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'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}
'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}
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'''Topic Expert''' - [[User:Claire Robertson|Claire Robertson]]
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'''Topic Expert''' - [[User:Claire Robertson|Claire Robertson]]
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== Definition/Description ==
== Definition/Description ==
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*Patellar tendinitis should also be distinguished from [[Osgood-Schlatter's Disease|Osgood-Schlatter’s disease]] which is a form of [[Osteochondritis Dissecans of the Knee|osteochondritis]].<ref name="Vargas B, Lutz N, Dutoit M, Zambelli PY">Vargas B, Lutz N, Dutoit M, Zambelli PY. Osgood-Schlatter disease. Rev Med Suisse. 2008 Sep 24;4(172):2060-3.</ref>
*Patellar tendinitis should also be distinguished from [[Osgood-Schlatter's Disease|Osgood-Schlatter’s disease]] which is a form of [[Osteochondritis Dissecans of the Knee|osteochondritis]].<ref name="Vargas B, Lutz N, Dutoit M, Zambelli PY">Vargas B, Lutz N, Dutoit M, Zambelli PY. Osgood-Schlatter disease. Rev Med Suisse. 2008 Sep 24;4(172):2060-3.</ref>
*Adolescents growing fast in a short time can be affected by the [[Sinding Larsen Johansson Syndrome|Sinding-Larsen-Johansson disease]]. <ref name="Stalder H">Stalder H. What is your diagnosis? Sinding-Larsen-Johansson syndrome. Praxis (Bern 1994). 1995 Mar 1;84(9):241-3.</ref>
*Adolescents growing fast in a short time can be affected by the [[Sinding Larsen Johansson Syndrome|Sinding-Larsen-Johansson disease]]. <ref name="Stalder H">Stalder H. What is your diagnosis? Sinding-Larsen-Johansson syndrome. Praxis (Bern 1994). 1995 Mar 1;84(9):241-3.</ref>
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[[Image:320px-Patellar_tendinopathy.jpg|patella tendinopathy]]
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== Clinically Relevant Anatomy ==
== Clinically Relevant Anatomy ==
The knee joint consists three bones, the femur, the tibia, the fibula and also the patella which is a sesamoid. The quadriceps muscles are connected to the patella with a shared tendon and there is also a tendon that connects the bottom of the patella to the tibia, called the patellar tendon. This tendon is extremely strong and allows the quadriceps muscle group to straighten the leg. The patellar tendon is made of tough string-like bands. These bands are surrounded by a vascular tissue lining providing nutrition to the tendon. The patellar tendon is also a ligament.<ref name="Blazina ME, Kerlan RK, Jobe FW, Carter VS, Carlson GJ.">Blazina ME, Kerlan RK, Jobe FW, Carter VS, Carlson GJ. Jumper’s knee. Orthop Clin North Am. 1973;4:665–78. [PubMed]</ref><ref name="Romeo AA, Larson RV.">Romeo AA, Larson RV. Arthroscopic treatment of infrapatellar tendonitis. Arthroscopy. 1999;15:341–5. [PubMed]</ref><ref name="Duri ZA, Aichroth PM, Wilkins R, Jones J.">Duri ZA, Aichroth PM, Wilkins R, Jones J. Patellar tendonitis and anterior knee pain. Am J Knee Surg. 1999 Spring;12(2):99-108.</ref>
The knee joint consists three bones, the femur, the tibia, the fibula and also the patella which is a sesamoid. The quadriceps muscles are connected to the patella with a shared tendon and there is also a tendon that connects the bottom of the patella to the tibia, called the patellar tendon. This tendon is extremely strong and allows the quadriceps muscle group to straighten the leg. The patellar tendon is made of tough string-like bands. These bands are surrounded by a vascular tissue lining providing nutrition to the tendon. The patellar tendon is also a ligament.<ref name="Blazina ME, Kerlan RK, Jobe FW, Carter VS, Carlson GJ.">Blazina ME, Kerlan RK, Jobe FW, Carter VS, Carlson GJ. Jumper’s knee. Orthop Clin North Am. 1973;4:665–78. [PubMed]</ref><ref name="Romeo AA, Larson RV.">Romeo AA, Larson RV. Arthroscopic treatment of infrapatellar tendonitis. Arthroscopy. 1999;15:341–5. [PubMed]</ref><ref name="Duri ZA, Aichroth PM, Wilkins R, Jones J.">Duri ZA, Aichroth PM, Wilkins R, Jones J. Patellar tendonitis and anterior knee pain. Am J Knee Surg. 1999 Spring;12(2):99-108.</ref>
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== Epidemiology /Etiology ==
== Epidemiology /Etiology ==
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*genetic abnormalities of the knee joint, and/or
*genetic abnormalities of the knee joint, and/or
*poor base strength of the quadriceps muscles.<ref name="Duri ZA, Aichroth PM, Wilkins R, Jones J.">Duri ZA, Aichroth PM, Wilkins R, Jones J. Patellar tendonitis and anterior knee pain. Am J Knee Surg. 1999 Spring;12(2):99-108.</ref><br>
*poor base strength of the quadriceps muscles.<ref name="Duri ZA, Aichroth PM, Wilkins R, Jones J.">Duri ZA, Aichroth PM, Wilkins R, Jones J. Patellar tendonitis and anterior knee pain. Am J Knee Surg. 1999 Spring;12(2):99-108.</ref><br>
