PATELLA TENDONITISPATELLA TENDONITIS

INTRODUCTIONINTRODUCTION

The patellar tendon / ligament joins the The patellar tendon / ligament joins the kneecap (patella) to the shin bone or tibia kneecap (patella) to the shin bone or tibia (video). This tendon is extremely strong (video). This tendon is extremely strong and allows the quadriceps muscle group to and allows the quadriceps muscle group to straighten the leg .straighten the leg .The quadriceps actively straighten the The quadriceps actively straighten the knee in jumping to propel the individual off knee in jumping to propel the individual off the ground as well as functioning in the ground as well as functioning in stabilizing their landing.stabilizing their landing.

As such this tendon comes under a large As such this tendon comes under a large amount of stress especially in individuals who amount of stress especially in individuals who actively put extra strain on the knee joint such as actively put extra strain on the knee joint such as those who regularly perform sports that involve those who regularly perform sports that involve direction changing and jumping movements .direction changing and jumping movements .

  Jumper’s knee is an inflammation of the   Jumper’s knee is an inflammation of the patellar tendon that attaches from the bottom of patellar tendon that attaches from the bottom of the kneecap to the top of the shin bone .the kneecap to the top of the shin bone .

  Jumper’s knee, as it is most commonly   Jumper’s knee, as it is most commonly referred to, is also known as referred to, is also known as patellar tendonitispatellar tendonitis

With repeated strain, micro-tears as well With repeated strain, micro-tears as well as collagen degeneration may occur as a as collagen degeneration may occur as a result in the tendon.result in the tendon.

This is known as patellar tendinopathy .This is known as patellar tendinopathy .

CAUSES OF PATELLAR CAUSES OF PATELLAR TENDINITISTENDINITIS

Patellar tendonitis is the condition that Patellar tendonitis is the condition that arises when the tendon and the tissues arises when the tendon and the tissues that surround it, become inflamed and that surround it, become inflamed and irritated. This is usually due to overuse, irritated. This is usually due to overuse, especially from jumping activities. This is especially from jumping activities. This is the reason patellar tendonitis is often the reason patellar tendonitis is often called "jumper's knee." called "jumper's knee."

When overuse is the cause of patellar When overuse is the cause of patellar tendonitis, patients are usually active tendonitis, patients are usually active participants of jumping-types of sports participants of jumping-types of sports such as basketball or volleyball. Patellar such as basketball or volleyball. Patellar tendonitis may also be seen with sports tendonitis may also be seen with sports such as running and soccer. Also, some such as running and soccer. Also, some patients develop patellar tendonitis after patients develop patellar tendonitis after sustaining an acute injury to the tendon, sustaining an acute injury to the tendon, and not allowing adequate healing. This and not allowing adequate healing. This type of traumatic patellar tendonitis is type of traumatic patellar tendonitis is much less common than overuse much less common than overuse syndromes. syndromes.

PATHOGENESISPATHOGENESIS

Extensor mechanism stress, Extensor mechanism stress, acceleration/deceleration, jumping/landing, acceleration/deceleration, jumping/landing, extrinsic overload of the tendonextrinsic overload of the tendon    - Microtears within the tendon matrix, rare     - Microtears within the tendon matrix, rare occurrences of ruptureoccurrences of rupture    - Patellar impingement theory    - Patellar impingement theory        - Impingement of the inferior patellar pole         - Impingement of the inferior patellar pole against the patellar tendon during knee flexion, against the patellar tendon during knee flexion, Often resulting from a “long inferior patellar pole”Often resulting from a “long inferior patellar pole”

