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
QUESTIONS 1 of 5 1 2 3 4 5 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK This is an AAOS Self Assessment Exam (SAE) question. Orthobullets was not involved in the editorial process and does not have the ability to alter the question. If you prefer to hide SAE questions, simply turn them off in your Learning Goals. (SAE07SM.39) A 17-year-old basketball player and pole vaulter who has had anterior knee pain for the past 18 months now reports a recent inability to jump. Based on the MRI scan shown in Figure 11, management should consist of QID: 8701 FIGURES: A Type & Select Correct Answer 1 debridement and repair. 74% (400/541) 2 cast immobilization. 9% (49/541) 3 aggressive overload eccentric strengthening. 10% (52/541) 4 ice massage and continued athletic participation. 5% (28/541) 5 steroid injection. 1% (7/541) L 2 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept (SBQ07SM.39) A 20-year-old football player with a two year history of anterior knee pain presents for re-evaluation. Over the last two years he has been treated conservatively with quadriceps stretching, eccentric strengthening, and activity modification with no improvement. An MRI is obtained, and a representative image is shown in Figure A. He undergoes surgical debridement, which allows him to return to his pre-injury condition. Which of the following predisposing factors are believed to lead to the development of this patient's condition? QID: 1424 FIGURES: A Type & Select Correct Answer 1 Gender 13% (284/2167) 2 Increased quadriceps strength 21% (449/2167) 3 Playing on soft surfaces 4% (86/2167) 4 Hamstring tightness 57% (1238/2167) 5 Training with low frequency 4% (97/2167) L 4 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept (SBQ04SM.44.1) An 18-year-old volleyball player has anterior right knee pain for 6 weeks. She is able to play through it but has stiffness and difficulty with stairs after practice. She notes that she has aching pain when sitting with the knee flexed for a prolonged period of time. On exam, she has anterior tenderness but no effusion, patellar apprehension or crepitus. Which of the following treatments would you recommend? QID: 214249 Type & Select Correct Answer 1 Low-dose corticosteroid injection 1% (7/1274) 2 Platelet-rich-plasma (PRP) injection 0% (2/1274) 3 Diagnostic arthroscopy with tendon debridement 1% (9/1274) 4 No sports participation until pain-free 2% (23/1274) 5 Rest, activity modification, quadriceps strengthening 96% (1228/1274) L 1 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept
All Videos (1) Podcasts (0) Login to View Community Videos Login to View Community Videos Arthroscopic Patellar tendonitis debridement Michael Hughes Knee & Sports - Patellar Tendinitis D 5/14/2012 2491 views 4.7 (3)