Your patellar tendon attaches your quadriceps muscles at the front of your thigh to your shin bone, or tibia, in your lower leg. The tendon begins just below the kneecap, or patella, and inserts at the tibia tuberosity, a large bump at the top of your shin bone.
Tendons are made of tough fibrous tissue that is continuous with the muscle, attaching it securely to bone. As the muscle shortens, it pulls on the bone to which it is attached, producing movement. The job of the patellar tendon is to straighten the knee by pulling on the tibia.
Patellar tendonosis is a common athletic overuse injury, although it can occur in non-athletic populations. During physical activity, the patellar tendon is subjected to great force loads as it straightens the knee during walking, running and jumping. Patellar tendon dysfunction is sometimes called jumper’s knee due to its prevalence in sports that involve jumping.
Tendinitis refers to inflammation of the tendon, but the term tendinosis offers a more accurate description of jumper’s knee, because tendon injuries tend to be degenerative rather than inflammatory.
Tendonosis occurs when excessive force causes disruption of the tendon cells, called tenocytes, making them weaker and less able to cope with repetitive load. If not given time to heal, painful degeneration of the entire tendon may occur.
Causes of patellar tendinosis include:
Diagnosis is based on symptoms and a physical exam. At NYDNR, we confirm our diagnosis with high resolution diagnostic ultrasound, to rule out other possible causes of knee pain.
Treatment for patellar tendonosis is geared to managing symptoms while the knee recovers and heals. Discontinuing activities that cause pain, applying ice and taking NSAIDs may help. Stretching the muscles of the upper leg can reduce load on the patellar tendon.
At NYDNR, we take an active approach to treating patellar tendinosis. Some of our treatment methods include:
Jumper’s knee physical therapy may include eccentric loading, knee stability exercises, and strengthening and stretching of the upper leg muscles.
Tendon tissue is not highly vascular, and getting nutrients to the cells is important for healing. ESWT is a non-invasive treatment that stimulates cellular regeneration and increases the flow of blood and nutrients to damaged cells to accelerate healing.
At NYDNR, part of our protocol for patellar tendonosis rehab is biomechanical evaluation and retraining. Making minor corrections in motor skills can improve performance and reduce the risk of injury.
Absence of pain alone is not enough to ensure the patellar tendon has fully healed. We monitor our patients’ progress with ongoing ultrasonography and biomechanical analysis. At NYDNR, we want our athletes to return to sport with confidence, fully recovered, and with a low risk of re-injury.
and a faulty diagnosis can make treatment a total waste of time.
Failure to accurately diagnose a condition in its early stages can lead
to chronic problems and sometimes devastating results.
Diagnostic musculoskeletal sonography (MSUS) provides the perfect tool for the rehab practitioner. Yet many doctors and physical therapists have no experience with MSUS, are unaware of its advantages, and have no idea how to use it as a diagnostic tool.
Below is a prime example of how ultrasound can take the guesswork out of diagnosis.Successful Treatment
A bad physical therapy experience is one of the primary causes of unnecessary surgery.
We have equipped our clinic with the latest research-grade technology to arrive at objective and accurate diagnoses, and to objectively measure our patients’ progress.
Most importantly, we are the only facility in the US where structural medical diagnosis is reflected in functional treatment, and vice versa.
In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.
Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.
The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.
Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup
Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)
Complete tear of rectus femoris
with large hematoma (blood)
Separation of muscle ends due to tear elicited
on dynamic sonography examination
