After injuries, severe physical activity or various diseases of the knee joint, the ligaments and tendons that attach the patella often become inflamed. This disease is called knee tendinitis. Tendons are most often affected where they attach to bones.
The inflammation mainly affects the ligaments that help to straighten the leg. They are located at the bottom of the patella and are attached to the tibia. The disease develops as a result of microtraumas to the ligaments. Due to heavy physical activity, small tendon ruptures occur. If they do not have time to recover, they become inflamed.
There is acute tendinitis of the knee joint, which develops as a result of injury or infection of the ligaments. If there is salt deposits in the joint, a chronic form of the disease occurs. The disease may be accompanied by bursitis - inflammation of the joint, tendinosis - inflammation of the surrounding soft tissues. Due to the inflammatory process, the strength of the ligament decreases as the disease progresses, so with any careless movement it can tear.
The disease can affect a variety of people, regardless of age and gender. But most often, athletes who constantly expose the knee to increased physical activity suffer from inflammation. Therefore, the joint affected by tendonitis is also called “jumper’s knee.” But inflammation can also develop for other reasons:
Pain first appears with increased physical activity
The main symptom of knee tendonitis is pain. In most cases, the disease goes through several stages. At first, pain appears only after heavy exertion, then after any work or even walking. It is especially noticeable when extending the leg: while climbing stairs or standing up. At the last stage, the pain becomes more severe and bothers the patient even at rest.
In addition to this symptom, the presence of the disease can be judged by other signs:
To prescribe the correct treatment, it is important to accurately determine the cause of inflammation, the stage and nature of the disease. For this, in addition to an external examination, the doctor prescribes various examination methods:
It is necessary to distinguish the disease from arthritis, with which it has similar symptoms. But with arthritis, the pain is constant, diffuse. Tendinitis causes localized pain, mainly with movement.
Drug injections help relieve pain and inflammation
The modern level of development of medicine makes it possible to completely cure inflammation of the ligaments without serious consequences. But for this you need to consult a doctor in time and follow all his recommendations. Treatment of tendinitis in the first stages of its development can be achieved by the following methods:
In the acute stage of the inflammatory process and severe pain, immobilization of the knee is necessary for some time. To reduce the load on the patellar ligaments, taping, wearing special orthoses or plaster casting are used. This helps relieve pain and prevent ligament damage. In the initial stages of the disease, it is enough to limit running, jumping, not kneeling, and less often climbing stairs.
Physiotherapeutic techniques are often used in the treatment of tendonitis
Medicines help relieve pain and reduce inflammation, but this is only an auxiliary treatment method. The most commonly prescribed non-steroidal anti-inflammatory drugs are: Ibuprofen, Naproxen, Piroxicam, Indomethacin. They can be used in the form of tablets, injections or ointments.
If after two weeks of therapy there is no improvement, more serious drugs are used - corticosteroids. In severe cases of the disease, the introduction of platelet-rich plasma can be used. This promotes faster regeneration of tendon tissue.
In case of infectious tendinitis, the use of antibacterial drugs is indicated.
Such methods are used as adjuvant treatment. This can be ingestion of various decoctions or tinctures, compresses or applications to the joint area. After consulting with your doctor, you can use the following remedies:
It must be remembered that heating and compresses are done only if there is no redness or swelling of the joint, and it is not hot to the touch.
Special exercises are needed to restore ligament mobility
Special exercises that strengthen muscles and ligaments are effective. Most of them should be aimed at stretching the quadriceps muscle. Yoga classes under the guidance of an instructor and swimming are very effective. The following exercises are useful:
It is very important that the increase in intensity of exercise is gradual. A return to normal activities, especially for athletes, is possible only after the complete disappearance of pain and inflammation.
It is important to avoid heavy loads and give your knees rest when playing sports.
Most often, massage is prescribed for knee tendinitis. It effectively relieves pain, helps heal and restore ligaments. In addition, the doctor may prescribe iontophoresis, UHF, magnetic therapy, electrophoresis, and paraffin baths. But warming procedures are contraindicated for rheumatoid arthritis, so they are used only after an accurate diagnosis of the causes of the disease.
It is necessary at the last stage of the disease, when a tear or complete rupture of the ligament has occurred. The operation also helps to remove cysts, eliminate vasoconstriction and other degenerative changes in the tissues of the knee. Tendon length correction is often performed to help restore quadriceps function. Rehabilitation after surgery is long, the patient can return to normal life in 3-4 months.
Treatment of ligament inflammation takes a long time, pain interferes with the normal course of life, and complications can lead to disability. Therefore, it is necessary to know how to prevent the development of tendinitis. To do this, you need to protect the knee joint from excessive and monotonous loads, and periodically give the muscles and ligaments rest when playing sports.
