Header: Patellar Tendinitis (Jumper

Patellar Tendinitis (Jumper's Knee)

Landing in a jump creates extreme forces in the knee joint. Absorbing these forces can, however, lead to injuries and of the knee joint. If, for example, it comes to chronic pain due to congestion at the inferior pole of the patella, the result is a patellar tendonitis or jumper's knee. This is a chronic, painful, degenerative disease of the tendon and the bone junction at the lower patellar tip. The disease is particularly common in athletes that participate in disciplines involving repeated and excessive jumping such as volleyball, basketball, long jump, high jump, etc.

What is a patellar tendonitis (tendinopathy) / jumper's knee?

The patellar jumper's knee is a condition caused by overloading the patellar tendon through repetitive, unusual and / or severe stressing of the tendons at the junction of tendon and bone located at the lower end of the knee cap, the patella. Athletes who are involved in jumping sports such as volleyball, basketball, long jump or high jump, are particularly susceptible for patellar tendinitis / jumper's knee. The frequency and intensity of the exercise but also the training condition (unusual stress, new sport, beginners) play an important role in developing jumper's knee / patellar tendonitis syndrome.

Other factors in developing the condition patellar tendonitis can be:

  • patient's age (most patients over the age of 15)
  • the kneecap is position higher than normal (patella alta),
  • growth disorders of the patella tendon or (Sinding Larsen's disease or Osgood-Schlatter disease)
  • shortened, hardened leg muscles
  • as well as a congenital ligament weakness (ligament laxity)

What are the symptoms of a patellar tendinitis / jumper's knee ?

Patients with patellar tendinitis / jumper's knee report a load-dependent pain in the knee cap tip. Depending on the stage of the disease, pain may be present at the beginning of exercise and disappear after warm-up, while the pain is present again after the stress phase. In advanced stages, the pain remains during the entire load. In very advanced cases, the patellar hurts not only in sporting activities but also permanently in everyday life, such as when climbing stairs. Typical is the persistent nature of the condition. Often it is a chronic condition, lasting for many months or years with asymptomatic poor phases, but recurrent symptoms after peak loads.
How is a patellar tendinitis / jumper's knee diagnosed?

The medical history (anamnesis) of patients who are involved with excessive jumping, such as sports, is pioneering. On physical examination, usually tenderness in the lower patellar tip is observed. Also typical is a painful stretching motion of the leg against resistance. If patellar tendonitis / jumper's knee is suspected, usually sonography (ultrasound) and a magnetic resonance imaging (MRI) are helpful to achieve an accurate diagnosis and thereby to assess the extent of the disease.

How is a patellar tendinitis / jumper's knee treated?

As with all overuse injuries, prevention is the best treatment. Among the most important preventive measures to avoid the jumper's knee / patellar tendonitis are:

  • good muscle stretching habits
  • warm-up before physical activity
  • slowly increasing the intensity level of loading or exercise activities
  • adequate regeneration
  • if necessary, shock absorbing sports inserts

When symptoms are felt, the load must be drastically reduced and a conservative treatment initiated. Stress reduction means in practice that no jumping and running should take place as long as the problems are present. Cycling, cross training and/or aqua jogging are alternative activities that may be performed. As soon as the knee is again free of symptoms, weight-bearing exercise must be performed cautiously and for short periods. To support the healing process, an intense stretching of the thigh muscles (preferably several times a day for a few minutes) is recommended.

Conservative therapy for patellar tendinitis / jumper's knee

The primary goal of a conservative therapy is to allow the irritated tendon to heal naturally. Aside from a relieving the leg of any strain, an intense stretching of the thigh muscles (preferably several times a day for a few minutes) is recommended to support the healing process.

In addition, measures that promote the metabolism, i.e. the local circulation at the tendon insert are very effective (e.g. rubbing with ice for about 10 minute, 1-2 times daily).

As additional treatment measures for acute patellar tendon syndrome / jumper's knee, aside from taking a break from sport activities and the self-medication, targeted physiotherapeutic and physical treatments are necessary. These include:

  • cold packs/ hot packs
  • electrical stimulation (iontophoresis, TENS, etc.)
  • ultrasound
  • massage (friction massage)
  • physiotherapy / manual therapy
  • shock wave therapy

The various therapies can also be combined. The aim of the therapy, is the regeneration of the tendon insertion by local metabolic activation (blood flow). In addition the therapy aims at loosening/relaxing of the tension in the tendon of the thigh muscles.

Promising is also the temporary use of anti-inflammatory ointment or drugs (NSAIDs) such as ibuprofen or diclofenac or homeopathic substances.
Additionally, the infiltration (encapsulation) of the peritendineum with homeopathic substances (castor oil, etc.) can reduce the pain and inflammation. The use of corticosteroids must be critically evaluated. More than a maximum of three cortisone injections in the Parthenon distributed over several weeks interval are not recommended since frequent cortisone applications reduce the regenerative capacity of the tendon tissue. The cortisone infiltration into the tendon tissue itself leads to a tendon death (necrosis), and might even cause permanent damage, even a rupture of the patellar tendon.

Surgical treatment of a patellar tendinitis / jumper's knee diagnosed?

In a number of patients (statistically about 10%) symptoms and pain are not relieved in spite of prolonged breaks from physical activities and intensive conservative treatment, and thus they can no longer participate in sports. In these cases, the surgical treatment of the patellar tendinitis / jumper's knee, may be the only option left. Treatment may consist of single procedure or a combination of different surgical procedures such as:

  • removal of the peritendineum
  • denervation of the tendon area
  • loosening the tendon at the patella tendon tip
  • removal of the degenerative area
  • tendon incision in the longitudinal direction of the fibers
  • Freshening of the lower end of the patella.

Which of the procedures are the most successful, depends on the extent of tendon change. Indispensable for the assessment is a magnetic resonance imaging (MRI). For changes of the tendon at the tendon insertion, an arthroscopy with a partial detachment of the tendon and removal of the degenerative area is recommended. For greave or long-term tendon damage, as well as partial tendon degeneration, open surgery is unavoidable.

Post operative treatment and prognosis for a patellar tendinitis / jumper's knee diagnosed

Post operative treatment must be individualized, depending on the actual tendon damage and the type of surgery performed. General guidelines are

  • relieving strain – walking on crutches for 3 - 5 days
  • mild physical therapy for about 2-6 weeks, then increasing activities in terms of coordination and strength exercises
  • exercising on bicycle ergometer after about 2 - 6 weeks
  • slow running training, slowly increasing speed after 4 - 8 weeks
  • strength training after 4-8 weeks
  • jump training after 6 weeks to 4 months
  • ability to fully participate in sports again after 2 to 6 months

The success rate after surgical treatment is according to the literature 70-90% good and very good results.

Experts: patellar tendonitis (tendinopathy) / jumper's knee / knee joint

For an optimal treatment of patellar tendonitis, the knee experts at the Klinik am Ring are particularly well-qualified. Stefan Preis, M.D. and Jörg Schroeder, M.D., senior physicians at the Practice and Department of Orthopedics and Sports Traumatology at the Klinik am Ring in Cologne, specialize together with their team in the treatment of knee and shoulder disorders. In 2004, they founded the WEST GERMAN SHOULDER KNEE & CENTER, Cologne. The team consisting of eight specialists, treats more than 10,000 patients per year. The team performs more than 2500 surgeries per year of which about 1200 are arthroscopic surgeries of knee joints.

Stretching thigh muscles (M. quadriceps)

 

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