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Updated: Aug 13 2021

Patellar Tendinitis

Images image.jpg ultrasound.jpg
  • Summary
    • Patellar tendinitis is tendinopathy of the patellar tendon associated with activity-related anterior knee pain.
    • Diagnosis is primarily made clinically with tenderness to palpation at the distal pole of patella in full extension.
    • Treatment is generally nonoperative with resting, ice, activity modifications and physical therapy to focus on hamstring, quadriceps and core strengthening. 
  • Epidemiology
    • Incidence
      • up to 20% of jumping athletes
    • Demographics 
      • males > females
    • Risk factors
      • volleyball most common
      • more common in adolescents/young adults
        • quadriceps tendinopathy is more common in older adults
      • poor quadriceps and hamstring flexibility
  • Etiology
    • Pathophysiology
      • mechanism
        • repetitive, forceful, eccentric contraction of the extensor mechanism
      • histology
        • degenerative, rather than inflammatory
        • micro-tears of the tendinous tissue are commonly seen
  • Classification
    • Blazina classification system
      • Blazina classification system
      • Phase I
      • Pain after activity only
      • Phase II
      • Pain during and after activity
      • Phase III
      • Persistent pain with or without activities (deterioration of performance)
  • Presentation
    • Symptoms
      • insidious onset of anterior knee pain at inferior border of patella
        • initial phase
          • pain following activity
        • late phase
          • pain during activity
          • pain with prolonged flexion ("movie theater sign")
    • Physical exam
      • inspection
        • may have swelling over tendon
      • palpation
        • tenderness at inferior border of patella
      • provocative tests
        • Basset's sign
          • tenderness to palpation at distal pole of patella in full extension
          • no tenderness to palpation at distal pole of patella in full flexion
  • Imaging
    • Radiographs
      • recommended views
        • AP, lateral, skyline views of knee
      • findings
        • usually normal
        • may show inferior traction spur (enthesophyte) in chronic cases
    • Ultrasound
      • findings
        • thickening of tendon
        • hypoechoic areas
    • MRI
      • indications
        • chronic cases
        • surgical planning
      • findings
        • tendon thickening
          • more diagnostic than presence of edema
        • increased signal intensity on both T1 and T2 images
        • loss of the posterior border of fat pad in chronic cases
  • Treatment
    • Nonoperative
      • ice, rest, activity modification, followed by physical therapy
        • indications
          • most cases
        • technique
          • physical therapy
            • stretching of quadriceps and hamstrings
            • eccentric exercise program
          • ultrasound treatment may be helpful
          • taping or Chopat's strap can be used to reduce tension across patellar tendon
      • cortisone injections
        • are contraindicated due to risk of patellar tendon rupture
    • Operative
      • surgical excision and suture repair as needed
        • indications
          • Blazina Stage III disease
          • chronic pain and dysfunction not amendable to conservative treatment
          • partial tears
        • technique
          • can be done open or arthroscopic
          • resect angiofibroblastic and mucoid degenerative area
          • follow with bone abrasion at tendon insertion and suture repair/anchors as needed
        • postoperative rehab
          • initial immobilization in extension
          • progressive range-of-motion and mobilization exercises as tolerated
          • weight bearing as tolerated
        • outcomes
          • return to activities is achieved by 80% to 90% of athletes
          • there may be activity-related aching for 4 to 6 months after surgery
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