- 1 Other Names
- 2 Background
- 3 Pathophysiology
- 4 Risk Factors
- 5 Differential Diagnosis
- 6 Clinical Features
- 7 Evaluation
- 8 Classification
- 9 Management
- 10 Rehab and Return to Play
- 11 Complications and Prognosis
- 12 See Also
- 13 References
- Jumpers Knee
- Patellar Tendinitis
- Patellar Tendinopathy
- Patellar Tendinosis
- Patellar tendon pain
- This page refers to tendinopathies of the Patellar Tendon
- Although similar, Quadriceps Tendonitis is discussed separately
- Patellar Tendon Rupture is also discussed separately
- 7% of 14-18 year old junior Australian basketball players had clinical signs of patellar tendinopathy
- The prevalence of patellar tendon pain was 5.8% among 760 athletes across 16 different sports
- Among Elite volleyball players, Ferretti found the incidence to be 22.8%
- Taunton found 4.8% of runners had patellar tendon pain
- Among Norwegian athletes, the overall prevalence was 14.2%, highest in volleyball (44.6%) and basketball (31.9%)
- Among non-elite athletes, the overall prevalence was 8.5% with the highest in volleyball (14.4%) (need citation)
- See: Tendinopathies (Main)
- Represents a common overuse injury of the knee extensor mechanism
- Can be seen acutely or chronically
- Sports that involve rapid changes of direction, jumping, and running such as basketball and volleyball
- Landing phase contributes more to injury than take off phase
- Occurs due to chronic repetitive tendon overload
- Microtrauma can lead to individual fibril degeneration due to stress across the tendon
- May result in weakening of the tissue
- Tension is greatest with increased knee flexion
- Other proposed theories of pathogenesis
- Nervous system
- Initially thought to be inflammatory, now considered a degenerative condition (tendinosis or tendinopathy)
- Patellar Apophysitis (Sinding-Larsen-Johnansson Disease)
- Tibial Tuberosity Apophysitis (Osgood Schalatters Disease)
- Patellofemoral Pain Syndrome (PFPS)
- Patellar Tendon
- Extends distally from the inferior pole of the Patella to the Tibial Tubercle
- Helps assist as part of the Knee Extensor Mechanism with the Quadriceps Muscle and Quadriceps Tendon
- Area of pathology
- Tends to occur at the inferior pole of the patella more commonly than tibial tuberosity
- Ice skating
- Intrinsic factors
- Single sport athletes in basketball, volleyball or soccer at 4x greater risk
- Among volleyball players
- Dislocations & Subluxations
- Patellar Dislocation (and subluxation)
- Knee Dislocation
- Proximal Tibiofibular Joint Dislocation
- Muscle and Tendon Injuries
- Ligament Pathology
- Patellofemoral Pain Syndrome (PFPS)/ Anterior Knee Pain)
- Bakers Cyst (Popliteal Cyst)
- Patellar Contusion
- Pediatric Considerations
- Patellar Apophysitis (Sinding-Larsen-Johnansson Disease)
- Patellar Pole Avulsion Fracture
- Tibial Tubercle Avulsion Fracture
- Tibial Tuberosity Apophysitis (Osgood Schalatters Disease)
- Proximal Tibial Metaphyseal Fracture
- Proximal Tibial Physeal Injury
- Onset of pain is typically insidious
- Patients will complain of knee pain just below the patella
- Initially pain is only after activity, then eventually during activity and potentially all the time
- Movie Theatre Sign: Patient can endorse pain after prolonged periods of sitting, for example in a movie theatre
- Physical Exam: Physical Exam Knee
- Swelling over the tendon may or may not be present
- Tenderness the inferior patella pole, along the tendon or at the tibial insertion
- Pain with resisted extension of the knee or with maximal stretching of the quadriceps
- Special Tests
- Bassets Sign: Tenderness of inferior patellar pole in extension but not in flexion
- Standard Radiographs Knee
- Radiographs are a common screening tool
- Typically normal
- Ultrasound can be used to evaluate tendon integrity
- Hyppoechoic areas
- Thickened tendon
- Neovascularization (chronic)
- Chronic cases
- Surgical planning
- Tendon thickening
- Increased signal on T1, T2
- Sometimes loss of posterior border of fat pad
Blazina Classification System
- Phase I: pain after activity only
- Phase II: pain during and after activity
- Phase III: persistent pain with or without activities, deterioration of performance
- Temporary discontinuation of offending sport
- Relative rest
- Ice Therapy
- Avoid complete immobilization to prevent atrophy
- Oral Medications
