Review Question - QID 1424

This athlete has a diagnosis of chronic patellar tendinitis. Figure A shows a focal area of abnormal increased signal intensity in the proximal portion of the patellar tendon at the bone-tendon insertion, which is consistent with this condition. Patellar hypermobility has been shown to predispose athletes to the development of this condition. Patellar tendon debridement is indicated in cases of severe tendinopathy, extensor mechanism disruption, or cases refractory to prolonged conservative treatment measures.

Al-Duri et al reviewed 18 knees with either primary or secondary patellar tendonitis who required operative treatment. Criteria were developed for subjective, objective, functional, and overall evaluation. At an average of 12 months postoperatively, 89% of the knees were rated as normal or nearly normal using their described surgical technique.

Beam et al describe the surgical treatment of chronic patellar tendinitis in a collegiate football player where they debrided the inflammed tissue. They describe the predisposing factors for this condition as being quadriceps inflexibility and atrophy, hamstring tightness, patellar hypermobility, playing on hard surfaces, and increased training frequency. The authors state that hamstring inflexibility places excessive stress on the extensor mechanism which in turn may increase forces in the patellar tendon during contraction.

Finally, Witzrouw et al evaluated 138 atheltes to determine the presence of intrinsic risk factors for the development of patellar tendinitis. Their analyses revealed that the only significant determining factor was muscular flexibility, with the patellar tendinitis patients being less flexible in the quadriceps and hamstring muscles. The results of this study demonstrated that lower flexibility of the quadriceps and hamstring muscles may contribute to the development of patellar tendinitis in an athletic population.