A Complete Overview of Patellar Tendonitis

Patellar tendinitis is an inflammation of the patellar tendon, which runs between the kneecap and the tibial tuberosity. For its diagnosis and treatment, all conditions have been created at the Yusupov Hospital:

• European level of comfort;
• Equipment from leading global manufacturers;
• Individual approach to the choice of therapeutic tactics for each patient;
• Application of modern surgical treatment methods according to indications;
• Attentive attitude of medical staff towards patients and their relatives.

The patellar tendon plays a key role in the use of the muscles of the lower extremity. It allows you to straighten your knee, allowing you to push a ball, jump and run uphill. Tendonitis of the patellar ligament most often occurs in athletes involved in sports that involve frequent jumping: volleyball, basketball. Knee tendinitis can also develop in people who do not exercise. After an unsuccessful turn of the leg, they may develop a partial rupture of their own patellar ligament and an inflammatory process may occur.

Symptoms of patellar tendinitis

The first sign of patellar tendonitis is pain. It is usually localized in the area that is located between the patella and the attachment of the tendon to the tibia. Pain in the knee joint initially appears only during physical activity or after intense exercise. It can intensify to such an extent that it reduces sports and physical activity. Ultimately, the patient is unable to climb stairs or get out of a chair independently.

If you ignore the warning signals the body is sending and try to continue working, the tendon rupture will increase. Pain localized in the patella area intensifies with flexion and extension of the knee, or displacement of the kneecap by hand. Swelling appears in the area of ​​the knee joint, limitation of movements, and a feeling of weakness in the thigh muscle. If factors that contribute to the development of patellar tendonitis are not addressed, knee pain and decreased function may persist. In this case, the disease will progress and patellar tendinopathy will develop. If pain in the knee joint occurs, it is necessary to implement self-help measures, namely: apply an ice pack to the affected area and temporarily reduce the activity that causes pain, or completely abandon it.

Four stages of the disease

Pathology can develop in 4 phases:

1. Initial stage – pain occurs only after physical activity.
2. Pain and (or) discomfort bother the patient “before” and “after” sports activity.
3. Pain accompanies physical activity and remains after it.
4. Due to degenerative changes, the patellar ligament ruptures.

If the disease is detected at an early stage, ligament rupture can be avoided by following all the instructions of the attending physician.

Diagnosis of knee tendinitis

If pain after a knee ligament injury persists or worsens, interferes with your ability to perform daily activities, or is accompanied by swelling or redness around the joint, you should consult a doctor. He will conduct a physical examination and determine the degree of dysfunction of the knee.

To examine the severity of the tear and determine whether the kneecap is in the correct position, the doctor will order an x-ray or magnetic resonance imaging. Using ultrasound, changes in the tendons and the patellar ligament are detected. This allows for a timely implementation of a set of conservative measures aimed at preventing tendinitis of the knee joint.

Classification

Depending on the nature and location of injuries to the patella and its structures, they are divided into several main types. Depending on the nature of the injury, there are:

• A fracture of the bone base, which can be with or without displacement of bone fragments. A comminuted fracture with the formation of several bone fragments is distinguished separately.
• A dislocation of the kneecap, which is usually accompanied by a torn ligament.
• Sprain and damage to the patellar ligament.

A common injury is injury to the patellar retinaculum (the main ligament that stabilizes the bony base of the kneecap). In this case, the medial suspensory ligament of the patella is predominantly injured. Damage to the structures of the ligamentous apparatus can be isolated or combined with other injuries (fracture or dislocation).

Thus, damage to the medial retinaculum of the patella is accompanied by dislocation and damage to the cartilaginous structures, the internal meniscus of the knee, collateral ligament and tendons of the femoral muscles are injured. Injury to cartilage structures is called osteochondral damage to the patella and is usually a consequence of degenerative pathological processes in cartilage tissue (osteoarthrosis).

Treatment of tendonitis of the patellar tendon

The main principle of treatment for tendonitis of the patellar tendon is its early onset. Tendons and ligaments have fairly poor nutrition. Over time, pathological changes occur in their tissue, which worsens the prognosis for recovery. Rheumatologists prescribe the following conservative treatment for patellar tendinitis:

• Unloading the knee by using a knee brace or fixing bandage;
• Limitation of physical activity;
• Cold on the joint during the first 24 hours after the onset of pain;
• Non-steroidal anti-inflammatory drugs for pain relief;
• Troxevasin ointment to reduce swelling in the joint area.

