Patellar tendonitis: causes, symptoms, diagnosis and treatment

Patellar tendonitis is an injury to the tendon that connects the kneecap to the tibia. The patellar tendon works with the muscles at the front of the thigh to extend the knee so you can kick, run, and jump.

Patellar tendonitis, also known as “jumper’s knee”, is more common in athletes whose sports involve frequent jumping, such as basketball and volleyball. However, people who don’t do jumping sports can get patellar tendonitis.

For most people, treatment for patellar tendonitis begins with physical therapy to stretch and strengthen the muscles around the knee.

Pain is the first symptom of patellar tendonitis, usually between the kneecap and the point where the tendon connects to the tibia (the tibia).

At first, you may only experience knee pain when you start to be physically active or after strenuous exercise. Over time, the pain worsens and begins to interfere with sports. Eventually, the pain interferes with daily movements, such as climbing stairs or getting up from a chair.

For knee pain, try self-care measures first, such as icing the area and temporarily reducing or avoiding activities that trigger your symptoms.

Call your doctor if the pain:

Continues or gets worse Interferes with your ability to perform routine daily activities Associated with joint swelling or redness

A combination of factors can contribute to the development of patellar tendonitis, including:

Physical activity.

Running and jumping are the most common factors associated with patellar tendonitis. A sudden increase in the intensity or frequency with which you perform the activity also increases stress on the tendon, as does changing running shoes.

Stiff muscles in the legs.

Tightness in the thigh (quadriceps) and hamstring muscles, which run up the back of the thighs, can increase stress on the patellar tendon.

Muscle imbalance.

If some leg muscles are much stronger than others, the stronger muscles may pull harder on the patellar tendon. This imbalance could cause tendonitis.

Chronic disease.

Some diseases interrupt blood flow to the knee, which weakens the tendon. For example: kidney failure, autoimmune diseases like lupus or rheumatoid arthritis and metabolic diseases like diabetes.

During the exam, the doctor may press on parts of your knee to determine where it hurts. Pain from patellar tendonitis usually originates from the front of the knee, just below the kneecap.

Your doctor may recommend one or more of the following imaging tests:

X-rays.

X-rays help rule out other bone problems that can cause knee pain.

ultrasound.

This test uses sound waves to create an image of the knee, revealing tears in the patellar tendon.

Magnetic resonance.

MRI uses a magnetic field and radio waves to create detailed images that can reveal subtle changes in the patellar tendon.

Doctors usually start with less invasive treatments before considering other options, such as surgery.

Pain relievers such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) can provide short-term relief from pain caused by patellar tendonitis.

There are several physical therapy techniques that can help reduce the symptoms associated with patellar tendinitis, such as the following:

Stretching exercises.

Regular, steady stretching exercises can decrease muscle spasms and help stretch the muscle-tendon unit. Do not bounce while stretching.

Strengthening exercises.

Weak thigh muscles contribute to stress on the patellar tendon. Exercises that involve lowering the leg very slowly after it is extended are particularly helpful, as are exercises that strengthen all of the leg muscles, such as the leg press.

Patellar tendon strap.

A strap that puts pressure on the patellar tendon can help distribute the force away from the tendon and direct it through the strap. It can help relieve pain.

Iontophoresis.

This therapy involves spreading a corticosteroid medication on the skin and then using a device that delivers a weak electric shock to push the medication through the skin.

If traditional treatments don’t help, your doctor may prescribe other treatments, including:

Injection of corticosteroids.

An ultrasound-guided injection of corticosteroids into the sheath surrounding the patellar tendon may help relieve pain. However, these types of drugs can also weaken tendons, making them more likely to rupture.

Injection of platelet-rich plasma.

This type of injection has been tried in some people with chronic patellar tendon problems. There are ongoing studies. It is hoped that the injections can promote new tissue formation and help heal tendon injuries.

Oscillating needle procedure.

The outpatient procedure is performed under local anesthesia. Your doctor uses ultrasound imaging to guide a small oscillating needle that cuts and removes the damaged area but preserves the healthy tendon. This is a relatively new procedure, but the results are promising.

Surgery.

In rare cases, if other treatments fail, your doctor may suggest surgical debridement of the patellar tendon. Some procedures can be done through small incisions around the knee.