Patellar Tendonitis “Jumper’s Knee”

1. Patellar Tendonitis“Jumper’s Knee”

2. Patellar Tendon • The patella or kneecap sits on the patellar articular surface of the proximal end of the femur in-between the lateral condyle and medial condyle. • The patellar tendon connects the kneecap (the patella) to the shin bone. • The patella tendon/ligament is a very strong tendon that allows the quadriceps muscles to straighten the leg. • Not to be confused with the quadriceps femoris tendon that connects the superior part of the patella to the femur; this is the area where all four quadriceps meet together.

4. Patellar Tendonitis • The patella tendon, and the tissues surrounding the tendon, become inflamed this is known as patella tendonitis. • This is usually due to overuse, especially from jumping activities. This is the reason patellar tendonitis is often called "jumper's knee." • Sports activities is the most common cause but anyone can be affected, even those who do not participate in sports or recreational activities.

5. Causes • The most common cause for patellar tendonitis is physical activity that involves repeated jumping. For example activities like basketball, volleyball, and even biking or running can cause patella tendonitis. • Intense running (such as long distance running) • Jumping (basketball , volleyball, and long-jumping) • Frequent starts and stops (tennis, high impact aerobics, soccer, and figure skaters) • Squatting (baseball catcher and supermarket shelf stockers) • Kneeling (such as a carpet layer or carpenter)

6. Internal Factors Continue • The Q-angle is the angle formed by the patellar tendon and the axis of pull of the quadriceps muscle. This angle varies depending whether the patient is male or female. It is larger in women compared to men. The normal angle is usually less than 15 degrees. Angles more than 15 degrees create more of a pull on the tendon, creating painful inflammation. • All of these causes lead to overuse of the tendon increasing stress on the tendon leading to degeneration of the tendon.

7. Outside Factors • Extrinsic (outside) factors that are linked with overuse tendon injuries of the knee. These include inappropriate footwear, training errors, and surface or ground (hard surface, cement) being used for the sport. • Training too much, too far, too fast, or too long.

8. Internal Factors • Intrinsic (internal) factors such as age, flexibility, and joint laxity are also important. • Being overweight causing increased stress on the patella tendon. • Having tight legs muscles that reduce flexibility of the quadriceps and hamstrings can also increase strain on the patellar tendon. • Misalignment of the legs hips or feet can also overtime increase stress on the patellar tendon leading to tendonitis.

10. Symptoms • Pain focused at the bottom part of the kneecap. • The pain is most noticeable when the patient moves their knee or tries to kneel. • The more the patient moves their knee, more tenderness develops in the area of the tendon attachment below the kneecap. • Swelling in and around the patellar tendon is often common.

11. Diagnosing • The doctor will look for tenderness, swelling, redness, muscle weakness and limited motion in the area of the sore tendon. • The examiner may apply pressure to different areas of the knee in order to rule out other injuries. Examiners may also use ultrasounds or magnetic resonance test if they are still unable to diagnose the injury or if they want to see whether the damage to the knee is so bad that the tendon could be ruptured or etc.

12. Treatment • Conservative (non-surgical) treatment is normally the treatment method that is used. • When first diagnosed the initial treatment that is given is just resting, icing and elevating the knee. • •  R - rest •  I - ice •  C - compression •  E - elevation • The patient should take anti-inflammatory pain medicine as prescribed by your healthcare provider. • Rehabilitation exercises are necessary to help strengthen the tendon.

13. Rehab • Many times extensive flexibility exercises programs must be undertaken, especially in teenagers. • Some exercises that are used are the standing hamstring stretch, the quadriceps stretch, side-lying leg lifts, straight leg raises, step-ups, wall squat with a ball, knee stabilization, resisted terminal knee extension and decline eccentric squats are also used. • Occasionally, your doctor will provide a support strap (called an infrapatellar strap or a Chopat strap), a knee brace, or custom orthotics. The benefit of these measures in the treatment of patellar tendonitis is not well known, but some patients find complete relief from using these products.

17. Surgery • In rare last resort methods to treat patellar tendonitis surgical methods can be used. Surgery is often only used to make excisions of the affected area of the patellar tendon. Small cuts are sometimes made on the sides of the tendon to take pressure off the middle third. Even after having surgery and extensive rehabilitation program is often advised.

18. Videos • http://www.youtube.com/watch?v=wY98htXP0O4&feature=player_embedded • http://www.youtube.com/watch?v=QwWLEgbUc_4&feature=player_embedded • http://www.blip.tv/file/743723/