ControversyControversy        - Johnson et al. 1996 (JBJS) found         - Johnson et al. 1996 (JBJS) found impingement of the interior pole at 60 degrees of impingement of the interior pole at 60 degrees of knee flexionknee flexion        - Schmid et al. 2002 suggested that there         - Schmid et al. 2002 suggested that there was no biomechanical evidence of impingement was no biomechanical evidence of impingement in their series in their series         - Almekinders and Shalaby 1999 found         - Almekinders and Shalaby 1999 found evidence of a “long inferior pole” in symptomatic evidence of a “long inferior pole” in symptomatic patients, but this abnormality did not always patients, but this abnormality did not always correlate to the region of involved tendoncorrelate to the region of involved tendon        - Many surgeons resect the infrapatellar         - Many surgeons resect the infrapatellar pole during both open and arthroscopic pole during both open and arthroscopic debridement of patellar tendonitisdebridement of patellar tendonitis

CLASSIFICATIONCLASSIFICATION

:(Blazina et al 1973, Roels et al 1978):(Blazina et al 1973, Roels et al 1978) . .

- phase I: pain only after activity;- phase I: pain only after activity;            - phase II: pain/discomfort during activity,             - phase II: pain/discomfort during activity, but does not interfere w/ participation;but does not interfere w/ participation;            - phase III: pain both during & after             - phase III: pain both during & after participation, which interferes w/ competition;participation, which interferes w/ competition;            - phase IV: complete             - phase IV: complete tendon disruption..

Symptoms of Jumper’s kneeSymptoms of Jumper’s knee

Pain with running or jumping especially downhill Pain with running or jumping especially downhill or downstairs or downstairs

Pain and tenderness around patellar tendon Pain and tenderness around patellar tendon

Pain and tenderness behind the knee cap Pain and tenderness behind the knee cap

Pain is worse at night Pain is worse at night

Restricted movement and swelling in the area Restricted movement and swelling in the area surrounding the injury surrounding the injury

Prevention of Jumper’s kneePrevention of Jumper’s knee

May be associated with poor May be associated with poor Vastus medialis obliquus (VMO) function . (VMO) function .

OTHERS CAUSESOTHERS CAUSES

Intensity and frequency of physical activity.Intensity and frequency of physical activity. Repeated jumping is most commonly associated Repeated jumping is most commonly associated with patellar tendinitis. Sudden increases in the with patellar tendinitis. Sudden increases in the intensity of physical activity or increases in intensity of physical activity or increases in frequency of activity also put added stress on frequency of activity also put added stress on the tendon. the tendon. Being overweight. Being overweight. Additionally, being Additionally, being overweight or obese increases the stress on the overweight or obese increases the stress on the patellar tendon, and some research suggests patellar tendon, and some research suggests that having a higher body mass index may that having a higher body mass index may increase the risk of patellar tendinitis. increase the risk of patellar tendinitis.

Tight leg muscles.Tight leg muscles. Reduced flexibility in your Reduced flexibility in your thigh muscles (quadriceps) and your hamstrings, thigh muscles (quadriceps) and your hamstrings, which run up the back of your thighs, could which run up the back of your thighs, could increase the strain on your patellar tendon. increase the strain on your patellar tendon. Misalignment of your leg.Misalignment of your leg. The way your leg The way your leg bones line up could be off slightly, putting strain bones line up could be off slightly, putting strain on your tendon. on your tendon. Raised kneecap (patella alta).Raised kneecap (patella alta). Your kneecap Your kneecap may be positioned higher up on your knee joint, may be positioned higher up on your knee joint, causing increased strain on the patellar tendon. causing increased strain on the patellar tendon. Muscular imbalance.Muscular imbalance. If some muscles in your If some muscles in your legs are much stronger than others, the stronger legs are much stronger than others, the stronger muscles could pull harder on your patellar muscles could pull harder on your patellar tendon. This uneven pull could cause tendinitis. tendon. This uneven pull could cause tendinitis.

CAUSES OF PATELLAR CAUSES OF PATELLAR TENDINOPATHYTENDINOPATHY

This depends on the extent or grade of the injury:This depends on the extent or grade of the injury:Grade 1: Pain only after training Grade 1: Pain only after training Continue training but apply ice orContinue training but apply ice or cold therapy to the to the injury after each training session. Cold therapy can be injury after each training session. Cold therapy can be applied by by ice massage or the use of ice packs. It is applied by by ice massage or the use of ice packs. It is important the cold is applied at the point of pain on the important the cold is applied at the point of pain on the tendon. tendon. Wear a Wear a heat retainer or support. . See a sports injury specialist / therapist who can apply See a sports injury specialist / therapist who can apply sports massage techniques and advise on rehabilitation. techniques and advise on rehabilitation. An eccentric strengthening programme is generally An eccentric strengthening programme is generally recommended. recommended.