In the acute stage of the disease, the patient is recommended to lie down with a cushion under his leg. You can move around using a cane. In severe cases, injections of glucocorticoids into the source of pain are used. This technique is not used to treat athletes, since hormonal drugs can cause progression of degeneration of the patellar ligament and lead to its rupture under load.

Surgical methods for the treatment of tendinitis of the knee joint ligaments are resorted to in the absence of a positive result from conservative therapy carried out for 1.5 - 3 months. During the operation, the patellar ligament is inspected, the damaged tissue is carefully excised, and the ligament is fixed with a special screw to the tibia.

Disease prevention

To avoid the development of mechanical tendinitis, certain rules should be followed:

1. Avoid putting excessive stress on your knee joints.
2. Don't increase the intensity or frequency of your workouts too suddenly.
3. Jogging should only be done on special paths or on a dirt road, but not on asphalt.
4. Always treat any bruises or sprains to the end. If you stop following your doctor's instructions once the pain goes away, the smoldering inflammation inside the joint may remain and eventually lead to tendonitis.
5. Recover properly after intense sports activities: take hot baths with eucalyptus or sea salt, go to the bathhouse, or have a massage.
6. It will be useful to apply therapeutic mud to your knees, so it is recommended to visit sanatoriums that provide this opportunity.

To prevent degenerative tendinitis you should:

• Even in the absence of the disease, perform the therapeutic exercises described in the article above. Before doing this, be sure to consult your doctor to make sure there are no contraindications.
• To strengthen ligaments and tendons, drink enough clean water (30 ml per 1 kg of body, for example, if you weigh 70 kg, you need 2.1 liters of water per day).

Dietary recommendations

To avoid the disease, you must:

• there are foods that help strengthen ligaments and tendons;
• exclude from the menu foods that adversely affect them.

Such nutrition will help maintain the health of the musculoskeletal system and avoid not only tendinitis, but also osteoporosis, arthritis and other diseases.

If you don’t know how to include foods that you need to eat in your diet and what to replace those that are not recommended for consumption, then it is better to contact a nutritionist to formulate a detailed nutrition plan.

This is especially important if you play sports, since your body, due to increased stress, requires exclusively proper and balanced nutrition.

Rupture of the patellar ligament[edit | edit code]

Numerous studies have been published in the literature on the results of treatment of patellar ligament ruptures. Currently, early surgery is considered the only favorable prognostic factor. In addition, success is more likely in young and physically fit patients with an isolated rupture than in older people or those with associated injuries. Sivek and Reio compared the results of early (within 7 days) and late (7 days after injury) surgical treatment and found that the former was significantly better in terms of range of motion and strength. Although some atrophy of the quadriceps muscle and a slight decrease in range of motion (up to 10%) are possible after surgery, it has been shown that 66-100% of patients had good or excellent

results, although among amateur athletes not all return to the original level of stress. Most studies use circumferential ligature or wire reinforcement of the ligament. A retrospective comparison of polydioxanone suture and wire bonding showed no significant differences.

Patellofemoral joint osteoarthritis or incongruity were not found to influence outcome. Although patellofemoral joint pathology is associated with generally worse outcomes, many asymptomatic cases also have radiographic evidence of incongruity or osteoarthritis. Therefore, it is possible that incongruity is not the only reason for the poor outcome. Contrary to evidence of the benefits of early mobilization, none of the studies found significant improvement with early mobilization compared with delayed mobilization. In general, the best results appear to be achieved with early treatment, in athletes who are in good physical condition or have undergone careful postoperative rehabilitation, and in the absence of significant atrophy of the quadriceps femoris muscle.

There are only a few clinical observations on the results of late surgery. Complex methods of restoration have been described, including primary suturing, supplemented by the use of autografts (fascia lata or posterior thigh muscles) or allografts. Late operations with preoperative stretching or intraoperative extension of the ligament using an allograft or autograft seem to give worse results.

General information

Knee injuries

– occupies a leading place among other injuries. This position is associated with the features of the normal anatomy (structure) and physiology (load) of the knee joint. Most injuries occur from falls and impacts. The resulting injuries are usually minor bruises, so treatment is carried out by a traumatologist on an outpatient basis. Amateur and professional athletes also often injure the knee. Their knee joint injuries are much more serious.

Less frequently reported are cases of knee injuries in road accidents, falls from height, and at work. For patients who are involved in such an incident, damage inside the joint is typical. They are characterized by the fact that the integrity of the anatomical structure is violated. Relief of symptoms and restoration of the structure occurs in the trauma department of a medical institution. In addition to a knee joint injury, there may also be a TBI (traumatic brain injury), fractures of other bones, and organ ruptures.