Patellar Tendinopathy
The patellar tendon joins the kneecap to the tibia (shin bone) as shown in this picture of the knee.
The patellar tendon connects the patella (kneecap) to the tibia (shin bone). To straighten the knee, the quadriceps muscles pull on the kneecap, which pulls on the patellar tendon, which pulls on the tibia. Patellar tendinopathy is when the tendon becomes inflamed and painful. It is usually due to overuse, causing multiple small injuries in the tendon which build up over time. It is also sometimes referred to as ‘jumpers knee’ due to its high prevalence in jumping sports.
Usually it comes on gradually, causing pain on the lower edge of the kneecap during activity, particularly jumping and bounding. It is often seen after a sharp increase in activity for example starting an exercise program. This pain is reproduced on pressing on the patella tendon. As the condition develops pain may be present for a long time after activity has stopped. Diagnosis of the condition is primarily based on your symtoms and the clinician’s examination. The clinician will also examine for precipitating factors, which may include muscle imbalances around the knee joint or problems with the way the limbs move (biomechanics). Questionnaires such as the Victoria Institute of Sport Assessment (VISA) questionnaire can also be used to help evaluate the severity of symptoms. Medical imaging such as ultrasound or MRI scan are useful in some cases.
The road to treatment of patellar tendinopathy is long and arduous, if not frustrating! There is not an instant and lasting cure. Therefore the first step towards the management of the condition is setting realistic expectations as well as a time frame. Initial management of patellar tendinopathy should always be nonoperative, with a multifaceted approach. Physiotherapy includes a combination of strengthening exercises, load reduction, proprioceptive work (training the bodies positional awareness) and postural correction. This should be complemented with therapeutic adjuncts including soft tissue therapy, ice and shockwave therapy. Steroid injections are not recommended because they may increase the risk of tendon rupture.
Surgical options include an operation to decompress the tendon and remove the diseased part of patellar tendon. This has good results in some individuals, but results are not instant and it is associated with risks and complications including the possibility of continued symptoms. Therefore surgery should only be considered when non-operative measures have failed.