Patellar Tendinitis

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management | References

Definition

Patellar tendinitis, also known as jumper's knee, is an overuse injury affecting the patellar tendon, which connects the kneecap (patella) to the shinbone (tibia). It is characterised by inflammation and degeneration of the tendon, leading to pain and impaired function.

Aetiology

Patellar tendinitis is caused by repetitive stress and overuse of the patellar tendon. Key aetiological factors include:

• Frequent participation in sports involving jumping, such as basketball, volleyball, and athletics
• Sudden increases in physical activity or intensity
• Improper training techniques or equipment
• Muscle imbalances or weakness, particularly in the quadriceps and hamstrings
• Reduced flexibility in the quadriceps and hamstrings

Pathophysiology

The pathophysiology of patellar tendinitis involves:

• Microtears in the patellar tendon due to repetitive stress
• Inflammation and degeneration of the tendon fibres
• Thickening and scarring of the tendon over time
• Potential for partial or complete tendon rupture in severe cases

Risk Factors

• Participation in high-impact sports
• Sudden increases in physical activity or intensity
• Inadequate warm-up or stretching before exercise
• Muscle imbalances or weakness
• Poor biomechanics or improper training techniques
• Previous history of knee injuries

Signs and Symptoms

The signs and symptoms of patellar tendinitis include:

• Pain and tenderness at the bottom of the patella
• Swelling and inflammation around the tendon
• Pain that worsens with physical activity, particularly jumping and running
• Stiffness and discomfort after periods of inactivity
• Weakness in the affected leg

Investigations

Specific investigations to diagnose patellar tendinitis include:

• Clinical examination: Physical assessment of pain, swelling, and tenderness over the patellar tendon.
• Imaging studies:
  • Ultrasound: To assess tendon thickness, inflammation, and tears.
  • MRI: To provide detailed images of the patellar tendon and surrounding structures.

Management

Primary Care Management

• Rest and activity modification: Reducing or avoiding activities that exacerbate symptoms.
• Pain management: Analgesics such as paracetamol or NSAIDs to relieve pain and inflammation.
• Ice application: Applying ice packs to the affected area to reduce swelling and pain.
• Stretching and strengthening exercises: Focused on the quadriceps and hamstrings to support knee function.
• Patellar tendon straps or knee braces: To reduce strain on the tendon during physical activity.

Specialist Management

• Physiotherapy: Referral to a physiotherapist for tailored exercise programmes and management strategies.
• Corticosteroid injections: May be administered for severe inflammation not responsive to conservative measures.
• Platelet-rich plasma (PRP) therapy: Experimental treatment to promote healing in chronic cases.
• Surgical intervention: In rare cases, surgery may be required to remove damaged tissue and stimulate healing.

References

1. NHS (2024) Patellar Tendinitis. Available at: https://www.nhs.uk/conditions/patellar-tendinitis/ (Accessed: 24 June 2024).
2. National Institute for Health and Care Excellence (2024) Patellar Tendinopathy. Available at: https://cks.nice.org.uk/topics/patellar-tendinopathy/ (Accessed: 24 June 2024).
3. British Medical Journal (2024) Patellar Tendinitis: clinical features, diagnosis, and management. Available at: https://www.bmj.com/content/350/bmj.h2548 (Accessed: 24 June 2024).
4. American Academy of Orthopaedic Surgeons (2024) Patellar Tendinitis (Jumper's Knee). Available at: https://orthoinfo.aaos.org/en/diseases--conditions/patellar-tendinitis-jumpers-knee/ (Accessed: 24 June 2024).

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