What is patellar tendonitis?
Patellar tendonitis is a common injury or inflammation of the tendon that connects your kneecap (patella) to your shinbone (tibia). Your pain may be mild or severe.
Anyone can get patellar tendonitis. But it’s such a frequent injury of athletes, especially those who play volleyball and basketball, that it’s called jumper’s knee. Among recreational volleyball players, an estimated 14.4 percent have jumper’s knee. The prevalence is even higher for top professional athletes. An estimated 40 to 50 percent of elite volleyball players have jumper’s knee.
Keep reading to learn more about why this happens, how to identify it, treatment options, and more.
What exactly causes this?
Patellar tendonitis comes from repetitive stress on the knee, most often from overuse in sports or exercise. The repetitive stress on the knee creates tiny tears in the tendon that, over time, inflame and weaken the tendon.
Contributing factors can be:
- tight leg muscles
- uneven leg muscle strength
- misaligned feet, ankles, and legs
- shoes without enough padding
- hard playing surfaces
- chronic diseases that weaken the tendon
Athletes are more at risk because running, jumping, and squatting put more force on the patellar tendon. For example, running can put a force of up to five times your body weight on your knees.
Long periods of intense sports training are associated with jumper’s knee. A 2014 study noted that jump frequency was also an important risk factor for amateur volleyball players.
What are the symptoms of patellar tendonitis?
Pain and tenderness at the base of your kneecap are usually the first symptoms of patellar tendonitis. You may also have some swelling and a burning feeling in the kneecap. Kneeling down or getting up from a squat can be especially painful.
The pain may at first be sporadic, occurring only after sports or exercise activity. As the tendon becomes more damaged, the pain can become progressively worse. It can interfere with any athletic activity, as well as with daily activities, such as climbing stairs or sitting in a car.
See your doctor if any pain or swelling lasts more than a day or two.
How is patellar tendonitis diagnosed?
At the start of your appointment, your doctor will ask about:
- your physical activity
- what symptoms you’re experiencing
- when the symptoms occur
- any remedy you’ve tried that eases the pain
Your doctor will physically examine your knee, probe for where you feel pain, and test your range of knee motion by bending and extending your leg.
Your doctor may also order imaging tests to look at your kneecap and tendon to determine if there’s any damage to the tendon or bone. These tests can also help rule out other possible causes of your pain, such as a fracture.
Your doctor may perform:
What are potential complications?
If you don’t have medical treatment, patellar tendonitis can worsen. You may damage your tendon more severely, limiting your everyday functioning.
Resting your legs and stopping activity can be emotionally difficult for athletes, in particular. They may not want to stop playing, even though it’s painful. For professional athletes, patellar tendonitis can be a career-ender if left untreated.
What’s a typical treatment plan?
Treatment depends on the severity of your injury.
Conservative measures to reduce pain, rest your leg, and stretch and strengthen your leg muscles are generally the first line of treatment. Your doctor will usually advise a period of controlled rest, where you avoid activity that puts force on the knee.
Your doctor may prescribe over-the-counter (OTC) drugs for short-term pain and inflammation reduction.
These can include:
If your pain is severe, your doctor may give you a corticosteroid injection in the area around your patellar tendon. This is more effective in reducing severe pain. However, the Mayo Clinic reports that it also may weaken the tendon and possibly make it more likely to rupture. So, it’s important to put considerable thought into this treatment and its associated risks.
Another way of delivering corticosteroid is by spreading the drug over your knee and using a low electrical charge to push it through your skin. This is called iontophoresis.
The goal of physical therapy is to reduce your pain and inflammation and to stretch and strengthen your leg and thigh muscles.
If your pain is severe even while you are resting your legs, your doctor may advise that you wear a brace and use crutches for a while to avoid further damage to the tendon. When you’re relatively pain free, you can begin physical therapy activities.
A therapy session generally includes:
- a warm-up period
- ice or massage for your knee
- stretching exercises
- strengthening exercises
Your therapist may also use ultrasound and electrical stimulation to ease your knee pain. A knee brace or taping of your knee may help reduce pain when you are exercising by keeping the kneecap in place.
Your physical therapist will develop an exercise program for you that may include the following:
- Isometric exercises, where your joint angle and muscle length remain fixed during contractions. This reported to relieve pain.
- Eccentric exercises, which are squats performed on a decline board that is at a 25-degree angle. A 2005 study found that this method of strengthening led to better improvement in athletes with patellar tendonitis who continued to play while being treated.
- Flexibility exercises for the thigh and calf.
A relatively new treatment is a platelet-rich plasma injection. This uses a concentration of platelets from your own blood to promote healing of the tendon. A 2015 study found that two consecutive injections were more effective than a single injection.
Other alternative treatments under study include:
- Ultrasound-guided dry needling: This process makes small holes in the tendon. This is called dry needle fenestration and has been found to relieve pain and help healing.
- Injections with polidocanol: This aims at breaking up new blood vessels on the tendon, which are associated with pain.
- High volume ultrasound-guided injections: This also aims at breaking up new blood vessels on the tendon.
- Hyperthermia thermotherapy: This uses deep-tissue heating along with a cooling device on the skin surface to relieve pain.
- Extracorporeal shockwave therapy: This has shown to reduce pain for up to two years.
When other treatments aren’t successful in relieving pain, your doctor may advise surgery to repair the patellar tendon.
Traditional surgery involves opening the knee to scrape the knee cap and tendon. More recently, arthroscopic surgery is used for this procedure. This involves making only four small incisions in the knee, and it has a shorter recovery time.
Recovery time from surgery varies. Some surgical protocols advise immobility in a cast after your operation. Another strategy for healing suggests that an aggressive and immediate rehabilitation exercise program works best. In this protocol, people were able to return to high-level activity in three months to a year.
What’s the outlook?
The outlook for patellar tendonitis varies depending on the severity of the injury. The subject is one of ongoing research, because it’s such a common occurrence for runners and other athletes. There are many opinions on what works best for rehabilitation.
For some athletes, the condition may be chronic. For others, therapy enables a return to normal functioning and sports.
Important factors in recovery are:
- sticking to your rehabilitation program and regularly exercising
- resuming your sports activity gradually
- paying attention to pain, and resting as necessary
- using OTC remedies and ice to help with returning pain
Talk to your doctor if you have concerns about how long your recovery is taking.