Grade 2: Pain before and after exercise Grade 2: Pain before and after exercise but pain reduces once warmed up.but pain reduces once warmed up.

Modify training activities to reduce the load Modify training activities to reduce the load on the tendon. Stop jumping or sprinting on the tendon. Stop jumping or sprinting activities and replace them with steady activities and replace them with steady running or swimming / running in water if running or swimming / running in water if necessary. necessary.

See a See a sports injury specialist / therapist / therapist who can apply who can apply sports massage techniques techniques and advise on rehabilitation. and advise on rehabilitation.

Grade 3: Pain during activity which Grade 3: Pain during activity which prevents you from training / performing prevents you from training / performing at your best.at your best.

Rest completely from the aggravating Rest completely from the aggravating activity. Replace it with swimming / activity. Replace it with swimming / running in water (if pain allows). running in water (if pain allows).

See a sports injury specialist / therapist See a sports injury specialist / therapist who can apply sports massage techniques who can apply sports massage techniques and advise on rehabilitation. and advise on rehabilitation.

Grade 4: Pain during every day Grade 4: Pain during every day activities which may or may not be activities which may or may not be getting worse.getting worse. Rest for a long period of time (at least 3 Rest for a long period of time (at least 3 months!). months!). See a sports injury specialist / therapist See a sports injury specialist / therapist who can apply sports massage techniques who can apply sports massage techniques for patella tendonitis / tendinopathy and for patella tendonitis / tendinopathy and advise on rehabilitation. advise on rehabilitation. If the knee does not respond to If the knee does not respond to rehabilitation then consult an Orthopaedic rehabilitation then consult an Orthopaedic Surgeon as surgery may be required. Surgeon as surgery may be required.

PREVENTION OF JUMPER’S PREVENTION OF JUMPER’S KNEEKNEE

The following are some measures that can be The following are some measures that can be taken to prevent jumper’s knee:taken to prevent jumper’s knee:Wear proper fitting shoes that are appropriate Wear proper fitting shoes that are appropriate for the court If necessary, wear orthotics for for the court If necessary, wear orthotics for proper arch support and joint alignment.  proper arch support and joint alignment.  Make sure to properly stretch your hamstrings Make sure to properly stretch your hamstrings and quadriceps prior to activity Strengthen your and quadriceps prior to activity Strengthen your quadriceps and hamstrings so they can better quadriceps and hamstrings so they can better withstand the forces of running and jumping.  withstand the forces of running and jumping.  Avoid playing on hard surfaces such as concrete Avoid playing on hard surfaces such as concrete for extended periods of time as this impact can for extended periods of time as this impact can lead to inflammation over time.lead to inflammation over time.

TREATMENT OF JUMPER’S TREATMENT OF JUMPER’S KNEEKNEE

First and foremost, decrease the frequency and First and foremost, decrease the frequency and duration of the activity that causes you the most duration of the activity that causes you the most pain.  In other words, if it hurts, don’t do it.pain.  In other words, if it hurts, don’t do it.

Apply ice for 20 minutes 2-3 times a day for 2-4 Apply ice for 20 minutes 2-3 times a day for 2-4 days or until pain and inflammation are reduced.days or until pain and inflammation are reduced.

If pain persists, see your doctor and maybe they If pain persists, see your doctor and maybe they can prescribe an anti-inflammatory or pain can prescribe an anti-inflammatory or pain medication.medication.

Wear a special brace called an infrapatellar Wear a special brace called an infrapatellar brace around the bottom of the patellar tendon. brace around the bottom of the patellar tendon.  This will help to prevent overuse by helping  This will help to prevent overuse by helping the tendon to better absorb impact.the tendon to better absorb impact.

