Patellar tendinitis

Patellar tendinitis is a common overuse injury often linked to sports. Patellar tendinitis has a variety of causes and can generally be managed with nonsurgical, conservative treatment. Patellar tendinitis is sometimes called jumper's knee.

Definition & Facts

Tendons are long cords of tissue that attach muscles to bones. The patella is the bone that moves in the front of the knee and is sometimes referred to as the knee cap. The patellar tendon helps straighten the leg by connecting the kneecap with the shin bone.

A type of knee injury, patellar tendinitis is an overuse injury directly related to the patellar tendon on either leg. Overuse injuries are any injury caused by repeated movements that result in tissue damage or some other form of irritation to the body. It can be a type of sports injury. In most cases, patellar tendinitis fully resolves on its own with plenty of rest, ice, and short-term activity restriction.

Symptoms & Complaints

• Pain located below the kneecap
• Stiffness of the knee noticed while climbing stairs, jumping, squatting or participating in exercise
• Tightness of the knee while standing or sitting
• Pain is most noticeable when moving the knee
• Pain caused by bending the knee
• Kneecap is especially tender to the touch
• Pain located within the quads (quadriceps femoris muscles)
• Pain ranges from mild to severe
• Leg weakness
• Calf weakness
• Difficulties with balance and other problems with the vestibular system.
• Tenderness and warmth around the knee
• Swelling around the knee

Causes

Patellar tendinitis can be caused by a variety of factors. Athletes that regularly participate in sports that involve a lot of jumping, such as basketball, are more likely to experience patellar tendinitis. Many repetitive movements can cause patellar tendinitis. For example, constant jumping, landing, running, kicking, or sudden changes in direction can easily aggravate the patellar tendon. Patellar tendinitis is most often seen in athletes. However, patellar tendinitis is an injury that can impact anyone. Other causes and risk factors include:

• Inappropriate or ill-fitting footwear
• Athletic training errors
• Overtraining: training too much, too often, or too long
• Age
• Lack of flexibility
• Ligamentous laxity
• Misalignment of the foot
• Misalignment of the ankle
• Misalignment of the leg
• Flat feet
• Differences in leg length
• Abnormalities of the patella
• Rotated tibia / Tibial torsion in which the tibia twists inward while walking.
• Muscle imbalances of the lower extremities

Diagnosis & Tests

Diagnosis of patellar tendinitis often begins with obtaining a patient's complete medical history. During an office visit, the doctor will conduct a thorough physical examination of the knee, especially the patella. The purpose of the examination is to assess the injured knee's range of motion, flexibility, strength as well as the stability of the joint.

Most often, the doctor will also need to order imaging tests to help diagnose the condition of the kneecap. X-rays can be very helpful in diagnosing any cracks, breaks or other types of bone fractures. However, X-rays are not very valuable in terms of the diagnosis of any soft tissue injury to the knee.

MRIs and ultrasounds are much more reliable in the diagnosis of damage to soft tissues around the kneecap. Ultrasounds diagnose soft-tissue injuries to the kneecap through the use of sound waves. MRIs diagnose soft-tissue injuries through the use of magnets. Ultrasounds and MRIs are completely painless.

Treatment & Therapy

Both surgical and nonsurgical options are available to effectively treat patellar tendinitis. Nonsurgical treatment is typically the first line of management for patellar tendinitis. The goal of nonsurgical, conservative treatment is to reduce swelling and inflammation of the patellar region. Often, doctors will suggest rest, ibuprofen, and other nonsteroidal anti-inflammatory drugs in order to treat patellar tendinitis.

Recovery time for patellar tendinitis varies with each individual, but most people can expect to achieve a full recovery within a few weeks to a few months' time. In general, it is best to avoid high-impact activities that aggravate the injury until a full recovery is made, though it is not advised to discontinue all activity unless one's doctor specifically restricts all activities. Low-impact activities such as walking and swimming will generally not aggravate patellar tendinitis.

In very rare instances, the patellar tendon is severely damaged and the injury causes persistent pain. If this is the case, surgery may be required in order to effectively treat the damaged tendon. After surgery, a patient will need physical therapy to restore full strength and function to the injured leg. The length of postoperative rehabilitation varies. Postoperative physical therapy generally assists patients in keeping leg pain manageable. Physical therapy also improves overall strength and flexibility of the knee.

Prevention & Prophylaxis

Appropriate warm-up plans involve adequate stretching of the quadriceps, calf muscle (triceps surae muscle), and hamstrings. It is also important to stretch after exercise in order to cool down heavily-worked muscles.

It is very important to wear appropriate footwear to prevent patellar tendinitis. Orthotic shoe inserts can also help prevent patellar overuse injuries by improving the alignment of the knee. This helps the overall function of the knee.