What is Patellar Tendonitis?
Patellar Tendonitis or jumper’s knee is a condition in which the patellar tendon which connects the kneecap or patellar bone to the tibia or the shin bone is stressed due to constant repetitive use. This is common in athletes and children who overexert themselves during physical activities.
Image 1: The Patellar Tendon
Anatomy of Patellar tendon
To understand dislocation of the kneecap, we need an anatomic understanding of the knee.
The Patellar Tendon connects the patellar bone/kneecap to the shin bone or the tibia. Little to no inflammation results but histology (microscopic analysis) of the tissues reveals increased breakdown of the fibers that hold the tendon in place. Tendons transmit the forces of muscle to the skeleton. As such repeated mechanical loads lead to tendinopathy. The exact pathogenesis of tendinopathy is unclear.
The term tendinopathy is a general term used to describe the condition affecting the tendons, which causes pain, swelling and impaired performance. Tendinopathy may actually be a better term for the lack of inflammation in most cases of tendonitis.
Repetitive use of the affected tendon causes an increase in the breakdown of the tissue vs its regenerative capabilities. Wear and tear is an everyday occurrence to these tendons of the lower extremity, but without proper rest and relaxation, the tendon cannot build up enough strength in time for the next activity.
Image 2: Mechanism of Patellar Tendinitis
Signs & Symptoms
The signs and symptoms of a patellar tendonitis are the following
- Slow onset of well-localized anterior knee pain
- Pain worsens when changing position from sitting to standing or when walking up hill
Depending on the severity, one can classify the pain based on different manifestations.
- Stage 1 – Pain occurs only after activity and there is no functional impairment
- Stage 2 – Pain during and after the activity but the performance is not impaired
- Stage 3 – Prolonged pain during and after activity with impaired performance
- Stage 4 – Complete tendon tear that requires surgical intervention
If you ever feel these signs and symptoms, it is important that you get medical attention so that the physician may prescribe a treatment regimen to resolve the tendonitis.
Radiologic examinations may be performed if the trauma is significant but usually there is no apparent damage on routine radiographs. Sometimes a fleck of bone may be seen which suggests a fracture at the site of insertion. A rough appearance of bone suggests a concurrent periostitis. Calcium deposits along the tendon may be visualized with calcium metabolism disorders.
Ultrasound, MRI are reserved when the patients doesn’t improve even after conservative medical therapy. Ultrasonography provides a quick, noninvasive imaging that will reveal any underlying structural defects responsible for the tendonitis.
Tendon changes are noted by alterations in tendon morphology decreased echogenicity (means there’s less of the tendon present). MRI is the gold standard for assessing the damage to soft tissues and can reveal if there is any concurrent cartilaginous damage that aids in management.
The goal of treatment is to reduce pain and return the patient’s performance to pre-tendonitis state. Non-pharmacologic interventions are as follows. Rest or a decrease in activity is needed to give the tendon enough time to repair itself. There are no recommendations on the exact amount or duration of activity but activities that cause pain are to be avoided.
Ice compresses are needed in the first 24-48 hours to decrease swelling and inflammation. Splinting or immobilization; this will prevent further insult to the affected tendon. Strengthening and stretching exercises in physiotherapy may provide the patient with some much needed tolerance to improve pain thresholds.
If ever these are not effective, pharmacologic management is warranted. Non-steroidal, anti-inflammatory drugs can be used to treat the acute pain that comes with tendonitis. But as already said a majority of tendonitis is not inflammatory in nature and may not solve the underlying cause of the disease.
Corticosteroid injections maybe given to eliminate the underlying inflammatory process as well as to prevent the formation of metabolites that are responsible for the patient feeling pain.
Chronic disability, rupture and adhesive capsulitis (in which the tendon is unable to move) may result as complications of patellar tendonitis. As long as the tendon is given enough rest and relaxation, there is a good chance that the tendon will resolve its pathologic processes on its own and the patient can return to a normal routine of daily activities of living.
Patellar tendonitis or jumper’s knee is a relatively common disorder of the tendon that results from overuse of the tendon. Not given the tendon enough rest and relaxation causes the tendon to breakdown and the regenerative process is not enough to make the repairs complete.
A variety of imaging modalities can be used to identify if there are any underlying cause of the tendinopathy. As in any sports injury, the management for this condition includes the RICE method. Rest, Ice compresses and elevation of the affected leg can increase blood flow and improve the healing rate of the affected tendon.
If the patient is unable to achieve a degree of comfort after the conservative measures are done, the patient can be pharmacologic agents to lessen the effects of the pain. Over-all, the patient has an excellent recovery if the treatment regimen is followed.