- NSAIDS are likely useful in the short term
- Topical Nitroglycerin
- No significant difference between topical NO and placebo + eccentric training at 24 weeks, with both groups showing improvement
- Physical Therapy
- Avoidance of jumping activities with stretching after physical activity may help in early disease
- Individuals performing eccentric exercises improved significantly compared with those undergoing a concentric exercise program
- RCT: Progressive tendon-loading exercises (PTLE) resulted in a significantly better clinical outcome after 24 weeks than eccentric exercise therapy (EET)
- Consider Patellar Counterforce Strap
- Corticosteroid Injection
- Aprotinin Injection
- When compared to corticosteroids and placebo, aprotinin had 72% good/excellent results compared with 59% in the CSI group and 28% in the placebo group
- High risk of side effects including anaphylaxis, bovine spongiform encephalopathy
- Sclerosing Injection
- Platelet Rich Plasma
- Extracorporeal Shock Wave Therapy (ESWT)
- Consider Needle Tenotomy
- Consider Orthobiologics
- Refractory cases
- Open debridement
- Arthroscopic debridement
Rehab and Return to Play
- Early phase
- Pain reduction
- Quadriceps strengthening
- Isometric strengthening
- Late phase
- Begin when symptoms/ pain has resolved
- Start eccentric strengthening
Return to Play
- Needs to be updated
Complications and Prognosis
- General conservative management
- 90% of patients will have pain free return to play at 6 months (need citation)
- Open surgical debridement
- In 11 knees that failed conservative treatment, open debridement and drilling of the inferior pole of the patella produced 7 (64%) excellent, 3 (27%) good, and 1 (9%) poor result at an average of 2.1 years follow-up
- Other studies have produced similar results: Griffiths (86%), Feetti found 70% had excellent results and 82% returned to play
- Arthroscopic surgical debridement
- Patellar Tendon Rupture
- Chronic pain
- Inability to return to sport
- Sports Medicine Review Knee Pain: https://www.sportsmedreview.com/by-joint/knee/
- ↑ Cook JL Khan KM Kiss ZS Griffiths L. Patellar tendinopathy in junior basketball players: a controlled clinical and ultrasonographic study of 268 patellar tendons in players aged 14-18 years. Scand J Med Sci Sports. 2000;10(4):216-220.
- ↑ Cassel M Baur H Hirschmuller A Carlsohn A Frohlich K Mayer F. Prevalence of Achilles and patellar tendinopathy and their association to intratendinous changes in adolescent athletes. Scand J Med Sci Sports. 2014.
- ↑ 3.0 3.1 Ferretti A. Epidemiology of jumper's knee. Sports Med. 1986;3(4):289-295.
- ↑ Taunton JE Ryan MB Clement DB McKenzie DC Lloyd-Smith DR Zumbo BD. A retrospective case-control analysis of 2002 running injuries. Br J Sports Med. 2002;36(2):95-101.
- ↑ Lian OB Engebretsen L Bahr R. Prevalence of jumper's knee among elite athletes from different sports: a cross-sectional study. Am J Sports Med. 2005;33(4):561-567.
- ↑ Lian OB, Engebretsen L, Bahr R. Prevalence of jumper’s knee among elite athletes from different sports: a cross-sectional study. Am J Sports Med. 2005;33:561-567.
- ↑ Karahan, Mustafa, and E. R. O. L. Bulent. "Muscle and tendon injuries in children and adolescents." Acta orthopaedica et traumatologica turcica 38 (2004): 37-46.
- ↑ Worp H, Ark M, Roerink S, Pepping GJ, Akker-Scheek I, Zwerver J. Risk factors for patellar tendinopathy: a systematic review of the literature. Br J Sports Med. 2011;45:446-452.
- ↑ Kujala UM Osterman K Kvist M Aalto T Friberg O. Factors predisposing to patellar chondropathy and patellar apicitis in athletes. Int Orthop. 1986;10(3):195-200.
- ↑ Allen GM Tauro PG Ostlere SJ. Proximal patellar tendinosis and abnormalities of patellar tracking. Skeletal Radiol. 1999;28(4):220-223.
- ↑ Hall R Barber Foss K Hewett TE Myer GD. Sport specialization's association with an increased risk of developing anterior knee pain in adolescent female athletes. J Sport Rehabil. 2015;24(1):31-35.
- ↑ Visnes H Bahr R. Training volume and body composition as risk factors for developing jumper's knee among young elite volleyball players. Scand J Med Sci Sports. 2013;23(5):607-613.
- ↑ Larsson, Maria EH, Ingela Käll, and Katarina Nilsson-Helander. "Treatment of patellar tendinopathy—a systematic review of randomized controlled trials." Knee surgery, sports traumatology, arthroscopy 20.8 (2012): 1632-1646.
