Patellar Tendon Facts
The patellar tendon connects the kneecap (the patella) to the shin bone. This is part of the ‘extensor mechanism’ of the knee, and together with the kneecap quadriceps tendon and the quadriceps muscle, these structures enables your knee to straighten out, and provide strength for a kicking motion. The patellar tendon, like other tendons, consists of tough string-like bands. A vascular tissue lining that provides nutrition to the tendon surrounds these bands.
What is Patellar Tendonitis and Tendinosis?
Patellar tendonitis is the condition that occurs when a tendon becomes inflamed and irritated. This condition is most common amongst athletes who do repetitive jumping, hence the reason patellar tendonitis is often called “jumper’s knee”.
Patellar tendinosis is a chronic condition. Instead of the tendon becoming inflamed and irritated, the condition develops gradually, and is characterized by microscopic tears and thickening of the tendon. Patellar tendinosis causes similar symptoms, but the treatment of this condition varies from that of Patella tendonitis.
A partial patellar tendon tear is usually a characteristic of chronic patellar tendinosis. These tears are differentiated from a complete patellar tendon tear where the entire tendon is detached and requires surgical repair.
What are the Symptoms of Patellar Tendon?
Patellar tendonitis and tendinosis usually cause pain directly over the patellar tendon. The tendon is usually tender and swollen. Movement of the knee may cause a crunching sensation called crepitus directly over the swollen tendon. The other common symptom of patellar tendon problems is pain during activities, especially jumping or kneeling.
X-ray tests are performed to ensure that there is no problem with the bones around the knee. At times, a calcium deposit may be detected, particularly in patients with a more chronic patellar tendinosis. An MRI may be helpful to look for symptoms of inflammation or partial tears within the tendon.
What are the Treatment for Patellar Tendon?
Treatment should be initiated once your doctor confirms a proper diagnosis. If the diagnosis points to an acute inflammation, treatment may include:
The most important first step in treatment is to avoid activities that aggravate the problem. Your body is the best guide to know how much rest is needed. If an activity causes hurt to the area of the injured patellar tendon, then you should refrain yourself from participating in that activity.
Nonsteroidal anti-inflammatory medications (NSAIDs) include a long list of possibilities such as Ibuprofen, Motrin, Naprosyn, Celebrex, and many others. Patellar tendonitis treatment can be assisted by these medications, which will decrease pain and swelling. Your doctor will advise you accordingly before prescribing you these medications.
Proper stretching of the quadriceps, hamstring, and calf muscles prior to any sporting activities is very important once you recover. Getting into a good stretching habit, even once the symptoms resolve, will help prevent a recurrence of the problem.
Icing the area of inflammation is a key aspect of tendonitis treatment. The ice will help to control the inflammation and decrease the swelling. By minimizing the inflammation and swelling, the tendon will be able to return to its usual state and perform normally.
Occasionally, your doctor will provide a support strap (called an infrapatellar strap or a Chopat strap), a knee brace, or custom orthotics. The benefit of these measures in the treatment of patellar tendonitis is not well known, but some patients find complete relief from using these products.
When the condition is chronic, treatment of inflammation is less likely to be helpful, therefore the focus of treatment for patellar tendinosis is with regular therapy sessions. The most helpful therapeutic exercises for treatment of tendinosis are eccentric strengthening exercises.
Some surgeons are also encouraging a treatment called PRP injections for treatment of patellar tendonitis and tendinosis. These injections help to stimulate a healing reaction in the body, although scientific evidence has yet to strongly support the use of this experimental treatment.
Is surgery ever needed for patellar tendonitis?
On some occasions, patients have persistent patellar tendonitis symptoms despite the treatments mentioned above. In these patients with chronic patellar pain, who have tried the above treatments for extended durations, surgery can be considered. Surgery is usually considered if damaged tendon is seen on the MRI. During surgery, this damaged tendon will be removed.