CNY Orthopedic Sports Medicine, PC: InjuryDetail: Patellar Tendonitis
 
Injuries and Conditions: Knee: Patellar Tendonitis: Medical Details
 
Overview
Transferring the considerable power of the quadriceps muscle across the knee to the lower leg requires that the connecting tendon be substantial and able to withstand tremendous stress. The patellar tendon is the largest and strongest tendon in the knee, joining the knee cap (patella) to the shin. It is unique in that it joins a bone (the patella) halfway across its bridge, becoming the quadriceps tendon above the patella, and connecting the knee cap to the quadriceps muscle.

Because the patellar tendon joins bone to bone, it is technically a ligament. However, because it continues above the patella and joins a bone to a muscle it has commonly become known as the patellar tendon.

As the patella tendon moves, it is channeled and cushioned by bursae, tiny fibrous sacs that reduce friction as the tendon slides over bone. Under normal conditions, bursa remain as thin layers under the skin with only a minimal amount of fluid inside. A strong impact or injury triggers the sacs to fill with fluid, the bursae expand to help protect against further injury.

Causes of Injury
  • The condition is typically the result of repetitive leg motion, running or jumping and sudden stops that place repetitive and cumulative stress on the tendon.
  • Over-exertion while exercising or sudden increases in the intensity and duration of training or athletic activity.
  • Changes in training routines that considerably alter the type of leg work, such as changing from running on a flat surface to stair or incline running.



  • Diagnosis
    The diagnosis of patellar tendonitis is made through an examination of the knee. Tenderness over the patellar tendon is usually enough evidence to confirm the diagnosis. There may also be increased heat and swelling over the front of the knee. Pain may be associated with movements that place stress on the patella such as running, climbing or squatting.

    A tendency for over-pronation of the feet, producing additional stress on the patella during walking or running, may be additional factor leading to the development of this condition.

    Patellar tendonitis may occur in conjunction with bursitis. In these cases, inflammation is often visible through swelling of the bursa under the skin. In more severe cases, the bursa may be aspirated (drained of some of the fluid) to relieve both pressure and pain.

  • The bursae beneath the tendon can become inflamed and irritated as well through repetitive motions similar to those that irritate the tendon. This condition is known as bursitis.
  • Patellar tendonitis is common in runners or participants in sports like basketball or soccer that involve a great deal of running and jumping.

    Symptoms
  • Pain across the patellar tendon; most commonly at the tendon attachement point to the kneecap (patella).
  • Pain during movement of the leg, particularly while extending or straightening the leg.
  • Increasing pain during activities which require repetitive bending of the knee, such as climbing stairs, walking down hill or jumping and running.
  • Swelling and pain around the knee (visible swelling is fairly uncommon).
  • Anatomy
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     Product Considerations
    Knee: Patellar Supports
    Patella tracking supports are used to maintain the kneecap in its proper position while the knee is in motion. Patients that have a poorly tracking or misaligned kneecap will usually be directed to wear a support to prevent the kneecap from dislodging from the femural groove. Pressure applied by the support is adjustable, allowing changes to the support according to the condition of the knee. The support fits firmly around the knee with pressure to each side of the kneecap. Construction of the support is thin and elastic, which allows for easy movement and enables the support to be worn under loose fitting clothing.

    Patella tracking supports can be used to treat:

  • Patellar malalignment
  • Patellar dislocation
  • Patellar instability
  • Anterior knee pain

  • Knee: Patellar Tendon Brace
    Patellar Tendon Braces are designed to provide stress relief to the patellar tendon. Patellar tendonitis is an inflammation of the patellar tendon, usually at the insertion site where the patellar tendon attaches to the tibia. These braces apply pressure over the patellar tendon just above or proximal to the insertion site. By applying pressure above the area where the tendon attaches to the tibia, the end point for the tendon is changed. This new end point now bears the stress of the patellar tendon during activity. This allows the inflamed insertion site to rest.

    Patellar Tendonitis is common among jumpers because of the stress that is applied to the tendon during this activity. Patients that have patellar tendonitis may be directed to wear a brace to allow the tendon to rest during activity. The role of a patellar tendon brace is to relieve the stress placed on the patellar tendon and its insertion site during activity.


    Knee: Cold Therapy
    Cold therapy is used to reduce pain and swelling and is a convenient method to apply cold to an injured or rehabilitating extremity, such as a knee or shoulder. A cuff fits like a sleeve around the extremity and utilizes cold water supplied by a connected thermos or canister to chill the extremity. Water flow into the cuff can be controlled by different mechanisms. The simplest way is gravity; elevating the canister fills the cuff and controls the amount of pressure against the extremity. Water flow may also be controlled by a pump which will automatically circulate the cold water to and from the cuff. After surgery or immediately following an injury, the canister should be refilled with cold water every one to two hours to maintain a proper temperature. The cold therapy may also be used during rehabilitation, especially after physical activity, reducing the inflammatory heat from exercise.

    Cold therapy can be used to treat: Knee, Shoulder, Elbow, Wrist and Hand, Back, Hip, and Foot & Ankle Injuries.

    Knee Examples include:

  • Pre-operative ACL/PCL injuries.
  • Non-surgical ACL/PCL injuries.
  • General knee pain or swelling.
  • Soft tissue injuries.


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