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Patellar tendonitis — Clinical Guidelines

Overview

Patellar tendinitis, also known as jumper's knee, involves inflammation and microtearing of the patellar tendon, typically due to repetitive overloading in athletes 15.

Diagnosis

Clinical presentation includes localized pain around the patellar tendon, especially with activities like jumping or squatting 8.

Thigh strength deficits and flexibility issues may be observed 8.

Radiographic imaging (X-rays) can rule out other conditions; MRI may be used to assess tendon integrity 5.

Grading systems often classify severity based on symptoms and functional impairment 15.

Management

First-line treatments:

- Conservative management including rest, ice, compression, and elevation (RICE protocol) 15. - Physical therapy focusing on strengthening quadriceps and improving flexibility 8.

Adjunctive treatments:

- Low-intensity pulsed ultrasound (LIPUS) shows promise in managing symptoms 7. - Cryoultrasound therapy and other modalities like laser therapy may be considered for pain relief 9.

Advanced interventions:

- Corticosteroid injections may be used cautiously due to potential tendon weakening 15. - Surgery, including debridement or tenotomy, considered in refractory cases 15.

Special Populations

Pediatrics: Young athletes may exhibit patellar instability or pain with specific physical stigmata like vastus medialis deficiency 16.

Elderly: Management focuses on conservative approaches with caution in prescribing high-impact exercises 15.

Comorbidities: No specific guidance provided in abstracts; individualized treatment plans are recommended 12.

Key Recommendations

Initiate conservative treatment with physical therapy and activity modification for patellar tendinitis (Evidence: Moderate 8 15).

Consider low-intensity pulsed ultrasound as an adjunctive therapy for symptom management (Evidence: Moderate 7).

Reserve surgical interventions for cases refractory to conservative management (Evidence: Weak 15).

Tailor rehabilitation programs to address strength deficits and flexibility issues observed in affected individuals (Evidence: Moderate 8).

Avoid iatrogenic complications like patella baja during surgical interventions by carefully adjusting tension on fixation devices (Evidence: Expert opinion 13).

References

1 Liu W, Jiang F, Han C, Yu G, Shi B, Sun J. Construction elements and preliminary framework of a sport-medicine-education collaborative intervention model for patellar tendinopathy. Frontiers in public health 2026. link 2 Chang CW, Chen YN, Chang HC, Li CT. Biomechanical comparison of different screw-included angles in crossing screw fixation for transverse patellar fracture in level walking: a quasi-dynamic finite element study. Journal of orthopaedic surgery and research 2023. link 3 Chen CH, Chen YN, Li CT, Chang CW, Chang CH, Peng YT. Roles of the screw types, proximity and anterior band wiring in the surgical fixation of transverse patellar fractures: a finite element investigation. BMC musculoskeletal disorders 2019. link 4 Lubowitz JH. Editorial Commentary: Operative Treatment of Patellar Dislocation. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association 2015. link 5 Neumann MV, Niemeyer P, Südkamp NP, Strohm PC. Patellar fractures--a review of classification, genesis and evaluation of treatment. Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca 2014. link 6 Korakakis V, Patsiaouras A, Malliaropoulos N. Cross-cultural adaptation of the VISA-P questionnaire for Greek-speaking patients with patellar tendinopathy. British journal of sports medicine 2014. link 7 Warden SJ, Metcalf BR, Kiss ZS, Cook JL, Purdam CR, Bennell KL et al.. Low-intensity pulsed ultrasound for chronic patellar tendinopathy: a randomized, double-blind, placebo-controlled trial. Rheumatology (Oxford, England) 2008. link 8 Crossley KM, Thancanamootoo K, Metcalf BR, Cook JL, Purdam CR, Warden SJ. Clinical features of patellar tendinopathy and their implications for rehabilitation. Journal of orthopaedic research : official publication of the Orthopaedic Research Society 2007. link 9 Costantino C, Pogliacomi F, Vaienti E. Cryoultrasound therapy and tendonitis in athletes: a comparative evaluation versus laser CO2 and t.e.ca.r. therapy. Acta bio-medica : Atenei Parmensis 2005. link 10 Corfield AR, Stevenson J. Vertical patellar dislocation: a case report. European journal of emergency medicine : official journal of the European Society for Emergency Medicine 2004. link 11 Paxton EW, Fithian DC, Stone ML, Silva P. The reliability and validity of knee-specific and general health instruments in assessing acute patellar dislocation outcomes. The American journal of sports medicine 2003. link 12 Grelsamer RP, Cartier P. Comprehensive approach to patellar pathology. Contemporary orthopaedics 1990. link 13 Madhok R. Tips of the trade #18. How to avoid iatrogenic patella baja. Orthopaedic review 1989. link 14 Kujala UM, Osterman K, Kvist M, Aalto T, Friberg O. Factors predisposing to patellar chondropathy and patellar apicitis in athletes. International orthopaedics 1986. link 15 Martens M, Wouters P, Burssens A, Mulier JC. Patellar tendinitis: pathology and results of treatment. Acta orthopaedica Scandinavica 1982. link 16 Reider B, Marshall JL, Warren RF. Clinical characteristics of patellar disorders in young athletes. The American journal of sports medicine 1981. link

Patellar tendonitis