Editors: Frassica, Frank J.; Sponseller, Paul D.; Wilckens, John H.
Title: 5-Minute Orthopaedic Consult, 2nd Edition
Copyright ©2007 Lippincott Williams & Wilkins
> Table of Contents > Jumper’s Knee (Patellar Tendinopathy)
Jumper’s Knee (Patellar Tendinopathy)
Gregory Gebauer MD, MS
John H. Wilckens MD
BasicsDescription
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Patellar tendinopathy, also known as “Jumper’s knee,” is an overuse injury of the patellar tendon.
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Children develop a similar condition known as OSD.
General Prevention
Avoidance of repetitive jumping exercises without proper quad strengthening
Epidemiology
Equally common among males and females
Incidence
Overall incidence in the community is unknown, but it is very common and usually self-limiting.
Prevalence
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Most prevalent in young athletes, particularly dancers and basketball and volleyball players
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Also commonly seen during basic training of military recruits
Risk Factors
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Participation in repetitive jumping sports.
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Repetitive leg extension exercises
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Training errors
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Limb malalignment
Etiology
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Recurrent microtrauma from overuse
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Can develop areas of mucoid degeneration and fibrinous necrosis of the tendon
Associated Conditions
Achilles tendinitis
DiagnosisSigns and Symptoms
History
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Patients often complain of dull, aching pain (insidious in onset) over the patellar tendon.
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Pain is exacerbated by active and resisted knee extension.
Physical Exam
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Tenderness is localized most commonly over the tendinous insertion at the inferior pole of the patella.
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May have tenderness over the tendon insertion on the proximal tibia and the tendon itself
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Quadriceps, hamstring, Achilles, and hip flexor tightness
Tests
Imaging
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AP and lateral views of the knee should be obtained to rule out other pathologic processes.
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Ultrasound and MRI are helpful in recalcitrant cases, identifying areas of mucoid degeneration.
TreatmentGeneral Measures
Activity
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Relative rest:
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Patients should refrain from activities that exacerbate the pain, particularly jumping and knee extension exercises.
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However, patients should not be immobilized.
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Gradual resumption of low-impact exercise, including swimming and cycling, and resumption of normal activity as symptoms permit
Nursing
Icing the affected area may help relieve some of the discomfort.
Special Therapy
Physical Therapy
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As the symptoms improve, physical
therapy, including stretching and quadriceps and hamstring
strengthening, should be initiated, with particular attention to
eccentric strengthening. -
Special attention should be paid to limb alignment and core strength.
Complementary and Alternative Therapies
Patients also may respond to modalities such as ultrasound, phonophoresis, and iontophoresis.
Medication
First Line
NSAIDs may help relieve some of the discomfort.
Second Line
Corticosteroid injection should not be considered because of the unacceptable risk of patellar tendon rupture.
Surgery
Refractory symptoms after 6 months of documented
physical therapy may respond to open or arthroscopic débridement of the
patellar tendon.
physical therapy may respond to open or arthroscopic débridement of the
patellar tendon.
P.205
Follow-upDisposition
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Patients should be seen again at 6 weeks after diagnosis to assess the effects of therapy.
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Patients may resume regular activity after symptoms resolve.
Prognosis
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Prognosis is good for patients compliant with activity restriction and physical therapy.
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For patients with persistent disease (>6 months) and for those who require surgery, 50–80% report resolution of symptoms (1).
References
1. Coleman
BD, Khan KM, Kiss ZS, et al. Open and arthroscopic patellar tenotomy
for chronic patellar tendinopathy. A retrospective outcome study. Am J Sports Med 2000;28:183–190.
BD, Khan KM, Kiss ZS, et al. Open and arthroscopic patellar tenotomy
for chronic patellar tendinopathy. A retrospective outcome study. Am J Sports Med 2000;28:183–190.
Additional Reading
Duri ZA, Aichroth PM, Wilkins R, et al. Patellar tendonitis and anterior knee pain. Am J Knee Surg 1999;12:99–108.
Panni AS, Tartarone M, Maffulli N. Patellar tendinopathy in athletes. Outcome of nonoperative and operative management. Am J Sports Med 2000;28:392–397.
Shalaby M, Almekinders LC. Patellar tendinitis: the significance of MRI findings. Am J Sports Med 1999;27:345–349.
Witvrouw
E, Bellemans J, Lysens R, et al. Intrinsic risk factors for the
development of patellar tendinitis in an athletic population. A
two-year prospective study. Am J Sports Med 2001;29:190–195.
E, Bellemans J, Lysens R, et al. Intrinsic risk factors for the
development of patellar tendinitis in an athletic population. A
two-year prospective study. Am J Sports Med 2001;29:190–195.
MiscellaneousCodes
ICD9-CM
726.64 Patellar tendonitis
Patient Teaching
Activity
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Patients should be educated about:
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Avoiding exacerbating (at-risk)
activities, such as knee squats, knee extension exercises, and jumping,
to promote healing and prevent recurrence -
Stretching, and quadriceps-, hamstring- and core-strengthening exercises (and proper technique) as symptoms begin to resolve
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Prevention
Core and quadriceps strengthening, hamstring flexibility, and limb-alignment improvement
FAQ
Q: When can I return to play/normal activity?
A: Athletes can return to normal activity/play when they are symptom-free.
Q: What can I do to prevent this in the future?
A: Quadriceps- and core-strengthening exercises and avoidance of exacerbating activities are the best ways to avoid recurrence.