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Patellar Tendonopathy

Definition

The patellar tendon connects the kneecap to the lower leg bone. Tendonopathy is an injury to the tendon. It can cause pain, swelling, and limited movement. The injury can include:

  • Tendonitis—inflammation of the tendon
  • Tendonosis—tiny tears in the tendon tissue with no significant inflammation

Treatment depends on the severity of the injury.

Patellar Tendonitis
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Causes

Tendonopathy is generally caused by overuse of a muscle-tendon unit. Over time, the strain on the tendon causes structural changes within the tendon.

Patellar tendonopathy occurs from overuse of the patellar tendon. Overuse may be caused by any activity that requires:

  • Intense running
  • Jumping
  • Frequent stops and starts
  • Frequent impact to the knee
  • Falls
  • Tendon weakness from certain diseases

Risk Factors

Physically active teenagers and young adults are at higher risk. Factors that increase your chance of developing patellar tendonopathy include:

  • An increase in the frequency of training
  • A sudden increase in the intensity of training
  • Changing from one sport to another
  • Training on a hard surface
  • Repeated improper movements while training
  • Muscle weakness or imbalance
  • Involvement in basketball, soccer, volleyball, or running

Symptoms

Symptoms may include:

  • Pain and tenderness in the patellar tendon below the kneecap
  • Pain or tightness in the knee when bending, squatting, or straightening the leg
  • Discomfort in the knee when jumping, squating, or walking up stairs

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done.

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Treatment

Talk with your doctor about the best treatment plan for you. Treatment will depend on the severity of the injury. Options include:

Supportive Care

Your knee will need time to heal. RICE is often the main part of treatment:

  • Rest—Activities will need to be restricted at first to reduce shock or vibrations to the knee. Normal activities will be gradually introduced as the injury heals.
  • Ice—Ice therapy may help relieve swelling.
  • Compression—Compression bandages can provide gentle pressure to help move fluids out of the area.
  • Elevation—Keeping the affected area elevated can help fluids drain out or prevent fluids from building up.

A strap called a counterforce brace may be advised to help support the tendon and reduce pain.

Over-the-counter or prescription medications may be advised to reduce pain. Cortisone injections may also be used if other treatments to do not reduce inflammation.

Physical Therapy

A physical therapist will assess the knee. An exercise program will be created to help recovery and to strengthen the muscle.

Surgery

You may need surgery if you have advanced damage to the tendon. Your doctor may also recommend surgery if you have not responded to other treatment methods over a period of several months.

Prevention

To reduce your chances of getting patellar tendonopathy, take these steps:

  • Avoid activities and sports that repeatedly stress the kneecaps, especially those that involve jumping.
  • Perform quadriceps muscle stretching and strengthening exercises.
  • Increase the frequency and intensity of your exercises gradually.
  • Learn proper techniques for sports.

Revision Information

  • The American Orthopaedic Society for Sports Medicine

    http://www.sportsmed.org

  • OrthoInfo—American Academy of Orthopaedic Surgeons Ortho Info

    http://www.orthoinfo.org

  • Canadian Orthopaedic Association

    http://www.coa-aco.org

  • Canadian Orthopaedic Foundation

    http://www.canorth.org

  • Aronen JG, Garrick JG. Sports-induced inflammation in the lower extremities. Hosp Pract. 1999;34:51.

  • Bursitis and tendinitis. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/Health%5FInfo/Bursitis/default.asp#3%5F3. Updated June 2013. Accessed March 9, 2015.

  • O'Connor FG, Howard TM, Fieseler CM, Nirschl RP. Managing overuse injuries: a systematic approach. Phys Sportsmed. 1997 May;25(5).

  • Patellar tendinopathy. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated July 18, 2014. Accessed March 9, 2015.

  • Patellar tendon knee tear. American Academy of Orthopaedic Surgeons Ortho Info website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00512. Updated August 2009. Accessed March 9, 2015.

  • Post WR. Patellofemoral pain: let the physical exam define treatment. Phys Sportsmed.1998;26(1).

  • Steunebrink M, Zwerver J, Brandsema R, Groenenboom P, Akker-Scheek Iv, Weir A. Topical glyceryl trinitrate treatment of chronic patellar tendinopathy: a randomised, double-blind, placebo-controlled clinical trial. Br J Sports Med. 2013 Jan;47(1):34-9.

  • 10/26/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Massey T, Derry S, Moore R, McQuay H. Topical NSAIDs for acute pain in adults. Cochrane Database Syst Rev. 2010;(6):CD007402.