Patellar tendinitis

Synonyms

Runner's knees

introduction

Patellar tendinitis is a painful disorder of the connective tissue that Kneecap (patella) and Shin (Tibia) connects. In the vast majority of cases, it affects the patellar tendinitis only one page, but also come bilateral Patellar tendinitis roughly 10-20% of the cases.

The most common cause is a chronic one overload, often in combination with Misalignments, Incorrect loads or increased friction. The disease has a tendency to be noticed late and to be taken seriously and treated too late and therefore often becomes chronic.

The most common complications of patellar tendinitis are chronification and changes in the tendon structure. The worst complication in the case of an infectious cause is the spread of the pathogen to the periosteum (Periosteum) of the shin (Tibia) or even a spread via the bloodstream (sepsis). Treatment is usually conservative. If the patient is disciplined, the prognosis is good.

anatomy

The largest knee extensor muscle (Quadriceps femoris muscle) has its origins in the pelvic bones and thigh bones (Femur). Its four parts pull the kneecap together (patella) up. This is over the patellar tendon with the shin (Tibia) connected. When the quadriceps femoris muscle is shortened, the tension on this tendon causes the leg to stretch in the knee joint.
In accordance with the size of the muscle and its task of holding the entire body weight in standing, walking and jumping, the patellar tendon is quite wide and very hard-wearing in a healthy state. In an untrained person, it can withstand about seven times his body weight without tearing (rupture).

Especially in the case of chronic overload or if the tendon is regularly rubbing against the bony structures of the knee, inflammation is promoted. This type of rubbing is particularly important in the case of misalignment or poor posture in the knee joint or in the case of muscular imbalances (especially between the different parts of the quadriceps femoris muscle) likely, especially if this causes the kneecap to deviate from its normal path due to poor or incorrect guidance.

Appointment with a knee specialist?

I would be happy to advise you!

Who am I?
My name is dr. Nicolas Gumpert. I am a specialist in orthopedics and the founder of .
Various television programs and print media report regularly about my work. On HR television you can see me every 6 weeks live on "Hallo Hessen".
But now enough is indicated ;-)

The knee joint is one of the joints with the greatest stress.

Therefore, the treatment of the knee joint (e.g. meniscus tear, cartilage damage, cruciate ligament damage, runner's knee, etc.) requires a lot of experience.
I treat a wide variety of knee diseases in a conservative way.
The aim of any treatment is treatment without surgery.

Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

You can find me in:

• Lumedis - your orthopedic surgeon
  Kaiserstrasse 14
  60311 Frankfurt am Main

Directly to the online appointment arrangement
Unfortunately, it is currently only possible to make an appointment with private health insurers. I hope for your understanding!
Further information about myself can be found at Dr. Nicolas Gumpert

causes

In principle, inflammation of the patellar tendon can be infectious or non-infectious. The inflammation due to invading pathogens is relatively rare compared to other causes and usually requires a portal for the germs to enter, for example in the form of a wound.

The non-infectious development of a patellar tendinitis usually has several causes or is based on an interplay of several factors. In most cases, however, the main component is repeated excessive and / or incorrect loading. In individual cases, however, short-term overloads, especially in an unheated training state, can lead to patellar tendinitis.

In addition, medication, such as some antibiotics (for example from the group of so-called fluoroquinolones) cause patellar tendinitis.

Symptoms

As with any tendinitis (Tendonitis) In the case of patellar tendinitis, there are almost always some, but rarely all of the classic five signs of inflammation. In addition to pain (dolor), which usually increase significantly with stress, is above all a functional restriction (functio laesa) expected, but also a swelling (tumor), a redness (rubor) or overheating (calor) of the affected area are possible.
Often (unless the cause is a sudden overload or an accident), come these symptoms (Symptoms) creeping, so are weak at the beginning and then gradually increase in strength.
Often the onset of a patellar tendinitis is not consciously perceived, as there can be complete freedom from symptoms in the early stages of the disease. In addition, some time usually elapses between noticing the first signs of illness and drawing conclusions. If the symptoms do not take place immediately, a significant increase in pain can be expected.

This pain, which is also the main symptom of the disease, is below the kneecap (patella) localizes and increases with movement in the knee joint or even heavy stress on the tendon (active leg extension) still clear. This is, for example, when walking upstairs, downhill or general exercise of the large thigh muscle (Quadriceps femoris muscle) is the case, but can also occur in peace and without stressful influences. In addition, the inflamed region can be more sensitive to external pressure, touch or heat.

If the patellar tendinitis becomes chronic, calcium deposits can also develop, which lead to increased friction in the corresponding tendon when moving. These calcium deposits can also cause grinding noises when the knee is moved. In addition, the affected patient can sometimes feel this crunch himself.
In the context of chronification, nodular thickenings on the tendon cannot be ruled out, and the tendon can lose its tensile strength due to the permanent inflammatory process. In the worst case, there is also a crack (Rupture) the tendon possible. Although this is extremely rare, it is favored by the previous damage to the tendon as part of its inflammation.

You might also be interested in: Pain in the patellar tendon

Diagnosis of patellar tendinitis

The finding (diagnosis) a patellar tendinitis usually results from the clinical picture, which the attending physician through detailed questioning (anamnese) and clinical physical exam wins. Anamnestically indicative are a gradual onset of the symptoms, especially the pain below the kneecap (infrapatellar) if the leg extensors are repeatedly subjected to unusually heavy loads (Extensors), for example through a resumed or newly resumed exercise. For example, running and ball sports or track and field disciplines that involve sudden changes of direction or acceleration and deceleration as well as jumps, etc., can also cause patellar tendinitis, as can excessive extensor training in the gym or through excessive running exercises.
If, after taking the history and physical examination, the picture is still unclear, the suspicion of patellar tendinitis can be raised by an ultrasound examination of the corresponding region (Sonography) or by magnetic resonance imaging of the knee (kneeMRI) are hardened.
Furthermore, a blood sample completes the diagnosis. The main focus here is on so-called inflammatory parameters such as the number of inflammatory cells (Leukocytes), but the C-reactive protein is also an important diagnostic marker.