- ↑ Andres BM, Murrell GA. Treatment of tendinopathy: what works, what does not, and what is on the horizon. Clin Orthop Relat Res. 2008;466:1539-1554
- ↑ Steunebrink M, Zwerver J, Brandsema R, Groenenboom P, Akker-Scheek I, Weir A. Topical glyceryl trinitrate treatment of chronic patellar tendinopathy: a randomised, double-blind, placebo-controlled clinical trial. Br J Sports Med. 2013;47:34-39
- ↑ Fredberg U, Bolvig L. Jumper’s knee. Review of the literature. Scand J Med Sci Sports. 1999;9:66-73.
- ↑ Jonsson P, Alfredson H. Superior results with eccentric compared to concentric quadriceps training in patients with jumper’s knee: a prospective randomised study. Br J Sports Med. 2005;39:847-850.
- ↑ Breda, Stephan J., et al. "Effectiveness of progressive tendon-loading exercise therapy in patients with patellar tendinopathy: a randomised clinical trial." British journal of sports medicine 55.9 (2021): 501-509.
- ↑ Lavagnino M, Arnoczky SP, Dodds J, Elvin N. Infrapatellar straps decrease patellar tendon strain at the site of the jumper’s knee lesion: a computational analysis based on radiographic measurements. Sports Health. 2011;3:296-302
- ↑ Schwartz, Aaron, Jonathan N. Watson, and Mark R. Hutchinson. "Patellar tendinopathy." Sports Health 7.5 (2015): 415-420.
- ↑ Fredberg U, Bolvig L, Pfeiffer-Jensen M. Ultrasonography as a tool for diagnosis, guidance of local steroid injection and, together with pressure algometry, monitoring of the treatment of athletes with chronic jumper’s knee and Achilles tendinitis: a randomized, double-blind, placebo-controlled study. Scand J Rheumatol. 2004;33:94-101
- ↑ Kongsgaard M, Kovanen V, Aagaard P. Corticosteroid injections, eccentric decline squat training and heavy slow resistance training in patellar tendinopathy. Scand J Med Sci Sports. 2009;19:790-802.
- ↑ Capasso G, Testa V, Maffulli N, Bifulco G. Aprotinin, corticosteroids and normosaline in the management of patellar tendinopathy in athletes: a prospective randomized study. Sports Exerc Inj. 1997;3:111-115.
- ↑ Hoksrud A, Ohberg L, Alfredson H, Bahr R. Ultrasound-guided sclerosis of neovessels in painful chronic patellar tendinopathy: a randomized controlled trial. Am J Sports Med. 2006;34:1738-1746.
- ↑ Willberg L, Sunding K, Forssblad M, Fahlstrom M, Alfredson H. Sclerosing polidocanol injections or arthroscopic shaving to treat patellar tendinopathy/jumper’s knee? A randomised controlled study. Br J Sports Med. 2011;45:411-415.
- ↑ Peers KH, Lysens RJ, Brys P, Bellemans J. Cross-sectional outcome analysis of athletes with chronic patellar tendinopathy treated surgically and by extracorporeal shock wave therapy. Clin J Sport Med. 2003;13:79-83.
- ↑ Wang CJ, Ko JY, Chan YS, Weng LH, Hsu SL. Extracorporeal shockwave for chronic patellar tendinopathy. Am J Sports Med. 2007;35:972-978.
- ↑ Pascarella A, Alam M, Pascarella F, Latte C, Di Salvatore MG, Maffulli N. Arthroscopic management of chronic patellar tendinopathy. Am J Sports Med. 2011;39:1975-1983.
- ↑ Griffiths GP, Selesnick FH. Operative treatment and arthroscopic findings in chronic patellar tendinitis. Arthroscopy. 1998;14:836-839.
- ↑ Ferretti A, Conteduca F, Camerucci E, Morelli F. Patellar tendinosis: a follow-up study of surgical treatment. J Bone Joint Surg Am. 2002;84:2179-2185.
- ↑ Lorbach O, Diamantopoulos A, Paessler HH. Arthroscopic resection of the lower patellar pole in patients with chronic patellar tendinosis. Arthroscopy. 2008;24:167-173.
- ↑ Pascarella A, Alam M, Pascarella F, Latte C, Di Salvatore MG, Maffulli N. Arthroscopic management of chronic patellar tendinopathy. Am J Sports Med. 2011;39:1975-1983
- ↑ Santander J, Zarba E, Iraporda H, Puleo S. Can arthroscopically assisted treatment of chronic patellar tendinopathy reduce pain and restore function? Clin Orthop Relat Res. 2012;470:993-997.
John Kiel on 5 June 2019 04:06:51
4 October 2022 15:46:44