|Other names: Quadriceps tendinopathy, patellar tendinopathy, jumper's knee, patellar tendinosis, patellar tendinitis|
|Location of the pain in patellar tendinitis|
|Specialty||Orthopedics, sports medicine|
|Symptoms||Pain at the front of the knee|
|Complications||Patellar tendon rupture|
|Risk factors||Jumping sports, being overweight|
|Diagnostic method||Based on symptoms and examination|
|Differential diagnosis||Chondromalacia patella, Osgood-Schlatter disease, patellofemoral syndrome, infrapatellar bursitis|
|Treatment||Rest, physical therapy|
|Prognosis||Recovery can be slow|
|Frequency||14% of athletes|
Patellar tendinitis, also known as jumper's knee, is an overuse injury of the tendon that straightens the knee. Symptoms include pain in the front of the knee. Typically the pain and tenderness is at the lower part of the kneecap, though the upper part may also be affected. Generally there is not pain when the person is at rest. Complications may include patellar tendon rupture.
Risk factors include being involved in athletics and being overweight. It is particularly common in athletes who are involved in jumping sports such as basketball and volleyball. The underlying mechanism involves small tears in the tendon connecting the kneecap with the shinbone. Diagnosis is generally based on symptoms and examination. Other conditions that can appear similar include infrapatellar bursitis, chondromalacia patella and patellofemoral syndrome.
Treatment often involves resting the knee and physical therapy. Evidence for treatments, including rest, however is poor. Recovery can take a year. It is relatively common with about 14% of athletes currently affected. Males are more commonly affected than females. The term "jumper's knee" was coined in 1973.
Signs and symptoms
People report anterior knee pain, often with an aching quality. The symptom onset is insidious. Rarely is a discrete injury described. Usually, the problem is below the kneecap but it may also be above. Jumper's knee can be classified into 1 of 4 stages, as follows:
- Stage 1 – Pain only after activity, without functional impairment
- Stage 2 – Pain during and after activity, although the person is still able to perform satisfactorily in his or her sport
- Stage 3 – Prolonged pain during and after activity, with increasing difficulty in performing at a satisfactory level
- Stage 4 – Complete tendon tear requiring surgical repair
Among the risk factors for patellar tendonitis are low ankle dorsiflexion, weak gluteal muscles, and muscle tightness, particularly in the calves, quadriceps muscle, and hamstrings.It may be associated with stiff ankle movement and ankle sprains.
Diagnosis is generally based on symptoms and a physical examination. Ultrasound or magnetic resonance imaging may help clarify how severe the problem is. Magnetic resonance imaging can reveal edema (increased T2 signal intensity) in the proximal aspect of the patellar tendon.
Evidence for treatment is poor. In the early stages rest, ice, compression, and elevation may be tried. Tentative evidence supports exercises involving eccentric muscle contractions of the quadriceps on a decline board. Specific exercises and stretches to strengthen the muscles and tendons may be recommended, eg. cycling or swimming. Use of a strap for jumper's knee and suspension inlays for shoes may also reduce the problems. Corticosteroid injections and NSAIDs are not generally recommended.
Surgery may be tried if other measures fail. This is reserved for people with severe pain for months despite conservative measures. Knee operations in most cases have no better effects than exercise programs, however in refractory cases they do produce a better prognosis
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