Patellar Tendinitis and TendinosisPatellar tendonitis is the condition that occurs when the tendon becomes inflamed and irritated. This condition is most often seen in athletes who do repetitive jumping, the reason patellar tendonitis is often called "jumper's knee." Patellar tendonitis is most often seen in participants of sports including basketball and volleyball, although can also be seen in runners and other types of athletes.
Patellar tendinosis is a chronic condition. Instead of the tendon becoming inflamed and irritated, the condition is more gradual in developing, and characterized by microscopic tears and thickening of the tendon. Patellar tendinosis causes similar symptoms, but the treatment of this condition is different from tendonitis.
Partial patellar tendon tears, a finding sometimes described on an MRI, are usually characteristic of chronic patellar tendinosis. These tears are differentiated from a complete patellar tendon tear where the entire tendon is detached and requires surgical repair.
Symptoms of Patellar Tendon ConditionsPatellar tendonitis and tendinosis usually cause pain directly over the patellar tendon. The tendon is usually tender and swollen. Movement of the knee may causes a crunching sensation called crepitus directly over the swollen tendon. The other common symptom of patellar tendon problems is pain with activities, especially jumping or kneeling.
X-ray tests are usually performed to confirm there is no problem with the bones around the knee. Occasionally, a calcium deposit may be seen, particularly in patients with a more chronic patellar tendinosis. An MRI may be helpful to look for symptoms of inflammation or partial tears within the tendon.
Patellar Tendon TreatmentTreatment should be initiated once the proper diagnosis is confirmed by your doctor. If the problem is an acute inflammation, treatment may include:
The most important first step in treatment is to avoid activities that aggravate the problem. Your body is the best guide to know how much to rest the injured knee--if an activity hurts in the area of the injured patellar tendon, then you should rest from that activity.
- Anti-Inflammatory Medications
Nonsteroidal anti-inflammatory medications (NSAIDs) include a long list of possibilities such as Ibuprofen, Motrin, Naprosyn, Celebrex, and many others. Patellar tendonitis treatment can be improved by these medications that will decrease pain and swelling. Be sure to talk to your doctor before starting these medications.
Stretching the quadriceps, hamstring, and calf muscles prior to activity is very important once you do resume activities. Getting into a good stretching habit, even once the symptoms resolve, will help prevent a recurrence of the problem.
- Ice Treatments
Icing the area of inflammation is an important aspect of tendonitis treatment. The ice will help to control the inflammation and decrease swelling. By minimizing inflammation and swelling, the tendon can return to its usual state and perform its usual function.
- Chopat Straps/Braces
Occasionally, your doctor will provide a support strap (called an infrapatellar strap or a Chopat strap), a knee brace, or custom orthotics. The benefit of these measures in the treatment of patellar tendonitis is not well known, but some patients find complete relief from using these products.
Some surgeons are also using a treatment called PRP injections for treatment of patellar tendonitis and tendinosis. These injections may help stimulate a healing reaction in the body, although scientific evidence has yet to strongly support the use of this experimental treatment.
Is surgery ever needed for patellar tendonitis?
Exceedingly rarely. On some occasions, patients have persistent patellar tendonitis symptoms despite the treatments mentioned above. In these patients with chronic patellar pain, who have tried the above treatments for extended durations, surgery can be considered. Surgery is usually considered if damaged tendon is seen on the MRI. During surgery, this damaged tendon can be removed.
Duri ZA, et al. "Patellar tendonitis and anterior knee pain" Am J Knee Surg. 1999 Spring;12(2):99-108.