In the News
April 19, 2017
At the end of a long ski season, I see a large number of patients with overuse injuries and conditions. Patellar tendonitis is one such common condition seen in our athletic population. Common sports associated with this condition is skiing, basketball, volleyball, gymnastics, or sports where there is a lot of jumping and landing. Another term for patellar tendonitis is “jumper’s knee.”
Patellar tendon pain is located right at the bottom of the knee cap. The pain is often described as sharp. The pain is worse after physical activity, but it can progress to the point where the pain is constant. Squatting often reproduces the pain. I see this in a lot of highschool athletes but also in older patients. In my experience, it is more common in female athletes than male athletes. The condition is also most common in patients who have recently undergone a large growth spurt.
In the acute phase, there is inflammation of the tendon. However, in the chronic condition, there is progressive degeneration of the tendon or so called “tendinosis.” An MRI of a knee with chronic patellar tendinosis demonstrates fluid or “increased signal” in the upper portion of the tendon and adjoining fat pad. There is a concern that left unchecked, chronic tendionsis can lead to partial or even full thickness tearing of the tendon as the degenerative changes in the tendon worsen.
Because patellar tendonitis and patellar tendinosis result from overuse, the first treatment is to remove an athlete from their sport and rest an athlete’s knee. Physical therapy to include eccentric exercises, or subjecting the muscle to a load which causes the muscle to lengthen as it contracts, is helpful.
As for injections, I do not recommend steroid injections for treatment of patellar tendonitis as this can predispose the tendon to rupture. Furthermore, the relief from steroid injections is typically short term only. However, I do treat chronic patellar tendonitis or tendinosis with platelet rich plasma injections (PRP). With this treatment, the growth factors from our platelets in our blood are concentrated and then injected into and around the tendon which can assist with healing of the tendon. Similarly, injecting the tendon with stem cells (usually those derived from a bone marrow aspirate) can help with healing.
Occasionally, surgery is required to treat recalcitrant patellar tendinosis. In surgery, the tendon is exposed and abnormal tissue is excised and the bone/tendon interface is debrided to incite healing at this juncture. Patients are placed in a knee brace for the first month after surgery, and a gentle rehab program is started. It can be 4 months to return an athlete to all sports following surgery.
Dr. Rick Cunningham is a Knee and Shoulder Sports Medicine Specialist with Vail-Summit Orthopaedics. He is a Physician for the US Ski Team. Do you have a sports medicine question you'd like him to answer in this column? Visit his website at http://www.vailknee.com to submit your question. For more information about Vail-Summit Orthopaedics, visit http://www.vsortho.com.
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