Dr. Kevin Yip

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

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Patellar Tendinosis

SYMPTOMS

Gradual onset of diffuse exercise induced pain or ache around the proximal part of the patellar tendon. It is common in middle-aged runners and recreational athletes in racket sports.

AETIOLOGY

Tendinosis is defined from histopathological findings as a free tendon condition with altered collagen structure, thickening of the tendon, re-vascularisation and increased cellularity. It can be looked upon as an active halt in an early healing stage and is an ongoing process, not a degenerative condition. The condition may or may not be symptomatic. A majority of complete Achilles tendon and rotator cuff ruptures show these changes. It is most often localised at the proximal, central and posterior part of the patellar tendon.

CLINICAL FINDINGS

There is localised tenderness on palpation over the tendon, which often is thicker than the other side. There may be inflammatory signs with redness and increased temperature. Compare to the other side.

INVESTIGATIONS

Ultrasound or MRI will show typical intra-tendinous findings.

TREATMENT

This often chronic ailment may respond to conservative treatment in the early stages, including modification of training and muscle strengthening exercises that can be tried over three months. If this regime is not successful, surgery may be necessary to excise parts of the tendon. Cortisone injections should be administered only in rare exceptions, due to the high risk of later tendon rupture; indeed, NSAID and cortisone injection is one of the possible triggers of this ailment. Surgery is followed by a few weeks’ partial immobilisation and a few months’ rehabilitation before resuming sport. Weight bearing is usually allowed soon after surgery, avoiding plyometric activities.

REFERRALS

Refer to Dr Kevin Yip (+65 9724 1219) senior consultant orthopaedic surgeon for consideration of surgery. Refer to physiotherapist for planning of a three to six months’ return programme back to sport.

EVALUATION OF TREATMENT OUTCOMES

Monitor clinical symptoms and signs. Note that the injured tendon will remain thicker than the noninjured. Calf muscle performance should be similar to the other side. Objective tests for quadriceps strength and for flexibility and proprioception, such as the one-leg hop test, are strongly recommended before resuming full sport.

DIFFERENTIAL DIAGNOSES

Tendinosis, tendinitis, bursitis, impingement from patella tip spur, meniscus tear, chondral injuries, OCD, medial plica syndrome, chondromalacia patellae, patellar instability or mal-tracking, quadriceps insufficiency, Sinding-Larsen’s syndrome, fat pad syndrome, synovitis, referred pain, secondary symptoms from ankle or back insufficiency, core instability and more.

PROGNOSIS

Good-Poor; in some cases this condition can be the beginning of the end for an elite athlete.

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