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=== Physiological background ===
=== Physiological background ===
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There is a higher prevalence noted in sports with high impact ballistic loading to the knee extensors. Microtrauma can occur when the patellar tendon is subjected to extreme forces such as rapid acceleration – decelaration, jumping, and landing. <ref>Johannes Zwerver, Evert Verhagen, Fred Hartgens, Inge van den Akker-Scheek and Ron Diercks – The TOPGAME-study: effectiveness of extracorporeal shockwave therapy in jumping athlets with patellar tendionpaty: RCT (level of evidence: A1) – © Biomed Central 2010</ref> Drastic changes in frequency and or intensity of training may also lead to overuse training errors. Intrinsic factors such as strength or flexibility may play a role. However the primary causes appear to relate to the extrinsic factors of overuse, improper training surfaces, insufficient foot-wear or inappropriate equipment. <ref>Witvrouw E, Bellemans J, Lysens, et al – Intrinsic risk factors for the development of patellar tendinits in an athletic population (LE: D)</ref>
There is a higher prevalence noted in sports with high impact ballistic loading to the knee extensors. Microtrauma can occur when the patellar tendon is subjected to extreme forces such as rapid acceleration – decelaration, jumping, and landing. <ref>Johannes Zwerver, Evert Verhagen, Fred Hartgens, Inge van den Akker-Scheek and Ron Diercks – The TOPGAME-study: effectiveness of extracorporeal shockwave therapy in jumping athlets with patellar tendionpaty: RCT (level of evidence: A1) – © Biomed Central 2010</ref> Drastic changes in frequency and or intensity of training may also lead to overuse training errors. Intrinsic factors such as strength or flexibility may play a role. However the primary causes appear to relate to the extrinsic factors of overuse, improper training surfaces, insufficient foot-wear or inappropriate equipment. <ref>Witvrouw E, Bellemans J, Lysens, et al – Intrinsic risk factors for the development of patellar tendinits in an athletic population (LE: D)</ref>
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== Characteristics/Clinical Presentation ==
== Characteristics/Clinical Presentation ==
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Thickness of the tendon may be noted also in all stages. Pain in the patellar tendon may be reproduces with resisted knee extension.<br>The symptomatic evaluation should include history, age and any recent growth spurts, location of pain, and special tests.<ref>Marsha Rutland, Dennis O’Connell, JM Brisméee, Gail Apte, Janelle O’Connell - Evidence-supported rehabilitation of patellar tendinopathy (LE: D)</ref>
Thickness of the tendon may be noted also in all stages. Pain in the patellar tendon may be reproduces with resisted knee extension.<br>The symptomatic evaluation should include history, age and any recent growth spurts, location of pain, and special tests.<ref>Marsha Rutland, Dennis O’Connell, JM Brisméee, Gail Apte, Janelle O’Connell - Evidence-supported rehabilitation of patellar tendinopathy (LE: D)</ref>
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== Diagnostic Procedures ==
== Diagnostic Procedures ==
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The key physical finding in patellar tendinopathy is tenderness at the inferior pole of the<br>patella or in the main body of the tendon when the knee is fully extended and the quadriceps relaxed. When the knee is flexed to 90 degrees, thus putting the tendon under tension, tenderness significantly decreases and often disappears altogether.<br>
The key physical finding in patellar tendinopathy is tenderness at the inferior pole of the<br>patella or in the main body of the tendon when the knee is fully extended and the quadriceps relaxed. When the knee is flexed to 90 degrees, thus putting the tendon under tension, tenderness significantly decreases and often disappears altogether.<br>
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== Differential Diagnosis ==
== Differential Diagnosis ==
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*Popliteal cyst (Baker’s cyst)
*Popliteal cyst (Baker’s cyst)
*Posterior cruciate ligament injury<br>
*Posterior cruciate ligament injury<br>
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== Examination ==
== Examination ==
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In both these tests, the patient should note a marked reduction of tenderness to palpation when the knee is flexed or the quadriceps contract, in order to confirm the diagnosis of patellar tendinitis.<br>
