• Patellar Tendinopathy

    (Jumper's Knee; Patellar Tendonitis; Patellar Tendinosis; Quadriceps Tendonitis; Infrapatellar Tendinopathy; Patellar Apicitis)

    Definition

    Tendinopathy is an injury to the tendon. It can cause pain, swelling, and limit movement. The injury can include:
    • Tendonitis—an inflammation of the tendon (Although this term is used often, most cases of tendinopathy are not associated with significant inflammation.)
    • Tendinosis—microtears (tiny breaks) in the tendon tissue with no significant inflammation
    The patellar tendon connects the patella (kneecap) to the lower leg bone (tibia). Tendinopathy and the associated pain may take months to resolve.
    Patellar Tendonitis
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    Causes

    Tendinopathy is generally caused by overuse of a muscle-tendon unit. Over time, the strain on the tendon causes structural changes within the tendon.
    Patellar tendinopathy occurs from overuse of the knee tendon. Overuse may be caused by any activity that requires:
    • Intense running
    • Jumping
    • Frequent stops and starts
    • Frequent impact to the knee
    Patellar tendinopathy is most common in the following sports:
    • Basketball
    • Soccer
    • Volleyball
    • Running

    Risk Factors

    Factors that increase your chance of patellar tendonopathy include:
    • Being a physically active teenager or young adult
    • An increase in the frequency of training
    • A sudden increase in the intensity of training
    • Changing from one sport to another
    • Training on a hard surface
    • Repeated improper movements while training
    • Muscle weakness or imbalance

    Symptoms

    Symptoms include:
    • Pain and tenderness in the patellar tendon below the kneecap
    • Pain or tightness in the knee when bending, squatting, or straightening the leg
    • Discomfort in the knee when jumping, running, or walking

    Diagnosis

    The doctor will ask about your symptoms, physical activity, and how the injury occurred. An exam of your knee will be done. You may be asked to perform certain movements.
    Your doctor may need pictures of your body structures. This can be done with:

    Treatment

    Treatment includes:

    Ice and Rest

    Apply ice or a cold pack to the knee for 15-20 minutes. Do this every four hours, for 2-3 days. Wrap the ice or cold pack in a towel. Do not apply the ice directly to your skin.
    Avoid the activity that caused the pain. Reduce shock or vibrations to the knee.

    Medication

    Over-the-counter medicines that are commonly used to reduce pain include:
    • Acetaminophen (Tylenol)
    • Aspirin
    Topical pain medicines (eg, creams, patches) applied to the skin are another option.

    Infra-patellar Strap

    This strap (also called a counterforce brace) can help support the tendon and reduce pain. It is worn as a band just below the knee.

    Physical Therapy

    Physical therapy will help:
    • Stretch and condition the quadriceps muscle, which attaches to the patella
    • Maintain muscle strength, flexibility, and endurance

    Cortisone Injections

    If the treatments above do not reduce inflammation, some doctors may recommend that you consider a cortisone injection. Check with your doctor to find out what is best for you. Avoid repeated cortisone injections.

    Glyceryl Trinitrate Patches

    Some doctors may recommend that you consider a glyceryl trinitrate patches. The medication helps improve circulation in the affected area.

    Resuming Exercise

    Return to high-impact physical activity gradually. Healing has occurred when:
    • The knee can bend and straighten without pain.
    • You are able to jump on the injured leg without pain.
    • You are able to jog in a straight line without pain.
    • Swelling is gone.
    • Normal strength of the quadriceps muscles has returned.

    Surgery

    You may need surgery if there is:
    • Advanced damage to the tendon
    • Little or no response to other treatments over a 6-12 month period

    Prevention

    You may prevent patellar tendinopathy by:
    • Avoiding activities and sports that repeatedly stress the kneecaps, especially those that involve jumping
    • Gradually increasing the frequency and intensity of exercise
    • Regularly doing quadriceps muscle stretching and strengthening exercises

    RESOURCES

    American Academy of Orthopaedic Surgeons http://www.orthoinfo.org/

    The American Orthopaedic Society for Sports Medicine http://www.sportsmed.org/

    National Institute of Arthritis and Musculoskeletal and Skin Diseases http://www.niams.nih.gov/

    CANADIAN RESOURCES

    Canadian Orthopaedic Association http://www.coa-aco.org/

    Canadian Orthopaedic Foundation http://www.canorth.org/

    References

    Aronen JG, Garrick JG. Sports-induced inflammation in the lower extremities. Hosp Pract . 1999;34:51.

    Bursitis and tendinitis. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/Health%5FInfo/Bursitis/default.asp#3%5F3 . Updated March 2011. Accessed January 7, 2013.

    O'Connor FG, Howard TM, Fieseler CM, Nirschl RP. Managing overuse injuries: a systematic approach. Phys Sportsmed . 1997 May;25(5).

    Patellar tendinopathy. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed . Updated November 3, 2012. Accessed January 7, 2013.

    Post WR. Patellofemoral pain: let the physical exam define treatment. Phys Sportsmed .1998;26(1).

    10/26/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Massey T, Derry S, Moore R, McQuay H. Topical NSAIDs for acute pain in adults. Cochrane Database Syst Rev. 2010;(6):CD007402.

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