Patella Tendonosis

Patella tendonosis is inflammation of the patellar tendon. The patella tendon (ligament) is the structure which runs from below the knee cap (patella) to the shin bone (tibia) and its function is to straighten the knee in activities such as jumping, walking and running.

What causes patella tendonosis? What are the symptoms? How is patella tendonosis diagnosed? Can patella tendonosis be treated without surgery? What operation may be beneficial?

Although this is a common condition, the cause is not known. It can affect anyone, but it is common in athletes who put large forces through their patella tendon through activity such as jumping; this condition was once known as jumper’s knee. It can also occur in runners. Poor flexibility in the thigh muscles (quadriceps) and hamstrings, and a raised kneecap (patella alta) are thought to increase the forces though the patella tendon and increase the risk of patella tendonosis. Another theory is that repeated stress on the tendon causes the tendon to be damaged faster than the tendon can be repaired.

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Patients complain of pain along the tendon which may feel sharp particularly after running or jumping. The pain can persist after exercise as a dull ache. The patella tendon becomes tender to touch.

The diagnosis is usually clear from the symptoms and examination. There may be subtle changes apparent on a MRI (magnetic resonance imaging) scan or an ultrasound scan, although these are usually ordered to exclude alternate diagnoses rather than to confirm this diagnosis.

Yes. Non surgical (conservative) measures are often successful. It will take a minimum of six weeks for the knee to improve and a diligent programme of rehabilitation is needed. Reoccurrence is not uncommon.

Conservative treatment options include avoiding activity that aggravates the pain until the condition improves. It is important to choose and continue with exercises that do not cause pain. Pain killers and ice will help control symptoms and allow rehabilitation exercises. Stretching of tight hamstrings and quadriceps reduces the forces through the patella tendon. An exercise regime with a physiotherapist consisting of a special exercise programme (‘eccentric exercises’) can help improve the condition of the tendon. Occasionally the condition does not resolve with these measures and patients can be treated by sports physicians with a specialist interest in this condition. Further treatment options may include GTN patches and injections around the knee.

For more detailed information on surgical vs non surgical options, please download the following research paper.

- Surgical Treatment Compared with Eccentric Training for Patellar Tendinopathy (Jumper’s Knee)

In the rare cases that conservative measures are not sufficient to alleviate symptoms surgical treatment will be considered. Rarely there are cystic or nodular changes in the tendon which need to be excised.