Since jumper’s knee is a chronic injury due to Since jumper’s knee is a chronic injury due to repetitive stress and overuse, it can last a few repetitive stress and overuse, it can last a few weeks to several months depending on your weeks to several months depending on your ability to pay attention to the symptoms and take ability to pay attention to the symptoms and take appropriate action early on.  Always remember appropriate action early on.  Always remember to listen to your body, if something hurts, your to listen to your body, if something hurts, your best plan of action is to reduce or stop that best plan of action is to reduce or stop that activity altogether before it develops into activity altogether before it develops into something more serious.something more serious.

Patellar Tendonitis (Jumper's Patellar Tendonitis (Jumper's Knee) Rehabilitation Exercises Knee) Rehabilitation Exercises

You can do the hamstring stretch right away. When the You can do the hamstring stretch right away. When the pain in your knee has decreased, you can do the pain in your knee has decreased, you can do the quadriceps stretch and start strengthening the thigh quadriceps stretch and start strengthening the thigh muscles using the rest of the exercises. muscles using the rest of the exercises. Standing hamstring stretch:Standing hamstring stretch: Place the heel of your leg Place the heel of your leg on a stool about 15 inches high. Keep your knee straight. on a stool about 15 inches high. Keep your knee straight. Lean forward, bending at the hips until you feel a mild Lean forward, bending at the hips until you feel a mild stretch in the back of your thigh. Make sure you do not stretch in the back of your thigh. Make sure you do not roll your shoulders and bend at the waist when doing this roll your shoulders and bend at the waist when doing this or you will stretch your lower back instead. Hold the or you will stretch your lower back instead. Hold the stretch for 15 to 30 seconds. Repeat 3 times. stretch for 15 to 30 seconds. Repeat 3 times.

Quadriceps stretch:Quadriceps stretch: Stand an arm's length Stand an arm's length away from the wall, facing straight ahead. Brace away from the wall, facing straight ahead. Brace yourself by keeping the hand on the uninjured yourself by keeping the hand on the uninjured side against the wall. With your other hand, side against the wall. With your other hand, grasp the ankle of the injured leg and pull your grasp the ankle of the injured leg and pull your heel toward your buttocks. Don't arch or twist heel toward your buttocks. Don't arch or twist your back and keep your knees together. Hold your back and keep your knees together. Hold this stretch for 15 to 30 seconds. Repeat 3 this stretch for 15 to 30 seconds. Repeat 3 times. times.

Side-lying leg lift:Side-lying leg lift: Lying on your uninjured side, Lying on your uninjured side, tighten the front thigh muscles on your injured tighten the front thigh muscles on your injured leg and lift that leg 8 to 10 inches away from the leg and lift that leg 8 to 10 inches away from the other leg. Keep the leg straight. Do 3 sets of 10. other leg. Keep the leg straight. Do 3 sets of 10.

Quadriceps isometrics:Quadriceps isometrics: Sitting on the Sitting on the floor with your injured leg straight and your floor with your injured leg straight and your other leg bent, press the back of your knee other leg bent, press the back of your knee into the floor by tightening the muscles on into the floor by tightening the muscles on the top of your thigh. Hold this position 10 the top of your thigh. Hold this position 10 seconds. Relax. Do 3 sets of 10. seconds. Relax. Do 3 sets of 10. Straight leg raise:Straight leg raise: Lie on your back with Lie on your back with your legs straight out in front of you. your legs straight out in front of you. Tighten up the top of your thigh muscle on Tighten up the top of your thigh muscle on the injured leg and lift that leg about 8 the injured leg and lift that leg about 8 inches off the floor, keeping the thigh inches off the floor, keeping the thigh muscle tight throughout. Slowly lower your muscle tight throughout. Slowly lower your leg back down to the floor. Do 3 sets of 10. leg back down to the floor. Do 3 sets of 10.

