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Etiology:
• Repetitive stress: Frequent jumping, landing, and rapid changes in direction
• Biomechanical factors: Muscle imbalances, poor alignment, or abnormal patellar tracking
• Training errors: Sudden increases in training intensity or volume
• Surface factors: Training on hard surfaces
• Genetic predisposition: Variations in tendon structure or healing capacity
Risk Factors:
• Sports participation: Basketball, volleyball, soccer, tennis, track and field
• Age: More common in younger athletes (15-30 years)
• Gender: Higher prevalence in male athletes
• Body composition: Increased body weight or BMI
• Previous injury: History of patellar tendinopathy or other knee injuries
Clinical Presentation:
• Pain: Localized to the inferior pole of the patella
• Onset: Gradual, often worsening with activity
• Aggravating factors: Jumping, landing, squatting, or prolonged sitting
• Stiffness: Particularly after periods of inactivity
• Functional limitations: Decreased performance in sport-specific activities
Physical Examination:
• Inspection: Swelling or thickening of the patellar tendon
• Palpation: Tenderness at the inferior pole of the patella
• Range of motion: Usually preserved, but may be painful
• Strength testing: Quadriceps weakness or pain with resisted knee extension
• Special tests:
– Single-leg decline squat test
– Victorian Institute of Sport Assessment (VISA) score
– Patellar tendon ultrasound
Imaging:
• Ultrasound: First-line imaging modality
– Reveals tendon thickening, hypoechoic areas, and neovascularization
• MRI: Useful for differential diagnosis and assessing severity
– Shows tendon thickening, increased signal intensity, and bone marrow edema
Differential Diagnosis:
• Patellofemoral pain syndrome
• Osgood-Schlatter disease (in adolescents)
• Quadriceps tendinopathy
• Infrapatellar fat pad impingement
• Meniscal tears
• Chondromalacia patellae
Management:
1. Conservative Treatment:
• Load management: Modify training volume and intensity
• Eccentric exercises: Focused on quadriceps strengthening
• Isometric exercises: For pain relief and tendon adaptation
• Flexibility: Stretching of quadriceps, hamstrings, and calf muscles
• Biomechanical correction: Addressing muscle imbalances and movement patterns
• Modalities:
– Ice therapy for acute pain relief
– Extracorporeal shock wave therapy (ESWT)
– Low-level laser therapy
• Bracing or taping: To offload the patellar tendon
2. Pharmacological Interventions:
• NSAIDs: For short-term pain relief, used cautiously
• Topical agents: Diclofenac gel or patches
3. Injection Therapies:
• Corticosteroid injections: Generally avoided due to potential tendon weakening
• Platelet-rich plasma (PRP): Emerging evidence for its efficacy
• Autologous blood injections: May promote healing
4. Surgical Intervention:
• Reserved for cases refractory to conservative management (6-12 months)
• Techniques:
– Arthroscopic debridement
– Open tenotomy and repair
– Ultrasound-guided percutaneous tenotomy
Rehabilitation:
• Phase 1: Pain control and protection
– Relative rest, ice therapy, isometric exercises
• Phase 2: Progressive loading
– Eccentric exercises, closed-chain exercises
• Phase 3: Sport-specific training
– Plyometrics, agility drills, return-to-sport protocols
Return to Sport:
• Criteria-based progression:
– Pain-free full range of motion
– Restored strength (>90% compared to unaffected side)
– Successful completion of sport-specific drills
• Gradual return: Phased reintroduction to training and competition
• Ongoing monitoring: Regular assessment of symptoms and load tolerance
Prevention Strategies:
• Proper warm-up and cool-down routines
• Gradual progression of training intensity and volume
• Regular strength and flexibility training
• Attention to proper technique in jumping and landing
• Adequate recovery between training sessions
• Use of appropriate footwear and playing surfaces
Patellar tendinitis remains a challenging condition in sports medicine. A comprehensive approach involving accurate diagnosis, tailored treatment plans, and structured rehabilitation is essential for optimal outcomes. Emphasis on prevention strategies and early intervention can significantly reduce the impact of this condition on athletic performance and long-term joint health.
Future Directions: Ongoing research in tendon biology and novel treatment modalities, such as stem cell therapies and tissue engineering, may provide additional options for managing recalcitrant cases of patellar tendinitis. Continued focus on biomechanical analysis and personalized rehabilitation protocols will likely improve outcomes and reduce recurrence rates in the athletic population.
©2025 Dr Frank McCormick All Rights Reserved.
©2025 Dr Frank McCormick All Rights Reserved.
