Patellar tendinitis

Overview

Patellar tendinitis is an injury to the tendon that joins the kneecap, also called the patella, to the shinbone. The patellar tendon works with the muscles at the front of the thigh to straighten the knee.

Patellar tendinitis also is called jumper's knee. It's most common in athletes whose sports involve a lot of jumping. Examples are basketball and volleyball. But people who don't play jumping sports also can get patellar tendinitis.

For most people, treatment of patellar tendinitis begins with physical therapy to strengthen the muscles that straighten the knee called the quadriceps muscles.

When to see a doctor

For knee pain, try self-care measures first. These include icing the area and reducing or not doing the activities that cause your symptoms for a time.

Call your doctor if your pain:

• Continues or gets worse.
• Keeps you from doing your daily activities.
• Is linked to swelling or redness about the knee joint.

Risk factors

A mix of factors may be part of getting patellar tendinitis. They include:

• Male sex. People assigned male at birth are more likely to get patellar tendinitis.
• Physical activity. Running and jumping most often are linked with patellar tendinitis. Training more than 20 hours a week for this type of impact exercises is a risk factor. Sudden increases in how hard or how often you do the activity also add stress to the tendon.
• Tight thigh muscles. Tight front-of-the-thigh muscles, called quadriceps, and tight back-of-the-thigh muscles, called hamstrings, can increase strain on your patellar tendon.
• Muscular that aren't balanced. If some muscles in your legs are much stronger than others, the imbalance could put strain on your patellar tendon. This uneven pull could cause tendinitis.
• Chronic illness. Some illnesses disrupt blood flow to the knee, which weakens the tendon. Examples include kidney failure, autoimmune diseases such as lupus or rheumatoid arthritis, and diseases such as diabetes that affect how the body uses food to make energy, called metabolic.

Prevention

To reduce your risk of developing patellar tendinitis, take these steps:

• Don't play through pain. As soon as you feel knee pain while exercising, rest and ice the area. Until your knee is pain-free, don't do activities that put stress on your patellar tendon.
• Strengthen your muscles. Strong front-of-the-thigh muscles can better handle the stresses that can cause patellar tendinitis. A type of exercise called eccentric involves lowering muscles slowly as you return to your start position. An example for the quadriceps muscles is slowly lowering a straight leg to a bent knee position while seated.
• Improve your form. Be sure to use the right form when doing an exercise or sport. You might take lessons or get help from a professional when you start a new sport or use exercise equipment.

Treatment

Surgery is rarely needed for patellar tendinitis. Treatment often starts with limiting activities that cause the pain and some of the following:

Medicines

Pain relievers such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others) may provide short-term relief from pain associated with patellar tendinitis.

Physical therapy

These physical therapy techniques can help reduce the symptoms linked to patellar tendinitis:

• Stretching exercises. Regular, steady stretching exercises of the quadriceps and other muscles can help lengthen the muscle and tendon.
• Strengthening exercises. Weak thigh muscles put strain on your patellar tendon. Exercises that increase the load on the tendon little by little can build strength to protect the tendon.
• Strapping or taping These two methods can help take pressure off the patellar tendon. They may help relieve pain.
• Iontophoresis. This therapy involves putting a steroid medicine on your skin. A device then gives a low electrical charge to push the medicine through your skin.

Surgical and other procedures

If other treatments don't help, your healthcare professional may suggest other therapies, such as:

• Corticosteroid shot. A corticosteroid shot, called an injection, into the sheath around the patellar tendon may help relieve pain. A healthcare professional may use ultrasound to guide the shot to the right place. But these types of medicines are used with care because they can weaken tendons and make them more likely to tear.
• Platelet-rich plasma. This type of shot has been tried in some people with chronic patellar tendon problems. Studies are ongoing. The hope is that platelet-rich plasma will help heal the tendon.

• Oscillating needle procedure (Tenex) or water debridement (Tenjet). These procedures are done in an outpatient setting using a local numbing medicine. In the Tenex procedure, your healthcare professional uses ultrasound imaging to guide a small needle that moves back and forth, called oscillating. The needle cuts away the damaged area while sparing healthy tendon.

  In the Tenjet procedure, water is used to remove damaged tissue. Both procedures need more study. But results have shown promise.

• Surgery. In rare cases, if other treatments fail, your healthcare professional might suggest surgery. The surgery removes damaged tissue, called debridement, from the patellar tendon. Some procedures can be done through small cuts around the knee.

Preparing for your appointment

If you have knee pain during or after physical activity that doesn't get better with ice or rest, see your healthcare professional. After an exam, your healthcare professional might send you to a sports medicine specialist.

Here's information to help you get ready for your appointment.

What you can do

Make a list of:

• Your symptoms and when they began.
• Key medical information, including other conditions you have and medicines, vitamins and supplements you take. Include the doses and how often you take them.
• Your typical daily activity, including how long and hard you exercise and what types of exercise you do. Note if you've recently changed your activity, your activity level or your equipment, such as running shoes.
• Recent injuries that may have damaged your knee joint.
• Questions to ask your healthcare professional.

Here are some basic questions to ask about possible patellar tendinitis.

• What is the most likely cause of my symptoms?
• What tests do I need?
• What treatment do you suggest?
• With treatment, will I be able to go back to my sport? How long will treatment take?
• What exercise can I do while healing, if any?
• What self-care measures should I take?
• Should I see a specialist?

What to expect from your doctor

Your healthcare professional is likely to ask you questions, including:

• Are your symptoms getting worse?
• What activities cause your pain?
• How bad is your pain?
• What strength or stretching exercises do you do?
• Does your pain occur before, during or after your workouts? Or do you have it all the time?
• Is your knee swelling, locking or buckling?
• Do your symptoms make it hard for you to exercise, climb stairs or do other activities?
• What at-home treatments have you tried? What, if anything, has helped?