What is the patellar tendon and what is patellar tendonitis?
The patellar tendon is actually a ligament that connects your patella (kneecap) to your tibia (shinbone). The kneecap is in turn connected to your thigh muscles. As your thigh muscles contract, the force generated is transmitted through the kneecap and to the patellar tendon, resulting in knee extension. Patellar tendonitis is an overuse injury and results in inflammation of the patellar tendon. Eventually, micro-tears of the tendon are commonly seen as inflammation worsens. Theoretically, this can lead to a complete Patella Tendon Rupture.
Activities most often associated with patellar tendonitis are those that involve running and jumping. Examples include: basketball, volleyball, track and field, and soccer, and any other sports subject to repetitive forceful loads through the patella. Poor hamstring and quadriceps flexibility is also known to increase the risk of patellar tendonitis. In addition, subtle anatomic differences between individuals can result in increased stress on the kneecap and patellar tendon and predispose certain patients to patellar tendonitis.
Pain over the tendon and lower border of the kneecap is the most common symptom. Pain onset tends to occur gradually during and after activity. However, as inflammation worsens, pain can occur eventually even at rest. Pain and stiffness after prolonged periods of sitting is a particularly common complaint.
X-ray is usually ordered to evaluate the knee joint and further evaluate for other bony pathology. MRI may be ordered to rule out other causes of knee pain.
Nonoperative management is the mainstay of treatment for patellar tendonitis and consists of activity modification, physical therapy, improvement of hamstring and quadriceps flexibility, and anti-inflammatory medications (as long as there are no contraindications with their use). In addition to avoiding activities that cause pain, Dr. Steven Lee recommends avoiding jumping, running, kneeling, resisted knee extensions, deep squats, deep lunges, and deep leg presses (especially where the knee bends greater than 90 degrees). Dr. Lee may also recommend the use of different straps (Chopat Strap) to help decrease the force on the tendon during activity, and if necessary may even recommend knee braces to help limit activity altogether. Use of ice over the area of pain and rest may help with pain after activity. Stopping the offending activities early in the disease course is crucial. Patients who continue to try and exercise through the pain will only make the condition worse and will not only significantly prolong the recovery process, but also increase the chance for requiring surgery.
If appropriate, Platelet-Rich Plasma (PRP) injections (Click here for more information) may be very helpful in healing and remodeling the tendon. Corticosteroid injections are NOT recommended here as the medication can weaken the tendon and increase chance of rupture.
Surgery is rarely required and recommended as a last resort. The most common procedure involves cleaning the patellar tendon of inflamed tissue. If there is an underlying cause of the condition, such as a bony spur or abnormal alignment of the knee cap, surgery may be considered to correct the malalignment.
Those undergoing surgery can expect to be kept in a knee brace for a few weeks following surgery. The brace keeps the knee in full extension and can only be removed to shower. Patients are usually allowed to be fully weight bearing while wearing the brace. Physical therapy is usually started 2-3 weeks after surgery, and is designed to progressively increase knee range of motion and strength. Patients can expect to wean their knee brace over a 6 week period of time as they progress with physical therapy. Full recovery can take up to 4-6 months following surgery, depending on the severity.
Immediate Post-Operative Instructions
Please refer to the following pages for more information:
*It is important to note that all of the information above is not specific to anyone and is subject to change based on many different factors including but not limited to individual patient, diagnosis, and treatment specific variables. It is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopedic advice or assistance should consult Dr. Steven Lee or an orthopedic specialist of your choice.
*Dr. Steven Lee is a board certified orthopedic surgeon and is double fellowship trained in the areas of Hand and Upper Extremity Surgery, and Sports Medicine. He has offices in New York City, Scarsdale, and Westbury Long Island.