Patellar Tendonitis

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Also Known As

Jumpers Knee, Runners Knee or Sindling-Larsen Disease in adults and adolescence

Mechanism of Injury

Repetitive overloading of the Quadriceps mechanism and Patellar tendon during jumping and to a lesser extent running. The greater the overloading the worse the condition.

Sports

Jumping Sports: High Jump, Long Jump, Basketball, Volleyball

Other Sports: Running, Football, Rugby, Weightlifting and Exercise Classes such as Step Aerobics

Incidence

• 15-30 years old
• More common in males
• Increases directly with amount of activity. An individual who plays activity 5 times a week is more likely to suffer than an individual who plays twice a week. Also aspects like poorly supporting footwear and playing on hard surfaces has to be taken into consideration.

Sites

There are three usual sites:

• Lower pole of the Patella (Knee Cap)
• Upper pole of the Patella
• Tibial Tuberosity

Pathology

• In Juveniles 10-14 years old – avulsion fractures of the lower pole of the patella occurs (Sindling Larsen’s Disease)
• In Adults micro-tears of the Patella Tendon
• Secondary inflammation occurs
• Calcification and ossification may occur
• Hyper mobility and abnormal patellar tracking may be predisposing factors
• With continued loading a total rupture may occur. This is more common in the older athlete

Symptoms

Pain is graded in four ways to determine the severity of the problem:

• Grade 1 – After activity
• Grade 2 – At the beginning of activity which then fades after warming up
• Grade 3 – Throughout activity
• Grade 4 – All the time

Signs

• Tenderness on palpation of the patella tendon
• Localised swelling of the Inferior Pole of Patella, Mid Tendon or Tibial Tubercle
• Pain on squatting, kneeling, resisted knee extension

Investigations

The following investigations will be useful to determine the diagnosis

• MRI
• X-ray (to check for calcification)
• Ultrasound to look at the tendon in real time

Complications

As previously stated the major complication can be a ruptured patellar tendon

Treatment

Conservative

• Rest from aggravating activity – total or relative
• Ice
• NSAIDS (Non Steroidal Anti-inflammatory Drugs – Ibuprofen up to Voltarol)
• Stretching to quadriceps, hip flexors, hamstrings, calf muscles
• Patellar bracing – Infrapatellar strap
• Deep Frictions
• Ultrasound
• Quadriceps strengthening exercises (without pain)
• Steroid injections around Patellar Tendon

Surgery

Is only really contemplated if conservative treatment fails or the tendon fully ruptures.