CNY Orthopedic Sports Medicine, PC: TreatmentPrint: Patellar Tendonitis
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Injuries and Conditions: Patellar Tendonitis : Patellar Tendonitis : Treatment Options
 

Overview
The pain and discomfort associated with patellar tendonitis can vary widely from patient to patient and depends upon the severity of the condition. Some patients may experience minor soreness while others may experience very severe and debilitating pain. In each case, treatment is essentially the same, although the length of time required for recovery will vary according to the severity of the tendonitis.
  • Tendonitis does not require surgery; treatment is typically limited to the use of R.I.C.E. (Rest, Ice, Compression, Elevation) and occasional physical therapy.
  • Patients who seek treatment and follow therapy instructions can expect a full recovery, sometimes in less than three weeks.
  • Patients in which the bursae are also inflamed may require an aspiration of one or more of the involved bursae, a process in which some of the fluid is drained from the sac.
  • Identifying the activities that irritate the tendon, followed by modifying or eliminating these injury producing activities is the most critical step in treating the patient.

    Treatment options:

    ACL Patellar Tendon Graft Overview
    The ACL, unable to regenerate or heal itself, is replaced with a section of the patellar tendon, located on the front of the knee.

    Evaluation of Patient for Surgery

  • Patients are given a complete physical examination which provides an assessment of the patient's overall health.
  • An examination is given of the range of movement in both the injured and uninjured knee.
  • Strength and walking (gait) measurements and analysis.
  • Knee arthrometry is utilized to measure the tightness and stability of the knee.
  • Post Operative Recovery

  • Immediately after surgery, as anesthesia wears off, patients will usually feel tired and slightly disoriented, though the after-effects of anesthesia can vary greatly from patient to patient.
  • The knee will remain tender and painful after surgery. However, the pain will tend to decrease as pain killers are administered and the knee recovers from the operation.
  • Immediately following surgery, it is important that the knee obtains full extension. A continuous passive motion machine (CPM) may be used after surgery to help facilitate the movement of the knee, and the patient is given instructions on extension exercises for self-exercise at home.
  • At the first post-operative visit to the doctor, the sutures are removed, motion is examined, and the patient is directed to a physical therapist.
  • Braces are recommended until the patient has good control of the knee and can easily extend the leg and do deep knee bends without difficulty.
  • Close examination of the knee during the following 4-6 weeks is needed to ensure that the knee is correctly healing.
  • Patients should avoid putting a pillow under the knee. (This will tend to bend the knee and will prevent the full straightening of the joint)
  • More athletic activities like jogging are usually allowed after three months, though often only in a controlled environment as on a treadmill.
  • Sport-specific exercises are allowed according to their intensity level and strain on the recuperating knee.
  • Post Operative Instructions:

  • Wear the brace at all times, except when bathing or showering.
  • Bear weight as tolerated in the brace with the knee locked in full extension.
  • Use crutches as needed until stability returns.
  • Ice the knee three times a day for 20 minutes.
  • Keep the wound dry until the sutures are removed. If necessary, the dressing can be removed for showering (with the knee wrapped in plastic kitchen film) after 4 days.
  • Unlock the brace when using the continuous passive motion (CPM) machine doing exercises, or sitting.
  • Use the CPM machine for up to 8 hours daily. Start at 30 degrees. Progress in 5 degree as comfort allows. Discontinue using the CPM machine when the knee can bend to 90 degrees without using the machine.
  • Three times a day, for 30 minutes each time, sit with a large towel role under the heel with the brace locked in full extension.
  • It is normal to have some discomfort and swelling, as well as some blood-tinged drainage, following ACL surgery. If this becomes severe or the patients develops a fever, calf pain, shortness of breath, or chest pain, contact a doctor immediately.
  • Rehabilitation Program

    Surgical Procedure
    A torn ACL is usually difficult to stitch together after injury because the torn ends are frayed and difficult to manage. Most often, the torn ligament is completely replaced with material from the patellar tendon, though the ligament can also be supplemented with synthetic material. An arthroscope is inserted into the knee joint through a small incision in the skin. The arthroscope contains a tiny fiber optic camera and is used to project images onto a monitor which the doctor uses to view the inside of the knee. Fluid is introduced to the knee through another incision to clear away any blood and to distend the joint.

    A third incision is made to allow working instruments, such as scissors or a knife, into the joint. As the doctor views the interior of the knee from the monitor, he is able to work the surgical instruments with one hand while placing the arthroscope with the other hand. With scissors and a knife, the doctor removes the central third of the patellar tendon for reconstruction, along with an attached block of bone at each end.

    Using a drill guide, drill holes are placed in the tibia (lower leg bone) and femur (upper leg bone) near the site of the original ligament attachments. The graft (replacement ligament) is then placed through the hole and held in place with screws.

