Patellar Tendonitis

Anatomy

Contributing Factors

Effective pain relief can restore the function of the knee, but it is also important to fully recover prior to resuming normal athletic activities. Abstaining from harmful activities is essential, but is also necessary to rehabilitate with an appropriate amount of exercise. There is an adaptive feature in recovering tissues, and too much rest can actually impair this function. Athletes need the right balance of rest and activity to optimize recovery in the patellar tendon. Examples include PLICA syndrome, PFPS, bursitis and chondromalacia. Clinical tests show the common traits of patellar tendinopathy in tests subjects without providing definitive diagnostic signs.

Incidence and prevalence

The prevalence of jumpers knee is 2:1 in male to female population of amateur and professional athletes. Patellar tendinopathie is present in more then twenty percent of population of athletes who jump.

Diagnosis

Localized pain reaches a high threshold during the extension of the knee with no contraction of the quadriceps; however, this test for pain does not constitute a definitive diagnosis. Due to superficial and extra-articular location of patellar tendon ultrasonography is considered the best diagnostic method. Gait, running and jumping analysis can significantly help in establishing causative biomechanical faults. This type of analysis is not only diagnostic but also serve a great purpose of return to play establishing athlete’s baseline at the moment of the injury.

Localized pain reaches a high threshold during the extension of the knee with no contraction of the quadriceps; however, this test for pain does not constitute a definitive diagnosis. Due to superficial and extra-articular location of patellar tendon ultrasonography is considered the best diagnostic method. Gait, running and jumping analysis can significantly help in establishing causative biomechanical faults. This type of analysis is not only diagnostic but also serve a great purpose of return to play establishing athlete’s baseline at the moment of the injury.

Pathogenesis

causation

Pathogenesis of this condition is not clearly defined, but several clear patterns have emerged from reliable clinical studies. For example, the lack of a definitive marker for diagnosis is a feature in most peer-reviewed studies on patellar tendinitis. However, there is agreement that the key sign is inflammation in the patellar tendon. The location of the lesion is deep in the fibers within the patellar tendon, and it is proximal to the tibial tuberosity during flexion of the knee. Successful clinical treatment plans focus on regenerative healing of the lesion by repairing the damage done to the patellar ligament fibers as well as restoration of eccentric strength and quadriceps muscle versus tendon ratio.

Signs and Symptoms

Tendon injuries frequently occur during athletic activities, and the morbidity rate is high for both amateur and professional athletes. Clinical studies reveal a tendency for this condition to become chronic. It affects the anterior portion of the patella as the patellar tendon crosses the knee joint. Advances in prevention of patellar dysfunction still rely heavily on patient education to succeed. New treatment methods are often met with excitement in athletic circles. This is understandable because the patellar tendon is notoriously difficult to manage.

The area immediately proximal and distal to the patellar surface is affected. The patellar tendon’s distal portion will show an unusual amount of thickness. There is also pain or tenderness upon palpation on the insertion point of the tendon as it approaches the tuberosity of the tibia. These symptoms can mimic other conditions that also present pain in the anterior knee.

The final stage of treatment involves introducing the original activity in gradual stages. This can allow the repaired tendon to adapt to the same activity that caused the original inflammation.

The first stage requires the patient to stop performing the specific actions that caused the initial inflammation. This usually includes the athletic activity that lead to the onset of the inflammation.

The patellar tendon is made up of a series of collagen fibers. The insertion of the patellar tendon is located at the tibial tuberosity, and the tendon originates from the patella’s inferior pole. In the coronal plane, the tendon is around three centimeters wide. It is comprised of fibrous tissues, and this substance is similar to the intricate pattern seen in steel cabling. The tensile strength of these fibers depends on the integrity of the direction and texture of the fibers. During a period of inflammation, some of the collagen fibers may deteriorate, and this weakens the entire area. The vascular distribution to the patellar tendon is asymmetrical, and it requires careful rehabilitation.

The second stage involves appropriate amounts of rehabilitation exercises and rest. The treating physician can recommend exercises that target the patellar tendon. It is important to follow these instructions carefully to rebuild the tissues in this area.

The third stage involves biomechanical retraining with feedback in order for the athletes to learn how to absorb shock and avoid overloading.

Return to sport

Patient education is essential to proper treatment. Patients must first understand the recommended treatment protocol and follow directions carefully to successfully heal from this condition. There is a tendency for patients to get excited once they recover from the pain associated with patellar tendonitis. The patellar tendon is not heavily innervated, so it is possible to injure the area without sensing any pain. This frequently leads to additional injury once the patient believes that the area has healed. Proper return to sport assessment needs to be conducted before athlete intends to return to play. Since patellar tendon is scarcely innervated the decision to return to sport should not be only based on absence of pain but also on the combination or repeat ultrasonography and biomechanical analysis of return to play data.