Patellar Tendinitis

PATELLA ANATOMY

DISEASE EXPLAINED

SYMPTOMS

Pain is the first symptom of patellar tendinitis, usually between your kneecap and where the tendon attaches to your shinbone (tibia).

Initially, you may only feel pain in your knee as you begin physical activity or just after an intense workout. Over time, the pain worsens and starts to interfere with playing your sport. Eventually, the pain interferes with daily movements such as climbing stairs or rising from a chair.

CAUSES

Patellar tendinitis is a common overuse injury, caused by repeated stress on your patellar tendon. The stress results in tiny tears in the tendon, which your body attempts to repair.

But as the tears in the tendon multiply, they cause pain from inflammation and weakening of the tendon. When this tendon damage persists for more than a few weeks, it’s called tendinopathy.

A combination of factors may contribute to the development of patellar tendinitis, including:

PHYSICAL ACTIVITY.
Running and jumping are most commonly associated with patellar tendinitis. Sudden increases in how hard or how often you engage in the activity also add stress to the tendon, as can changing your running shoes.

TIGHT LEG MUSCLES.
Tight thigh muscles (quadriceps) and hamstrings, which run up the back of your thighs, can increase strain on your patellar tendon.

MUSCULAR IMBALANCE.
If some muscles in your legs are much stronger than others, the stronger muscles could pull harder on your patellar tendon. This uneven pull could cause tendinitis.

CHRONIC ILLNESS.
Some illnesses disrupt blood flow to the knee, which weakens the tendon. Examples include kidney failure, autoimmune diseases such as lupus or rheumatoid arthritis and metabolic diseases such as diabetes.

TREATMENT

TREATMENT OPTIONS

Doctors typically begin with less invasive treatments before considering other options, such as surgery.

MEDICATIONS
Pain relievers such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others) may provide short-term relief from pain associated with patellar tendinitis.

THERAPY
A variety of physical therapy techniques can help reduce the symptoms associated with patellar tendinitis, including:

STRETCHING EXERCISES.
Regular, steady stretching exercises can reduce muscle spasm and help lengthen the muscle-tendon unit. Don’t bounce during your stretch.

STRENGTHENING EXERCISES.
Weak thigh muscles contribute to the strain on your patellar tendon. Exercises that involve lowering your leg very slowly after extending it can be particularly helpful, as can exercises that strengthen all of the leg muscles in combination, such as a leg press.

PATELLAR TENDON STRAP.
A strap that applies pressure to your patellar tendon can help to distribute force away from the tendon and direct it through the strap instead. This may help relieve pain.
Iontophoresis. This therapy involves spreading a corticosteroid medicine on your skin and then using a device that delivers a low electrical charge to push the medication through your skin.

If conservative treatments don’t help, your doctor may suggest other therapies, such as:

CORTICOSTEROID INJECTION.
An ultrasound-guided corticosteroid injection into the sheath around the patellar tendon may help relieve pain. But these types of drugs can also weaken tendons and make them more likely to rupture.

PLATELET-RICH PLASMA INJECTION.
This type of injection has been tried in some people with chronic patellar tendon problems. Studies are ongoing. It is hoped the injections might promote new tissue formation and help heal tendon damage.

OSCILLATING NEEDLE PROCEDURE.
This outpatient procedure is performed using local anesthesia. Your doctor uses ultrasound imaging to guide a small oscillating needle that cuts away the damaged area while sparing healthy tendon. This is a relatively new procedure, but results have shown promise.

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