Step-up:Step-up: Stand with the foot of your injured leg on a Stand with the foot of your injured leg on a support (like a block of wood) 3 to 5 inches high. Keep support (like a block of wood) 3 to 5 inches high. Keep your other foot flat on the floor. Shift your weight onto the your other foot flat on the floor. Shift your weight onto the injured leg and straighten the knee as the uninjured leg injured leg and straighten the knee as the uninjured leg comes off the floor. Lower your uninjured leg to the floor comes off the floor. Lower your uninjured leg to the floor slowly. Do 3 sets of 10. slowly. Do 3 sets of 10. Wall squat with a ball:Wall squat with a ball: Stand with your back, shoulders, Stand with your back, shoulders, and head against a wall and look straight ahead. Keep and head against a wall and look straight ahead. Keep your shoulders relaxed and your feet 1 foot away from your shoulders relaxed and your feet 1 foot away from the wall and a shoulder's width apart. Place a rolled up the wall and a shoulder's width apart. Place a rolled up pillow or a soccer-sized ball between your thighs. pillow or a soccer-sized ball between your thighs. Keeping your head against the wall, slowly squat while Keeping your head against the wall, slowly squat while squeezing the pillow or ball at the same time. Squat squeezing the pillow or ball at the same time. Squat down until you are almost in a sitting position. Your down until you are almost in a sitting position. Your thighs will not yet be parallel to the floor. Hold this thighs will not yet be parallel to the floor. Hold this position for 10 seconds and then slowly slide back up the position for 10 seconds and then slowly slide back up the wall. Make sure you keep squeezing the pillow or ball wall. Make sure you keep squeezing the pillow or ball throughout this exercise. Repeat 10 times. Build up to 3 throughout this exercise. Repeat 10 times. Build up to 3 sets of 10. sets of 10.

Knee stabilization:Knee stabilization: Wrap a piece of elastic Wrap a piece of elastic tubing around the ankle of your uninjured leg. tubing around the ankle of your uninjured leg. Tie the tubing to a table or other fixed object. Tie the tubing to a table or other fixed object. Stand on your injured leg facing the table and bend Stand on your injured leg facing the table and bend

your knee slightly, keeping your thigh muscles tight. your knee slightly, keeping your thigh muscles tight. While maintaining this position, move your uninjured While maintaining this position, move your uninjured leg straight back behind you. Do 3 sets of 10. leg straight back behind you. Do 3 sets of 10.

Turn 90° so your injured leg is closest to the table. Turn 90° so your injured leg is closest to the table. Move your uninjured leg away from your body. Do 3 Move your uninjured leg away from your body. Do 3 sets of 10. sets of 10.

Turn 90° again so your back is to the table. Move Turn 90° again so your back is to the table. Move your uninjured leg straight out in front of you. Do 3 your uninjured leg straight out in front of you. Do 3 sets of 10. sets of 10.

Turn your body 90° again so your uninjured leg is Turn your body 90° again so your uninjured leg is closest to the table. Move your uninjured leg across closest to the table. Move your uninjured leg across your body. Do 3 sets of 10. your body. Do 3 sets of 10.

Hold onto a chair if you need help balancing. Hold onto a chair if you need help balancing. This exercise can be made even more This exercise can be made even more challenging by standing on a pillow while you challenging by standing on a pillow while you move your uninjured leg. move your uninjured leg. Resisted knee extension:Resisted knee extension: Make a loop from a Make a loop from a piece of elastic tubing by tying it around the leg piece of elastic tubing by tying it around the leg of a table or other fixed object. Step into the loop of a table or other fixed object. Step into the loop so the tubing is around the back of your injured so the tubing is around the back of your injured leg. Lift your uninjured foot off the ground. Hold leg. Lift your uninjured foot off the ground. Hold onto a chair for balance, if needed. onto a chair for balance, if needed. Bend your knee about 45 degrees. Bend your knee about 45 degrees. Slowly straighten your leg, keeping your thigh muscle Slowly straighten your leg, keeping your thigh muscle

tight as you do this. tight as you do this.

