PATELLAR TENDINOPATHY                                        KANDIL NOTES

INTRODUCTION

  • Patellar tendinopathy is a common cause of anterior knee pain characterized by the degeneration of the proximal patellar tendon

  • The patella tendon is a part of the extensor mechanism of the knee, allowing you to straighten your knee

  • Patellar tendinopathy is not an inflammatory process and therefore patellar tendinitis is no longer commonly used to describe this disease

  • This disease process is more common in males and has been reported in all activity levels from recreational to professional athletes

CAUSES 

  • Patellar tendinopathy is often an overuse injury caused by excessive activities that require jumping, running, or rapid changes in direction

  • The reported prevalence ranges from 14% to 32% in basketball players and 45% in volleyball players 

SIGNS AND SYMPTOMS

  • Patients with patellar tendinopathy have knee pain that is worse with squats and knee extension

  • Patients often complain of anterior knee pain and tenderness to palpation of the proximal patellar tendon and inferior pole of the patella

  • The decline squat test, in which a single leg squat is performed in 30 degrees of knee flexion, reproduces the pain associated with patellar tendinopathy

TREATMENT​​

  • The mainstay of treatment for patellar tendinopathy is conservative management, consisting of physical therapy, extracorporeal shock wave therapy, chopat strap, and dry needling. 

  • An eccentric exercise physical therapy program is considered the standard treatment for patellar tendinopathy. Eccentric exercises have been proposed to help in patellar tendinopathy by increasing the remodeling process of the collagen fibers in the diseased portion patellar tendon

  • Orthobiologics such as platelet rich plasma (PRP) can be considered for patellar tendinopathy that is refractory to conservative management

  • The theory behind this is that PRP can deliver growth factors to the degenerative patellar tendon which have poor blood supply and healing potential. This may result in healing and decreased pain

  • Numerous high-quality studies show improvement in symptoms and many show a significant improvement compared to other conservative options.

  • Surgery can be considered if patients fail at least 6 months of conservative management. Surgery consists of a patellar debridement and repair

 PREVENTION

  • Avoiding repetitive knee squatting activities may decrease the chance of developing patellar tendinopathy

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