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Introduction

Patellar Tendonitis

Jumper's knee (patellar tendonitis) is a condition characterized by inflammation of your patellar tendon. This connects your kneecap (patella) to your shin bone (tibia). This produces pain, weakness, and swelling of the knee joint.


Patellar tendonitis is a common overuse condition associated with running, repeated jumping and landing, and kicking. It occurs most often as a result of stresses placed on the supporting structures of the knee.

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Causes

Overuse and training errors. Running, jumping, and repetitive knee flexion into extension (e.g., rising from a deep squat) place additional stress on the knee tendon. Increasing the frequency, intensity or duration of training too quickly is a major cause of patellar tendonitis.

Inappropriate footwear. 

Inappropriate surface or ground (hard surface, cement) used for sport. 

Malalignment of the foot, ankle, and leg. Flat foot position, tracking abnormalities of the patella, rotation of the tibia called tibial torsion, and a leg length difference can create increased and often uneven load on the quadriceps mechanism. 

Muscle imbalance of the lower extremity (from the hip down to the toes). This can impact the quadriceps muscle and affect the joint. 

Obesity. Individuals who are overweight may have added issues with load and muscle imbalance leading to patellar tendonitis.

Symptoms
  • Pain and tenderness just below the patella (kneecap) which is worsened when you move your knee or kneel

  • Swelling

  • Warmth or burning pain

Diagnosis

Diagnosis begins with a complete history of your knee problem followed by an examination of the knee, including the patella. There is usually tenderness with palpation of the inflamed tissues at the insertion of the tendon into the bone. The knee will be assessed for range of motion, strength, flexibility and joint stability.

 

The physician will look for intrinsic and extrinsic factors affecting the knee (especially sudden changes in training habits). Potential problems with lower extremity alignment are identified. The doctor will also check the hamstrings for telltale weakness and tightness.

 

X-rays may be ordered on the initial visit to your doctor. An X-ray can show fractures of the tibia or patella but X-rays do not show soft tissue injuries.

 

In these cases, other tests, such as ultrasonography or magnetic resonance imaging (MRI), may be suggested. Ultrasound uses sound waves to detect tendon tears. MRIs use magnetic waves rather than X-rays to show the soft tissues of the body. Usually, this test is done to look for injuries, such as tears in the quadriceps. 

Non-surgical treatments
  • Using the RICE (rest, ice, compression, elevation) method: The RICE method involves resting your knee, icing your knee, wearing an elastic bandage around your knee (compression) and elevating your knee while you’re resting. This helps to reduce pain and swelling.

  • Taking pain relievers: Your healthcare provider may recommend taking pain relievers (non-steroidal anti-inflammatory medications, or NSAIDs) to help reduce pain and swelling in your knee. Acetaminophen can be used as an alternative if you cannot tolerate NSAIDs or are allergic.

  • Wearing a knee brace: Bracing or taping the patella can help you do exercises and activities with less pain. This helps the patella stay in better alignment within the femoral groove, and also improves the pull of the quadriceps muscle so that the patella stays lined up in the groove. Therapists may also design special shoe inserts (orthotics) to improve knee alignment and function of the patella.

  • Doing physical therapy: Stretching and strengthening exercises are then used to correct any muscle imbalances. Flexibility exercises are often designed for the thigh and calf muscles. Specific exercises are used to maximize control and strength of the quadriceps muscles. Your physiotherapist will show you how to ease back into jumping or running sports using good training techniques. Off-season strength training of the legs, particularly the quadriceps muscles is advised.

Surgery