Do this 10 times. Do 3 sets. An easier way to do Do this 10 times. Do 3 sets. An easier way to do this is to perform this exercise while standing on this is to perform this exercise while standing on both legs. both legs.

TAPING (JUMPER'S KNEE) TAPING (JUMPER'S KNEE)

The following guidelines are for The following guidelines are for information purposes only. We information purposes only. We recommend seeking professional advice recommend seeking professional advice before beginning rehabilitation.before beginning rehabilitation.

The aim of this taping is to provide support The aim of this taping is to provide support to the patella tendon or patella ligament to the patella tendon or patella ligament and take some of the stress of the patella and take some of the stress of the patella tendon insertion into the shin bone (tibia).tendon insertion into the shin bone (tibia).

What is required?What is required?3.8 cm (1.5 inch) non stretch white tape or 5 cm 3.8 cm (1.5 inch) non stretch white tape or 5 cm (2 inch) elastic tape. Some athletes may prefer (2 inch) elastic tape. Some athletes may prefer one, some the other depending on amount of one, some the other depending on amount of support required. support required. Step 1Step 1Sit the athlete on the floor or coach with the Sit the athlete on the floor or coach with the knee bent to 90 degrees. knee bent to 90 degrees. A small amount of underwrap may be applied A small amount of underwrap may be applied around the knee for comfort and to stop the tape around the knee for comfort and to stop the tape pinching. Or if the leg is particularly hairy then it pinching. Or if the leg is particularly hairy then it may be best to shave the leg as well where the may be best to shave the leg as well where the tape will be applied. tape will be applied.

. . Step 2Step 2Starting on the outside of the leg Starting on the outside of the leg pass the tape just under the lower pole pass the tape just under the lower pole (bottom) of the patella and around the (bottom) of the patella and around the back of the knee (image 1).back of the knee (image 1).

Step 4Step 4As the tape passes around the As the tape passes around the front of the knee it is twisted to give extra front of the knee it is twisted to give extra support. Continue wrapping the tape support. Continue wrapping the tape around the knee a couple of times.around the knee a couple of times.

Step 5Step 5Apply one third and final wrap Apply one third and final wrap around the knee without twisting the tape around the knee without twisting the tape as it passes under the patella. sas it passes under the patella. s

TREATMENTTREATMENT

Nonsurgical TreatmentNonsurgical Treatment

In some cases of jumper's knee, the In some cases of jumper's knee, the patient may need to stop sports activities patient may need to stop sports activities for a short period. This gets the pain and for a short period. This gets the pain and inflammation under control. Usually inflammation under control. Usually patients don't need to avoid sports for a patients don't need to avoid sports for a long time.long time.

To treat jumper's knee, the doctor may prescribe To treat jumper's knee, the doctor may prescribe anti-inflammatory medicine to help reduce anti-inflammatory medicine to help reduce swelling. A variety of knee straps and sleeves swelling. A variety of knee straps and sleeves are available that may help keep pain to a are available that may help keep pain to a minimum. The doctor may also suggest working minimum. The doctor may also suggest working with a physical therapist.with a physical therapist.Physical therapy treatments might use ice, heat, Physical therapy treatments might use ice, heat, or ultrasound to control inflammation and pain. or ultrasound to control inflammation and pain. As symptoms ease, the physical therapist works As symptoms ease, the physical therapist works on flexibility, strength, and muscle balance in the on flexibility, strength, and muscle balance in the knee. Posture exercises can help improve knee knee. Posture exercises can help improve knee alignment. The therapist may also design special alignment. The therapist may also design special shoe inserts, called shoe inserts, called orthoticsorthotics, to support flat feet , to support flat feet or to correct knock-kneed posture.or to correct knock-kneed posture.