    Long Term Expectations for Recovery

  • A surgically rebuilt ACL which is rehabilitated properly will allow the patient to eventually regain complete strength, stability, motion, and control of the knee.
  • Patients that are in good physical condition are likely to recover within 7 months and will then usually be able to perform at previous levels of intensity.
  • Patients that are in poorer overall condition will also be able to return to previous activity levels, though rehabilitation and physical therapy will tend to be more lengthy and involved.
  • In all cases, physical therapy is required to restore the muscle strength, flexibility and balance lost during the injury and to acclimate the body to the repaired ligament.
  • Possible Complications and Risks

  • Risks during and after surgery include problems that may develop in relation to bleeding, the possibility of infection, and reactions to anesthesia.
  • Re-injury to the ACL is possible if physical therapy or other activities during rehabilitation are overly strenuous, causing damage to the recent tendon graft.
  • The patient may experience reduced mobility in the knee, even after the patient has followed physical therapy routines.
  • The knee may be subject to arthrofibrosis, the development of a fiber like material that the body sometimes generates in joints after injuries which can limit movement and cause stiffness.
  • Though the reconstructed ACL is often as strong as the original ligament, it will require a period of acclimation and will tend to remain robust if not subjected to abuse.
  • Conservative Treatment of Patellar Tendonitis Overview

  • After the activity or behavior that has caused the tendonitis is identified, modification or elimination of the injurious activity is required.
  • A period of rest is required to allow the tendon to heal and irritation to subside. This may vary from one to two days or as long as several weeks.
  • If the patient has a tendency for over-pronation of the feet, orthotics, or corrective inserts for shoes, may be recommended.
  • For severe injuries, a knee immobilizer and crutches may be recommended for use during initial treatment.
  • Ice packs around the knee are used to help reduce pain and swelling, usually for 20-30 minutes 4-6 times daily until the swelling subsides.
  • The use of a compression sleeve helps reduce and prevent further swelling.
  • Anti-inflammatory medication is sometimes administered to treat the pain associated with the inflammation.
  • More severe cases, where the bursae are very swollen, may be treated by aspirating the bursa to reduce pain caused by the accumulation of fluid.

    Medication and Medical Products
    Knee: Compression SleevesKnee compression sleeves give added support, increasing stability and helping to reduce swelling in an injured knee. Patients that have light sprains may be directed to use a compression sleeve during the early stages of rehabilitation. Other patients that have ongoing knee problems or chronic conditions may be recommended to use a sleeve on a daily basis. These sleeves are less restricting than most other knee supports and can be worn under loose fitting clothing.

    Knee compression sleeves can be used to treat:

  • Light swelling.
  • Light knee strains.
  • Chronic inflammation.
  • Degenerative joint disease.


  • Knee: Support A knee support is a sleeve-like support that fits firmly around the knee. The support is used to reinforce the joint during motion and provide compression to aid healing and reduce pain and swelling. Patients suffering from knee strains or inflammation will usually be directed to use a support during daily activities.

    The thin and flexible construction of the support allows for normal movement of the knee and also allows the support to be worn under loose fitting clothing. To prevent harmful pressure to certain structures, the support applies differing compression around the knee. The sides of the joint receive intermittent pressure to help stimulate blood flow while the rear of the support fits relatively loose to prevent constriction of circulation. The kneecap is aided in positioning, but remains free of compression to allow its natural movement.

    Knee supports can be used to treat:

  • Strains
  • Sprains
  • Inflammation
  • Chondromalacia patella

  • Hot/Cold Pack The use of hot and cold packs to relieve pain and inflammation is a common method of treatment for many conditions. When the soft tissue groups become strained or irritated the rotating application of hot and cold can be beneficial. Cold therapy numbs the nerves to reduce pain and combats swelling by constricting blood vessels and by slowing blood flow to the site of injury. The application of heat to an injury after a few days of cold therapy and after swelling and redness has been reduced promotes the healing process. Heat therapy speeds up healing by increasing the flow of blood to the site of injury. Heat will also restore flexibility, relieve muscle cramping, and arthritic symptoms.


    Long-Term Expectations for Recovery

  • Patients can expect a full recovery after treatment.
  • With moderate exercise to recondition the surrounding muscles and reduce stiffness after the injury, a patient may participate in athletic activities at their pre-injury level.
  • If the bursitis is a result of a common athletic activity, the patient may need to discontinue or modify the activity to prevent re-injury.

    Possible Complications and Risks

  • The tendonitis may recur if the patient returns to the injury producing habit or activity.
  • If the bursa is aspirated, the procedure may have to be repeated if fluid re-accumulates.

    Surgical Hardware Considerations

    This condition does not require surgical hardware.


    Factors in Transplant Source
    This condition does not require the transplanting of tissue.