The most likely alternative disease, which can cause a similar symptom, is the so-called patellar tip syndrome, which, however, in contrast to patellar tendinitis, is a purely wear-and-tear disease that presents itself without inflammation and has the attachment of the patellar tendon to the kneecap as the main pain point, while the patellar tendinitis is usually a larger one Part of the tendon affects.
Nonetheless, a patellar tendinitis can develop on the basis of a patellar tendinitis.

Treatment / therapy

Patellar tendinitis is usually treated conservatively, but in individual cases, for example in the case of particularly severe courses, failure of conservative treatment or a chronic non-controllable chronicity, it can be treated surgically.

In the rare case of justified suspicion of an infectious cause of the patellar tendinitis, conservative therapy is mainly based on the administration of a so-called broad spectrum antibiotic, i.e. an antibacterial drug that has a wide range of effects against a particularly large number of pathogens.
If this antibiotic does not work, a more targeted antibiotic therapy against the pathogen to be determined first must be started.

In the much more frequent case of the development of patellar tendinitis as a result of repeated overloading, the most important therapeutic measure is the immediate cessation of stressful activities. This ban on sports can take weeks to months, depending on the severity and the speed of healing, and should be followed by a slow increase in exercise.

The healing process is usually accompanied by physiotherapy and supported by suitable measures such as anti-inflammatory cold applications and, if necessary, first stretching exercises and then light muscular training.

Above all, in the acute or early phase of the disease, anti-inflammatory medication is prescribed by the attending physician as standard. The main pillar of this treatment is long-term therapy with drugs from the class of active ingredients known as non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or diclofenac, which are not only pain-relieving but also have anti-inflammatory effects.

In severe cases, injection of an anti-inflammatory agent (Cortisone / glucocorticoid) into the patellar tendon region. It is particularly important to ensure that the tendon itself must not be hit.

If the affected knee has increased mobility of the joint or, above all, of the kneecap, an orthopedic bandage, which gives the joint stability and the kneecap guidance, can sometimes accelerate the healing process and alleviate discomfort.
The patient can also accelerate the healing process by taking care of himself and cooling the patellar tendon independently, but not excessively.

In an emergency, if the conservative therapeutic measures have failed or other factors speak against conservative treatment, surgical therapy must be considered. This is performed as part of an operation using a joint mirror (Arthroscopy) severely inflamed tendon tissue is removed.

Kinesio tapes

Kinesio tapes can help heal patellar tendinitis by increasing blood flow and supporting muscles. Tapes also provide pain relief in the tendon. The tapes are stuck to the skin and create elastic tension in the muscles. They are breathable and can be worn for several days, even during sports. They both promote healing and can both prevent recurrence.

Read more on the subject at: Kinesio tape

OP

Surgery for patellar tendinitis is considered the last resort if all conservative measures have failed to cure. There are two methods for this, on the one hand the knee mirror image (Arthroscopy) and on the other hand open surgery. In both procedures, the affected parts are removed and the knee joint is irrigated. In addition, calcium deposits that may have led to the inflammation can be removed and any torn tendons can be sewn. However, a short rest period is also required after an operation until the knee is fully resilient. Surgery also has its own risks.

(Sports) break

The patellar tendon is a very stressed tendon. The expected healing time depends on various factors, including age and fitness level. Before the full load is started, the patellar tendinitis should be completely cured to prevent chronic inflammation. In the case of acute inflammation, the leg should first be protected and cooled as far as possible, i.e. sit up and put little strain on the knee. Anti-inflammatory and pain reliever medications can also help.

If the tendon no longer hurts so badly, you can start with small loads. Knee wraps can be worn for 3 to 6 weeks to provide support. These promote blood circulation and thus lead to faster healing. Crutches can also help. Recovery can be accelerated by means of light exercises, possibly also with the help of physiotherapy. Overall, however, it can take up to 6 months for complete healing.

physical therapy

Physiotherapy can help to speed up the healing process and prevent muscle breakdown during sports breaks. The training exercises are aimed primarily at strengthening the thigh muscle. Examples of such exercises are squats and wall sitting. The physiotherapeutic method of transverse friction can help, for example, with pain relief in the knee joint. The muscle groups are treated with massage.
However, sufficient stretching of the muscles and ligaments of the thigh and lower leg also helps prevent patellar tendonitis. You can also learn to perceive your own body better through training exercises. In this way, incorrect and overloading can be reduced.

forecast

The prognosis for patellar tendinitis is general Well. It can longer take until the symptoms have completely subsided, but if the patient conscientiously observes the closed season and then the stress very slowly increases is the probability to recover completely, very large.
Nevertheless, it should be noted that if the patient is again overloaded, a increased susceptibility for suffering another patellar tendonitis.

To go biking

Cycling is one of the most common causes of patellar tendinitis because cycling puts a lot of stress on the tendon. If the tendon has already been damaged or if there is a chronic inflammation, inflammation quickly occurs again. Frequent inflammation can lead to calcium deposits, which increases the risk of a patellar tendon rupture. In the case of inflammation, you should wait until it has completely healed before getting back on the bike. Knee supports can help with chronic complaints.

prevention

To avoid patellar tendonitis, it is best to refrain from overstressing or to do an activity that puts a lot of strain on the patellar tendon, such as sports (Running, jumping etc.) to increase the training intensity only slowly.