- Jumpers Knee
- Patellar Tendinitis
- Patellar Tendinopathy
- Patellar Tendinosis
- Patellar tendon pain
- This page refers to tendinopathies of the Patellar Tendon
- 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
- 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
- Muscle and Tendon Injuries
- Ligament Pathology
- Patellofemoral Pain Syndrome (PFPS)/ Anterior Knee Pain)
- Pediatric Considerations
- 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
- 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/
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