diagnosis while MRI can sometimes confirm the presence of chronic irritation of the patellar tendon. Imaging studies can help to identify the severity of the degeneration.
How is it treated?
Patellar tendinitis is difficult to treat, because symptoms tend to resolve and recur. Conservative measures including reducing or stopping exacerbating activities (i.e. jumping, running), rest, icing, and anti-inflammatory pain medications are usually recommended first. Bracing may help by “unloading” the insertion of the tendon. As the pain begins to subside, physical and exercise therapy will restore function. Eccentric squat-based training is a mainstay of treatment and is preferred for the treatment of athletes.
However, conservative treatment approaches fail in about 10% of athletes and up to 27% of professional athletes choose surgery to relieve chronic symptoms. Alternatively, platelet rich plasma (PRP) therapy and extracorporeal shock wave treatments can both produce good outcomes. PRP therapy for chronic patellar tendinopathy has been shown to provide improved clinical outcomes in almost 77% of patients and allowed them to return to their pre-symptom activity levels in 86% of cases.
Surgery is usually reserved for patients whose symptoms persist after conservative management. Physical therapy is important for optimizing improvements after surgery.
The gold standard treatment is arthroscopic debridement, removal of the diseased part of patellar tendon, and bone drilling to stimulate a healing response. Return to play rates are high, but the timeline is variable (3-12 months).
Tendon injuries are very common, and because tendons have limited blood supply, injuries are difficult to heal. Dr. Jorge Chahla is a renowned orthopedic surgeon in Chicago, Illinois. He is an expert in the treatment of complex knee, hip and sports related injuries. Dr. Chahla specializes in minimally invasive arthroscopic techniques that successfully treat the condition and reduce recovery times. He and his team focus on joint preservation and cartilage restoration to help patients from professional athletes to weekend warriors. Contact Dr. Chahla to schedule a consultation to receive the correct diagnosis and learn about all your treatment options.