REHABILITATIONREHABILITATION

Nonsurgical RehabilitationNonsurgical RehabilitationIn nonsurgical rehabilitation, the goal is to In nonsurgical rehabilitation, the goal is to reduce pain and inflammation. Nonsurgical reduce pain and inflammation. Nonsurgical treatment can help ease symptoms of treatment can help ease symptoms of jumper's knee. Some doctors have their jumper's knee. Some doctors have their patients work with a physical therapist. patients work with a physical therapist. Treatments such as heat, ice, and Treatments such as heat, ice, and ultrasound may be used to ease pain and ultrasound may be used to ease pain and swelling.swelling.

Therapists also work on the possible causes of Therapists also work on the possible causes of the problem. For example, flexibility exercises the problem. For example, flexibility exercises for the hamstring and quadriceps muscles can for the hamstring and quadriceps muscles can help reduce tension in the patellar tendon where help reduce tension in the patellar tendon where it attaches to the patella. Orthotics are it attaches to the patella. Orthotics are sometimes issued to put the leg and knee in sometimes issued to put the leg and knee in good alignment. Strengthening exercises to good alignment. Strengthening exercises to improve muscle balance can help the kneecap improve muscle balance can help the kneecap to move correctly during activity. Therapists work to move correctly during activity. Therapists work with athletes to help them improve their form and with athletes to help them improve their form and reduce knee strain during their sports. When reduce knee strain during their sports. When symptoms are especially bad, patients may need symptoms are especially bad, patients may need to avoid activities that make their pain worse, to avoid activities that make their pain worse, including sports.including sports.

Therapists work with athletes to help them Therapists work with athletes to help them improve their form and reduce knee strain during improve their form and reduce knee strain during their sports. When symptoms are especially bad, their sports. When symptoms are especially bad, patients may need to avoid activities that make patients may need to avoid activities that make their pain worse, including sports.their pain worse, including sports.

When the problem involves the bone growth When the problem involves the bone growth plate (Sinding-Larsen-Johannson disorder), the plate (Sinding-Larsen-Johannson disorder), the symptoms tend to go away slowly over time. symptoms tend to go away slowly over time. This means nonsurgical rehabilitation probably This means nonsurgical rehabilitation probably won't cure the problem. Treatments can only won't cure the problem. Treatments can only give short-term relief.give short-term relief.

What is the treatment for patellar What is the treatment for patellar tendonitis?tendonitis?

RestRestThe most important first step in treatment is to avoid The most important first step in treatment is to avoid activities that aggravate the problem. Your body is the activities that aggravate the problem. Your body is the best guide to know how much to rest the injured knee--if best guide to know how much to rest the injured knee--if an activity hurts in the area of the injured patellar tendon, an activity hurts in the area of the injured patellar tendon, then you should rest from that activity. then you should rest from that activity. Anti-Inflammatory MedicationsAnti-Inflammatory MedicationsNonsteroidal anti-inflammatory medications (NSAIDs) Nonsteroidal anti-inflammatory medications (NSAIDs) include a long list of possibilities such as Ibuprofen, include a long list of possibilities such as Ibuprofen, Motrin, Naprosyn, Celebrex, and many others. Patellar Motrin, Naprosyn, Celebrex, and many others. Patellar tendonitis treatment can be improved by these tendonitis treatment can be improved by these medications that will decrease pain and swelling. Be sure medications that will decrease pain and swelling. Be sure to talk to your doctor before starting these medications. to talk to your doctor before starting these medications.

StretchingStretchingStretching the quadriceps, hamstring, and calf Stretching the quadriceps, hamstring, and calf muscles prior to activity is very important once muscles prior to activity is very important once you do resume activities. Getting into a good you do resume activities. Getting into a good stretching habit, even once the symptoms stretching habit, even once the symptoms resolve, will help prevent a recurrence of the resolve, will help prevent a recurrence of the problem. problem. Ice TreatmentsIce TreatmentsIcing the area of inflammation is an important Icing the area of inflammation is an important aspect of tendonitis treatment. The ice will help aspect of tendonitis treatment. The ice will help to control the inflammation and decrease to control the inflammation and decrease swelling. By minimizing inflammation and swelling. By minimizing inflammation and swelling, the tendon can return to its usual state swelling, the tendon can return to its usual state and perform its usual function and perform its usual function

