Updated: 5/29/2021

Patellar Tendinitis

0%
Topic
Review Topic
0
0
N/A
N/A
Questions
5
0
0
0%
0%
Evidence
13
0
0
100%
0%
Videos / Pods
1
Topic
Images
https://upload.orthobullets.com/topic/3015/images/key image.jpg
https://upload.orthobullets.com/topic/3015/images/mri2.jpg
https://upload.orthobullets.com/topic/3015/images/mri.jpg
https://upload.orthobullets.com/topic/3015/images/normal 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
Questions (5)
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK

(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:
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 E

Select Answer to see Preferred Response

(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:
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 C

Select Answer to see Preferred Response

(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
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 D

Select Answer to see Preferred Response

Evidence (13)
VIDEOS & PODCASTS (1)
EXPERT COMMENTS (4)
Private Note