Sports Medicine

Patella Tendinitis and Patella Tendinosis

Anatomy

The kneecap (patella) connects muscles in the front of the thigh to the shinbone (tibia). As you bend or straighten a leg, the kneecap is pulled up or down. This movement of the kneecap is accommodated by a V-shaped notch (femoral groove) at one end of the thighbone (femur). The medial patella femoral ligament (MPFL)—located on the inside (medial side) of the knee—helps hold the kneecap in place and stop it from sliding/popping off of the outer side (lateral side) of the knee.

The patella tendon is in the front of the knee. It connects the patella (knee cap) to the tibia (shin bone).

Description

Pain in the patella tendon is a common problem, especially in people who participate extensively in running or jumping activities. Pain in the patella tendon can be separated into two main conditions: patella tendinitis and patella tendinosis.

• Patella tendinitis—An acute condition (quick, recent onset) that can follow a strain of the patella tendon or a period of high activity.
• Patella tendinosis—A chronic condition (persistent, long-lasting) that is frequently difficult to treat.

Treatment—Patella Tendinitis

Patella tendinitis usually responds to rest, icing, anti-inflammatories and rehab. Patella straps may also help to relieve symptoms.

• Rest—Discontinue participation in athletic activities that caused the problem.
• Ice—Apply ice several times a day to help reduce swelling and pain.
• Nonsteroidal anti-inflammatory medication (NSAIDs)—Drugs such as ibuprofen or naproxen may help relieve pain, inflammation and swelling. Most people are familiar with nonprescription NSAIDs such as aspirin and ibuprofen, however, whether using over-the-counter or prescription strength, they must be taken carefully. Using these medications for more than one month should be reviewed with your primary care physician. If you develop acid reflux or stomach pains while taking an anti-inflammatory, be sure to talk to your doctor.
• Rehabilitation—Your physician may prescribe specific exercises to help you improve strength and provide relief from symptoms.

Treatment—Patella Tendinosis

Treatment for patella tendinosis is initially conservative with hamstring stretching, quadriceps stretching and strengthening (especially eccentric exercises), and core strengthening. Using patella straps can also help relieve symptoms. However, even with good rehab patella tendinosis is sometimes difficult to cure.

Cortisone injections into the patella tendon are not recommended because they can cause a possible rupture in the tendon and there is no medical evidence supporting the treatment. For cases that are not responsive to rehab, PRP injections are a potential option. According to some lab reports, results of PRP therapy have been promising. However, clinical trials have failed to produce consistently good results and in many of these trials, the results are no better than that of placebo treatments.

Surgery is an option for cases that have failed to respond to many months or more of nonoperative treatment. Although surgical treatment can yield good results, it is a last resort and not considered for most cases.