What is patella tendinosis?
Patella tendonitis is a chronic inflammation of the patellar tendon. The patella tendon (ligament) is the structure which runs from below the knee cap (patella) to the shin bone (tibia) and its function is to straighten the knee in activities such as jumping, walking and running. Acute inflammation of the patella tendon is called patella tendonitis, and as this persists, the tendon degenerates and this state of inflammation is called patella tendinosis.
What causes patella tendinosis?
It can affect anyone, but commonly occurs in athletes who are involved in jumping sports, hence is known as ‘Jumper’s knee’. We most commonly see it in runners. Poor flexibility in the thigh muscles (quadriceps) and hamstrings, and a raised kneecap (patella alta) are thought to increase the forces though the patella tendon and increase the risk of patella tendinosis.
What are the symptoms?
Patients complain of pain along the tendon which may feel sharp particularly after running or jumping. The pain can persist after exercise as a dull ache. The patella tendon becomes tender to touch.
How is patella tendinosis diagnosed?
The diagnosis is usually clear from the symptoms and examination. There may be subtle changes apparent on a MRI (magnetic resonance imaging) scan or an ultrasound scan, although these are usually ordered to exclude alternate diagnoses rather than to confirm this diagnosis.
Can patella tendinosis be treated without surgery?
Non surgical measures are often successful. It will take a minimum of six weeks for the knee to improve and a programme of rehabilitation is needed. Reoccurrence is not uncommon.
Conservative treatment options include avoiding activity that aggravates the pain until the condition improves. It is important to choose and continue with exercises that do not cause pain. Pain killers and ice will help control symptoms and allow rehabilitation exercises. Stretching of tight hamstrings and quadriceps reduces the forces through the patella tendon. An exercise regime with a physiotherapist consisting of a special exercise programme (‘eccentric exercises’) can help improve the condition of the tendon.
A commonly used treatment is the use of Extra Corporeal Shockwave Therapy (or Shockwave Treatment). This involves 3-5 treatments lasting around 5 minutes each. It is non-invasive and can be very effective for the treatment.
If the condition does not resolve with these measures, patients can be treated by new injections called PRP Injections (Platelet Rich Plasma) which involves taking the patients own blood and extracting the platelet rich plasma and then re-injecting the substance to the inflamed area. The injections work by creating repair and regeneration in the damaged portion.
Surgery is rarely required.