Pain at the front of your knee or anterior knee pain, commonly affects people of all ages and abilities. Your pain maybe caused by patella tendinitis, also known as jumpers knee, or patella tendinopathy. The patella tendon attaches your knee cap (patella) to your shinbone (tibia). Frequently, patella tendinitis (PT) is associated with athletes, in particular volleyball and basketball players, hence the term jumpers knee. It is estimated that 40-50% of elite volleyball players have jumpers knee.
What causes PT?
PT comes from repetitive strain and overloading of the tendon causing micro-tears of the tendon and some inflammation and weakening and reducing the loading capacity/tolerance of the tendon. In Figure 1 and 2, diagnostic ultrasound demonstrates tendon micro-tears and defects with associated inflammation and thickening of the tendon. Therefore, bouts of intense running and jumping, which can put a force 5-7 times your bodyweight through your knees, can slowly affect your patella tendon capacity/tolerance to exercise. Contributing factors include tight and weakened muscles, biomechanics, obesity, foot wear, playing surfaces and medical conditions associated with tendons and soft tissue.
Symptoms of PT?
Most PT clients complain of tenderness and a burning sensation at the base of their kneecap. Pain is elicited particularly on loading and bending their knee e.g. squat, stairs and jumping. Symptoms maybe intermittent initially, but then may deteriorate to become more constant.
Diagnosis of PT?
Good physical examination should be enough to diagnose PT, but in recalcitrant cases diagnostic ultrasound is an early and useful investigation to assess the patella tendon integrity and rule in/out other diagnoses. In most cases ultrasound is more useful than MR in examining tendon integrity, but MR has advantages to assessing compartments of the knee in the absence PT.
What is the management of PT?
Conservative management in most cases will resolve the symptoms, but full resolution takes time, therefore patience is required by athletes. Therefore, some modification of exercise loading may be appropriate to reduce the repetitive strain on the patella tendon, in combination with addressing the contributing factors highlighted above. Extracorporeal shockwave therapy has excellent results in most cases, and is available at ECP. Other, alternative treatments are available including PRP injections, high volume injections and in some cases surgery maybe indicated.
Figure 1. Patella tendon on ultrasound
Figure 2. Patella tendinopathy with associated inflammation on power doppler
