Patellar tendinopathy is also known as Jumper’s Knee, patellar tendonitis or tendinitis. Tendinopathy comprises of tendinosis (degeneration of the tendon) and tendinitis (inflammation of the tendon). Patellar tendinopathy is an overuse injury that affects the knee and is usually a result of the patellar tendon being overstressed. Patella tendinopathy can be a debilitating disease and results in prolonged absence and potential retirement from sports.
Prevalence & Risk Factors
Patellar tendinopathy usually occurs in those who are relatively young (between 15 to 30 years old), in athletes, especially men who are involved in sports such as basketball, volleyball, track and field jumping events, tennis, and football which requires repeated use of the patellar tendon. These sports require repeated bursts of energy for jumping, landing, cutting and pivoting. Repetition of this activity can cause damage and change in the tendon. It has been reported to be the most common injury in volleyball, reaching as high as 40% among high-level volleyball players.
It is one of the most common injuries in sports and up to 40% of professional players have experienced symptoms of this condition during their career. It was also found that chronic patellar tendinopathy leads to athletes abandoning their careers and still suffer mild but long lasting symptoms in a 15-year follow-up study.
Patients usually present with anterior knee pain that is localized to the inferior pole of the patella. It may be described as a sharp and aching pain. The pain is also aggravated by activities that require the patient to jump, land after jumping, running and sometimes prolonged sitting. The pain is gradual in its onset and increases with activity.
Localized tenderness is found over the inferior pole of the knee and it may feel stiff in the morning. The affected tendon may also appear thickened compared to the unaffected side.
Other associated symptoms include swelling either at the superior or inferior pole of the kneecap, crepitus or the occurrence of the knee “giving way” or momentary weakness.
The diagnosis of patellar tendinopathy is a clinical diagnosis and is made via the patient’s history and examination of the patient. Palpation was found to be reliable in identifying patellar tendinopathy . It is important to rule our other disorders that may have a similar presentation and this can be aided with the use of imaging such as magnetic resonance imaging (MRI) scan, computed tomography (CT) scan, ultrasound and the standard radiograph.
Classification for Jumper’s Knee (patellar tendonitis) include:
Stage 0 – No pain
Stage 1 – Pain only after intense sports activity; no undue functional impairment
Stage 2 – Pain at the beginning and after sports activity; still able to perform at a satisfactory level
Stage 3 – Pain during sports activity; increasing difficulty in performing at a satisfactory level
Stage 4 – Pain during sports activity; unable to participate in sport at a satisfactory level
Stage 5 – Pain during daily activity; unable to participate in sport at any level
The pain-rest-reinjury cycle is important in regards to patellar tendinopathy treatment. It is vital that patients do not return to sport or vigorous activities before there is adequate tissue healing. Conservative management is usually recommended in phases 1 to 3.
Patellar tendinopathy is usually managed conservatively when it presents in the early stages. It includes restriction or modification of activity, applying ice packs, using analgesics or anti-inflammatories, stretching, massage or taping. The non-operative treatment of patellar tendinopathy may not be effective in all cases despite months of treatment.
In patients with phase 1, treatment includes adequate warm up, cryotherapy after sports, using non-steroidal anti-inflammatory drugs (NSAIDs) as an anti-inflammatory and pain relief, bracing, and strengthening exercises.
In phase 2, moist heat before an activity is added to phase 1 treatment protocol. Corticosteroid injections are no longer administered as it has been associated with detrimental side effects and have no significant improvement. Corticosteroid injections can also provide pain relief leading to the continuation of damage on the tendon.
In phase 3, the phase 2 protocol is used with the addition of prolonged rest. It is also at this stage that surgery is considered.
Studies comparing surgical and conservative treatment found that both groups showed significant improvement over a twelve-month period with no statistical significance between the two groups. Due to the long time needed for patients to recover for both surgical and conservative therapy, a study was conducted on arthroscopic (endoscopic surgery on the joint) surgery and patients were able to return to their activities within two months in the majority of cases.
There are multiple types of open surgical procedures that can be done for patellar tendinopathy but the most common one involves the open excision of the diseased portion of the patellar tendon. The negative aspects of an open surgery are not related to the success rate but rather the amount of time needed post-operatively to return to their routine activities or sports. The time to recover post open surgery can range from six to ten months. With arthroscopic surgery, studies have reported up to 85% of symptom improvement, a return to sporting function from 46% to 85% of patients and the time taken to return to activities was found to be between two and six months.
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