In both these tests, the patient should note a marked reduction of tenderness to palpation when the knee is flexed or the quadriceps contract, in order to confirm the diagnosis of patellar tendinitis.<br>
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== Medical Management <br> ==
== Medical Management <br> ==
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'''Surgical treatment''' Very good results were achieved. In the chronic stage the lesions are irreversible and constitute permanent intratendinous lesions. It thus seems logical to excise these lesions from their origin at the apex of the patella and entry into the adjacent tendon.<br>
'''Surgical treatment''' Very good results were achieved. In the chronic stage the lesions are irreversible and constitute permanent intratendinous lesions. It thus seems logical to excise these lesions from their origin at the apex of the patella and entry into the adjacent tendon.<br>
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== Physical Therapy Management <br> ==
== Physical Therapy Management <br> ==
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Physical therapy for about four to six weeks (3 times a week) is usually
recommendet
.<ref name="E.Witvrouw,M.Lorent">E.Witvrouw,M.Lorent. Oefentherapie bij knieaandoeningen.1e druk 2005</ref> The first step before treatment is rest. It’s important that the patient avoids activities that aggravate the problem. He can take non steroidal anti- inflammatory medications. These will decrease pain and swelling.<ref name="Duri ZA, Aichroth PM, Wilkins R, Jones J.">Duri ZA, Aichroth PM, Wilkins R, Jones J. Patellar tendonitis and anterior knee pain. Am J Knee Surg. 1999 Spring;12(2):99-108.</ref>
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Physical therapy for about four to six weeks (3 times a week) is usually
recommended
.<ref name="E.Witvrouw,M.Lorent">E.Witvrouw,M.Lorent. Oefentherapie bij knieaandoeningen.1e druk 2005</ref> The first step before treatment is rest. It’s important that the patient avoids activities that aggravate the problem. He can take non steroidal anti- inflammatory medications. These will decrease pain and swelling.<ref name="Duri ZA, Aichroth PM, Wilkins R, Jones J.">Duri ZA, Aichroth PM, Wilkins R, Jones J. Patellar tendonitis and anterior knee pain. Am J Knee Surg. 1999 Spring;12(2):99-108.</ref>
The physiotherapist can use ice massage(cryotherapy), electrotherapy, Iontophoresis , and ultrasound to limit pain and to control swelling.<ref name="Khan K, Cook J.">Khan K, Cook J. The painful nonruptured tendon: clinical aspects. Clin Sports Med 2003;22:711-25.</ref> <ref name="Almekinders LC, Temple JD.">Almekinders LC, Temple JD. Etiology, diagnosis, and treatment of tendonitis: an analysis of the literature. Med Sci Sports Exerc 1998;30:1183-90.</ref>
The physiotherapist can use ice massage(cryotherapy), electrotherapy, Iontophoresis , and ultrasound to limit pain and to control swelling.<ref name="Khan K, Cook J.">Khan K, Cook J. The painful nonruptured tendon: clinical aspects. Clin Sports Med 2003;22:711-25.</ref> <ref name="Almekinders LC, Temple JD.">Almekinders LC, Temple JD. Etiology, diagnosis, and treatment of tendonitis: an analysis of the literature. Med Sci Sports Exerc 1998;30:1183-90.</ref>
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'''Conclusion''' A variety of rehabilitation techniques are necessary to assist an individual in returning the recreational en daily living activities. A combination of active rest, education eccentric exercise, progressing the training regime by 10% weekly, and modifying activity have all been found to be effective in tendinopathy treatment. <ref>Kennedy JC, Hawkins R, Krissoff WB – Orthopaedic manifestations of swimming (LE: D)</ref> <ref>Marsha Rutland, Dennis O’Connell, JM Brisméee, Gail Apte, Janelle O’Connell - Evidence-supported rehabilitation of patellar tendinopathy (LE: D)</ref>
'''Conclusion''' A variety of rehabilitation techniques are necessary to assist an individual in returning the recreational en daily living activities. A combination of active rest, education eccentric exercise, progressing the training regime by 10% weekly, and modifying activity have all been found to be effective in tendinopathy treatment. <ref>Kennedy JC, Hawkins R, Krissoff WB – Orthopaedic manifestations of swimming (LE: D)</ref> <ref>Marsha Rutland, Dennis O’Connell, JM Brisméee, Gail Apte, Janelle O’Connell - Evidence-supported rehabilitation of patellar tendinopathy (LE: D)</ref>
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== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) ==
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== Recent Related Research (from
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http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed
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== References ==
== References ==
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