PATELLAR TENDINITIS
- Caused by activities involving repeated extension of
the knee.
•Termed jumper’s knee, as it’s most common in sport-
ing activities such as basketball, volleyball, and
soccer. Seen most commonly in younger individuals
from their adolescent years to 40 years of age (Feretti
et al, 1985). - Predisposing factors include abnormal patellofemoral
tracking, patellar alta, chondromalacia, Osgood-
Schlatter disease, and leg length discrepancy. - Can be confused with Sindig-Larsen-Johansson dis-
ease that is a traction apophysitis of the distal pole of
the patella that presents with similar complaints in a
younger age group.
•Involves the most proximal part of the patellar tendon
and its attachment to the distal pole of the patella. This
area of tendon is thought to impinge on the adjacent
patella during knee flexion causing injury to the
tendon (King et al, 1990). - The affected area of tendon resembles tendonosis in
the form of tendon degeneration and not inflamma-
tion. Histologically, this tissue is chacterized as
undergoing angiofibroblastic hyperplasiawith fibrob-
last proliferation, new blood vessel formation, chon-
dromucoid deposition, and collagen fragmentation
(Kannus and Jozsa, 1991).
CLINICAL PRESENTATION
•Pain to palpation in the area of tendon involvement
just distal its insertion on the inferior pole of the
patella.
•Pain is increased with activity requiring knee exten-
sion against resistance.
•Tendon may acquire bogginess; however, there is no
associated joint effusion.
- Blanzina et al have classified this condition based on
the patients’ symptoms: ( 1 ) Pain only after activity.
( 2 ) Pain is present before activity, and then disap-
pears, only to return near the end of activity with mus-
cular fatigue. ( 3 ) Pain is constant with both rest and
activity. ( 4 ) Patellar tendon rupture (Blanzina et al,
1973).
RADIOGRAPHIC EVALUATION
- Mainly a clinical diagnosis, but plain X-rays while usu-
ally normal, can, at times, demonstrate an osteopenia at
the distal pole of the patella, a traction osteophyte in the
area of involvement, and calcification of the tendon.- MRI is the study of choice in the chronic setting as it can
clearly identify the area of tendon involvement. This
area usually involves the posterior aspect of the tendon
in its proximal third (Johnson, Wakely, and Watt, 1996).
- MRI is the study of choice in the chronic setting as it can
TREATMENT- Conservative treatment is usually successful and
includes rest, ice, and anti-inflammatory medication.
Therapeutic modalities including ultrasound,
ionophoresis, and phonophoresis are helpful in pain
relief (Martens et al, 1982; Panni, Tartarone, and
Maffulli, 2000). - Once the pain has subsided, physiotherapy in the form
of quadriceps strengthening and hamstring stretching
are begun with gradual return to activity. - An elastic knee sleeve or counterforce brace have also
proved beneficial. - More chronic cases with pathology demonstrable on
MRI scan require surgical debridement and excision
of the diseased tendon and adjacent bone through
either an open or arthroscopic approach (Griffiths and
Selesnick, 1998; Romeo and Larson, 1999; Coleman
et al, 2000).
QUADRICEPS TENDINITIS- Not as common as patellar tendonitis but has similar
risk factors. - Repetive microtrauma through overuse can lead to
localized degeneration of the quadriceps tendon at its
insertion into the superior pole of the patella. - Chronic symptoms in this area appear to be a risk
factor for future tendon ruptue.
CLINICAL PRESENTATION•Pain with exertion and tenderness over affected area
of quadriceps insertion. This most commonly is the
lateral aspect of the tendon.- Radiographs often demonstrate calcification of the
tendon at its insertion to the patella or a traction osteo-
phyte at the osseous margin.
TREATMENT•Treatment is similar to that of patellar tendonitis.
Results of conservative treatment are excellent,
although more chronic cases can require open surgical
debridement (James, 1995).362 SECTION 4 • MUSCULOSKELETAL PROBLEMS IN THE ATHLETE