Patellar Tendinitis

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Patellar Tendinitis

• Brianne Peterson

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Background

• Also known as Jumpers or Kickers Knee
• Inflammation of the tendon that connects the
  patella to the tibial tuberosity
• Helps mainly with knee extension

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Possible Factors Contributing to Injury

• Pt. will probably not remember an exact MOI
  because it is a subtle onset
• Main MOI
• repetitive jumping, cutting, or kicking
• rapid acceleration/deceleration
• Other factors that increase the risk of injury
• increase in training frequency intensity
• muscular imbalance
• leg misalignment
• foot problems (i.e. hindfoot valgus)

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Signs and Symptoms

• Pain and tenderness of inferior patella, midway
  down tendon, or near insertion onto tibia
• Slight swelling over the tendon
• Discomfort when jumping or walking/running on
  incline
• Pain is a dull ache or nagging discomfort
• In early cases, pain will not be constant and
  will not start until after exercise has stopped

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Palpation

• Tendon must be palpated the entire length
• Feel for
• swelling over tendon
• possible crepitus during movement
• point tenderness on the inferior
  patellar pole
• divots or indents which may indicate a
  more serious condition

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ROM Strength Testing

• Test knee flexion and extension for all types of
  range of motion
• AROM
• pain during knee extension
• PROM
• pain during end range of knee flexion
• RROM
• pain throughout knee extension

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ROM/ Strength Cont.

• ROM and Strength are apparent, but are decreased
  due to pain
• Knee extension pain is caused by the contraction
  of the quads. pulling on the patella therefore
  elongating the tendon
• Knee flexion pain is caused by the forced
  stretching out of the tendon

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Functional Testing

• No special tests
• Can use functional tests (ROM, strength, etc.) in
  order to grade the severity
• Grading System
• I. Pain only after exercise ceases
• II. Discomfort during exercise with pain
  after
• exercise ceases
• III. Pain during and after exercise that
• interferes with normal participation
• IV. Rupture of tendon

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Management Options

• Ice
• Rest
• NSAIDS
• Ultrasound
• Electrical stimulation
• Recondition quads and hamstrings
• Patellar tendon taping
• Patellar tendon strap
• Transverse friction massage

Above One of many options for a patellar
tendon strap Below What a patellar tendon
taping looks like
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Management Cont.

• More invasive measures include
• Surgery to remove chronic problem area so
  scar
• tissue may form
• Cortisone injections to reduce
• inflammation
• These treatments are used only when the condition
  is chronic for months at a time

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Exercises

• Always stretch before exercise!
• Straight leg raises (later add increasing weight)
• sit with injured leg
• out straight
• lift leg straight off ground
• 5-6 inches, hold, and
• slowly bring back down to
• floor
• Step ups
• Wall sits w/ ball

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A Few Side Notes

• Other knee problems can present themselves very
  similarly to patellar tendinitis (i.e.
  Larsen-Johansson disease, fat pad inflammation,
  and Osgood-Schlatter disease) so be aware of the
  differential diagnoses.
• Patellar tendinitis has a slow rehab process and
  may take weeks to months to get better.
• Patellar tendinitis is a main precursor for a
  patellar tendon rupture and must be treated
  appropriately or a rupture is likely to occur.

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Works Cited

1. Nicholas JA, Hershman EB, eds. Patellar
   tendinitis. The Lower Extremity and Spine in
   Sports Medicine. Vol 1. second ed. St. Luis
   Mosby-Year Book, Inc. 1995 920-924.
2. Prentice WE. Arnheims Principles of Athletic
   Training. New York McGraw-Hill 2006645.
3. Patellar Tendinitis. Mayo Clinics website. 2006.
   Available at http//www.mayoclinic.com/health/pat
   ellar-tendinitis/DS00625/DSECTION5. Accessed
   February 22, 2007.
4. Badash M. Patellar Tendinitis. Brigham and
   Womens Hospitals website. 2006. Available at
   http//healthgate.partners.org/browsing/browseCont
   ent.asp?fileName11630.xmltitlePatellar20Tendin
   itis. Accessed February 22, 2007.
5. White T. Patellar Tendonitis (Jumper's Knee)
   Rehabilitation Exercises. University of
   Michigans Health Systems website. 2005.
   Available at http//www.med.umich.edu/1libr/sma/s
   ma_jumpersk_rex.htm. Accessed February 22, 2007.