Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Jumper’s Knee (Patellar Tendinopathy)

Basics
Description
  • Patellar tendinopathy, also known as Jumper’s knee, is an overuse injury of the patellar tendon.
  • 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
  • Most prevalent in young athletes, particularly dancers and basketball and volleyball players
  • Also commonly seen during basic training of military recruits
Risk Factors
  • Participation in repetitive jumping sports.
  • Repetitive leg extension exercises
  • Training errors
  • Limb malalignment
Etiology
  • Recurrent microtrauma from overuse
  • Can develop areas of mucoid degeneration and fibrinous necrosis of the tendon
Associated Conditions
Achilles tendinitis
 
Diagnosis
Signs and Symptoms
History
  • Patients often complain of dull, aching pain (insidious in onset) over the patellar tendon.
  • Pain is exacerbated by active and resisted knee extension.
Physical Exam
  • Tenderness is localized most commonly over the tendinous insertion at the inferior pole of the patella.
  • May have tenderness over the tendon insertion on the proximal tibia and the tendon itself
  • Quadriceps, hamstring, Achilles, and hip flexor tightness
Tests
Imaging
  • AP and lateral views of the knee should be obtained to rule out other pathologic processes.
  • Ultrasound and MRI are helpful in recalcitrant cases, identifying areas of mucoid degeneration.
Treatment
General Measures
Activity
  • Relative rest:
    • Patients should refrain from activities that exacerbate the pain, particularly jumping and knee extension exercises.
    • However, patients should not be immobilized.
  • 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
  • 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 debridement of the patellar tendon.
 
Follow-up
Disposition
  • Patients should be seen again at 6 weeks after diagnosis to assess the effects of therapy.
  • Patients may resume regular activity after symptoms resolve.
Prognosis
  • Prognosis is good for patients compliant with activity restriction and physical therapy.
  • For patients with persistent disease (>6 months) and for those who require surgery, 50-80% report resolution of symptoms.
Miscellaneous
Codes
ICD9-CM
726.64 Patellar tendonitis
 
Patient Teaching
Activity
  • Patients should be educated about:
    • 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
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.

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