Chopat Straps/BracesChopat Straps/BracesOccasionally, your doctor will provide a Occasionally, your doctor will provide a support strap (called an infrapatellar strap support strap (called an infrapatellar strap or a Chopat strap), a knee brace, or or a Chopat strap), a knee brace, or custom orthotics. The benefit of these custom orthotics. The benefit of these measures in the treatment of patellar measures in the treatment of patellar tendonitis is not well known, but some tendonitis is not well known, but some patients find complete relief from using patients find complete relief from using these products. these products.

EXAMINATIONEXAMINATION

            - Perform exam with knee in full extension- Perform exam with knee in full extension      - Bassett Sign:      - Bassett Sign:        - Tenderness to palpation with knee at full extension and         - Tenderness to palpation with knee at full extension and patellar tendon relaxedpatellar tendon relaxed        - Non-tender with knee in flexion and patellar tendon taut        - Non-tender with knee in flexion and patellar tendon taut      - Quadriceps atrophy      - Quadriceps atrophy      - Quadriceps and hamstring tightness      - Quadriceps and hamstring tightness      - Knee effusion is rare      - Knee effusion is rare      - Ligaments usually stable      - Ligaments usually stable      - Various biomechanical derangements may be present on       - Various biomechanical derangements may be present on examexam        - excessive foot pronation;        - excessive foot pronation;        - ie. Malalignment, patellar hypermobility, patella alta/baja,         - ie. Malalignment, patellar hypermobility, patella alta/baja, tibial/femoral rotation, etc.tibial/femoral rotation, etc.        - However, no correlation with jumper’s knee exists for these         - However, no correlation with jumper’s knee exists for these intrinsic factors (Ferretti 1986)intrinsic factors (Ferretti 1986)

TREATMENT OF PATELLA TREATMENT OF PATELLA TENDINOPATHY / PATELLA TENDINOPATHY / PATELLA

TENDONITIS TENDONITIS

Treatment of patellar tendonopathy is slow Treatment of patellar tendonopathy is slow and may require a number of months of and may require a number of months of rehabilitation in order to notice a decrease rehabilitation in order to notice a decrease in aggravating symptoms. This may in aggravating symptoms. This may include several months of rest.  include several months of rest. 

During rehabilitation the VISA During rehabilitation the VISA questionnaire may be filled out to monitor questionnaire may be filled out to monitor the progress of the tendonopathy. the progress of the tendonopathy.

Two modes of treatment may be advised - Two modes of treatment may be advised - conservative treatment and surgical conservative treatment and surgical treatment:treatment:

Conservative (non-surgical) Treatment Conservative (non-surgical) Treatment of patella tendonitis / patella of patella tendonitis / patella tendinopathytendinopathy

This is normally advocated initially after This is normally advocated initially after diagnosis of patellar tendonopathy. Care diagnosis of patellar tendonopathy. Care must be taken so as to not overload the must be taken so as to not overload the tendon. Treatment may involve:tendon. Treatment may involve:

Quadriceps muscle strengthening program: in Quadriceps muscle strengthening program: in particular eccentric strengthening. These particular eccentric strengthening. These exercises involve working the muscles as they exercises involve working the muscles as they are lengthening and are thought to maximise are lengthening and are thought to maximise tendinopathy recovery. tendinopathy recovery. Muscle strengthening of other weight bearing Muscle strengthening of other weight bearing muscle groups, such as the calf muscles, may muscle groups, such as the calf muscles, may decrease the loading on the patellar tendon. decrease the loading on the patellar tendon. Ice packs to reduce pain and inflammation. Ice packs to reduce pain and inflammation. Massage therapy-Transverse (cross) friction Massage therapy-Transverse (cross) friction techniques may be used. techniques may be used. Aprotinin injections may help tendinopathies by Aprotinin injections may help tendinopathies by restoring enzyme balance in the tendon. restoring enzyme balance in the tendon.