Monday, May 4, 2015

Treating patella tendonitis or "jumper's knee"

Patella tendonopathy is one of the most common causes of anterior knee pain in an active person of all ages and all levels of ability. It is seen more frequently in athletes participating in sports that involve a lot of jumping and running.

Treating patella tendonitis or "jumper's knee"

Michael Carter-Williams (1) passes the ball during the second half of the East Regional final in the NCAA men´s college basketball tournament, Saturday, March 30, 2013 in Washington. (AP Photo/Alex Brandon)
Michael Carter-Williams (1) passes the ball during the second half of the East Regional final in the NCAA men's college basketball tournament, Saturday, March 30, 2013 in Washington. (AP Photo/Alex Brandon)

Winter season is upon us, recreational and competitive athletes alike. For some of us that means the long anticipated basketball season is finally here (break out your favorite college or NBA gear), and that leads us to the topic of this week’s blog.

Patella tendonopathy is one of the most common causes of anterior knee pain in an active person of all ages and all levels of ability. It is seen more frequently in athletes participating in sports that involve a lot of jumping and running, such as basketball, volleyball, soccer and track (hence the term “jumper’s knee”).

In one study of high level basketball players, approximately 1/3 had some patella tendonopathy. Not surprisingly, the risk of developing patellar tendon problems does appear to increase with increasing training intensity, frequency and duration.  Poor flexibility, and specifically tight quadriceps and hamstrings, may also contribute to an athlete developing patellar tendonopathy.  It does appear to affect males and female athletes equally. 

To provide some technical context, the term patellar tendonopathy encompasses the spectrum of patella tendon problems, ranging from tendonitis to tendonosis to a frank rupture or tear of the tendon.  

Tendonosis is more commonly seen than tendonitis.

  • In tendonitis, the tendon itself is normal and there is inflammation, edema and fluid around the normal tendon.
  • In tendonosis, typically resulting from chronic injury and irritation, the tendon’s structure itself can become abnormal; there is disorganization of the normally organized collagen fibers, and fibrosis within the tendon itself (a process akin to laying down of scar tissue within the tendon.)

The actual root cause of tendonosis causing pain and dysfunction is not entirely clear—it may be due to poor blood supply (ischemic) or may be due to abnormal pain mechanisms (neuropathic) within the abnormal tendonotic tendon. Regardless, once structural changes occur at the tissue level and the athlete is experiencing pain and dysfunction, the patellar tendon problem may be more challenging to treat successfully.

A good history and physical exam is essential to making the appropriate diagnosis. There are other causes of anterior knee pain in an active person. Imaging is not usually necessary to make the diagnosis of patellar tendonopathy, though it can be helpful in determining the extent of the condition or to exclude other causes. MRI or ultrasound are the most helpful imaging modalities in differentiating between tendonitis and tendonosis, or if concerned about a tendon tear.  

The treatment goals are to maximize comfort and to restore and maximize function. A key part of the management—and one supported by the medical literature, is good physical therapy, and specifically eccentric strengthening exercises. Anti–inflammatory medications are often used as an adjunct, as is counter force brace (jumper’s knee strap) that helps to reduce tension on the insertion of the proximal tendon. Surgery for patellar tendonopathy is rarely, if ever, required and entails excision or debridement of the abnormal tendon tissue.  There are two newer treatments with promising initial results in the medical literature: topical nitroglycerin to the affected tendon (increases blood flow and stimulates cellular activity), and injection of platelet rich plasma into the abnormal tendon (promotes healing with factors derived from the patient’s own blood.)

As with other overuse injuries in the active person, a common sense approach can be useful in the busy athlete of all ages. If there is no trauma history, ice applied topically, acetaminophen (Tylenol), and relative rest or activity modification (avoiding aggravating exercises) are usually good first line self-management approaches.  Redness, swelling, bruising, numbness or weakness, or inability to flex and extend the knee may be signs to get medical attention sooner. 

For the cases that do come to medical attention, patellar tendonopathy can be a challenging condition, and our goal in sports medicine is to help the athlete return to their sport or desired activity with appropriate intervention and management. 


Read more Sports Doc for Sports Medicine and Fitness.

About this blog

Whether you are a weekend warrior, an aging baby boomer, a student athlete or just someone who wants to stay active, this blog is for you. Read about our growing list of expert contributors here.

J. Ryan Bair, PT, DPT, SCS Founder and Owner of FLASH Sports Physical Therapy, Board Certified in Sports Physical Therapy
Brian Cammarota, MEd, ATC, CSCS, CES Partner at Symetrix Sports Performance
Ellen Casey, MD Physician with Drexel University Sports Medicine
Desirea D. Caucci, PT, DPT, OCS Co-owner of Conshohocken Physical Therapy, Board Certified Orthopedic Clinical Specialist
Michael G. Ciccotti, M.D. Head Team Physician for Phillies & St. Joe's; Rothman Institute
Julie Coté, PT, MPT, OCS, COMT Magee Rehabilitation Hospital
Justin D'Ancona Philly.com
Peter F. DeLuca, M.D. Head Team Physician for Eagles, Head Orthopedic Surgeon for Flyers; Rothman Institute
Joel H. Fish, Ph.D. Director of The Center For Sport Psychology; Sports Psychology Consultant for 76ers & Flyers
R. Robert Franks, D.O. Team Physician for USA Wrestling, Consultant for Phillies; Rothman Institute
Ashley B. Greenblatt, ACE-CPT Certified Personal Trainer, The Sporting Club at The Bellevue
Brian Maher, BS, CSCS Owner, Philly Personal Training
Julia Mayberry, M.D. Attending Hand & Upper Extremity Surgeon, Main Line Hand Surgery P.C.
Jim McCrossin, ATC Strength and Conditioning Coach, Flyers and Phantoms
Gavin McKay, NASM-CPT Founder/Franchisor, Unite Fitness
Heather Moore, PT, DPT, CKTP Owner of Total Performance Physical Therapy, North Wales and Hatfield, PA
Kelly O'Shea Senior Producer, Philly.com
Tracey Romero Sports Medicine Editor, Philly.com
David Rubenstein, M.D. Sports Medicine Surgeon, Rothman Institute
Robert Senior Event coverage, Sports Doc contributor
Justin Shaginaw, MPT, ATC Athletic Trainer for US Soccer Federation; Aria 3B Orthopaedic Institute
Thomas Trojian MD, CAQSM, FACSM Associate Chief of the Division of Sports Medicine at Drexel University
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