Athletes and people who perform monotonous leg movements or stay in one position for a long time are at risk for tendinitis. To prevent tendon inflammation, it is important to dose physical activity. If you experience pain in your knee, you should consult a doctor so that treatment can begin on time. Then after 1-2 months the functionality of the knee will be restored.
Knee movement and stability are possible thanks to the coordinated work of its five ligaments:
In addition to the unpleasant situations associated with direct injury to the knee (torn ligaments, dislocation or fracture), another danger arises - tendonitis of the knee joint (inflammation of the tendons and ligaments). The most common diagnosis is tendonitis of the patellar tendon.
The ligament proper continues the quadriceps femoris tendon and attaches it anteriorly to the tibial tubercle located below the kneecap.
This original structure makes the knee joint unique: it provides not only motor functions, but also works on the principle of a lever-and-block mechanism, multiplying the efficiency of the quadriceps muscle:
The patella itself can be considered a block, and its own ligament can be considered a long arm of a lever.
Knee tendonitis is caused by either mechanical or degenerative causes.
The first type (mechanical) is associated with sports or professional activities:
The greatest tension always appears at the place of attachment of the ligament, and, consequently, tendonitis develops mainly at the place of its fixation to the patella or the tibial tubercle (the first is more common). Thus, it is more appropriate to consider it not tendinitis, but enthesitis.
Precipitating factors for tendinitis are:
The second type of tendinitis is age-related and is associated with aging of the ligaments and degenerative changes in them:
Ligament degeneration can be caused by:
In a weakened ligament, the process of regeneration simultaneously occurs - the restoration of degeneratively changed areas:
Knee tendinitis goes through four stages:
The rupture occurs naturally: chronic inflammation in the ligament leads to its structural changes, reducing mechanical strength. If the rupture did not occur due to a normal injury, but due to tendonitis, then it is considered a complication of tendonitis.
To clarify the diagnosis, an x-ray of the knee is taken: frontal and lateral projection.
X-rays can reveal fatigue microtraumas, areas of ossification and calcification.
Please note that knee pain can occur for many reasons:
Closer examination of localized areas of the ligament or meniscus may require precise examination using computed tomography or magnetic resonance imaging.
In the first two stages, conservative treatment is used:
It is better not to use intra-articular local injections of NSAIDs or glucocorticosteroids for knee tendonitis, as they contribute to the development of ligament atrophy.
All these drugs give a temporary effect and have many side effects, especially for the gastrointestinal tract.
The main method of treating knee tendonitis is exercise therapy with exercises for hyperextension and strengthening of the quadriceps and posterior muscles.
They take a long time to perform (sometimes several months), but the effect of the exercises is very good - they allow you to cure tendinitis and resume training or work in full mode.
Another type of conservative non-drug treatment is taping.
The point of taping is to use special tapes that relieve the ligament.
There are different types of taping:
Just like taping, wearing orthoses helps to relieve the knee ligament, but it is not placed directly on the kneecap, but a little lower.
Tendonitis of the knee joint of the third or fourth degree is difficult to eliminate conservatively, and then surgical treatment may be required.
Arthroscopy is often used, a method in which an instrument is inserted through small punctures under the supervision of a microscopic video camera and the damaged areas are removed. In this way it is possible to delete:
Cysts and other formations require open surgery.
But these methods can lead to weakening and rupture of the ligament in the future. At the fourth stage, the preferred operation is plastic reconstruction.
Sometimes surgeons resort to other types of operations:
These exercises are very effective for knee tendinitis:
Quadriceps stretching exercises:
Exercises for the posterior thigh muscles:
Video: Self-healing knee tendinitis.
Tendonitis is inflammation of a tendon where it attaches to a bone. Tendinitis is characterized not only by inflammatory, but also by degenerative processes in the tendon tissue. Often other diseases develop at the same time. For example, tendinitis can be accompanied by tenosynovitis - inflammation of the tendon sheath or tenobursitis - inflammation of the tendon bursa.
Tendonitis can occur anywhere on the body and at any age. The hip, shoulder, elbow, and hands are most often affected. In children, tendonitis of the patellar ligament occurs mainly. The patellar ligaments are located between the kneecap and the lower leg.
With constant physical activity, the body (in particular, muscles) does not have time to recover. At a critical moment, inflammatory and degenerative processes are launched. In other words, the main causes of tendonitis are overload and microtrauma of the joints. Professional athletes and people involved in hard work often experience muscle tendon tendonitis. At risk are older people whose bodies are exhausted. After 40 years, natural aging processes begin and it becomes more difficult to cope with stress.
Other causes of tendinitis include:
Recently, neuropathies and stress conditions have also been considered as causes of tendonitis.
Clinical symptoms of tendonitis: pain (prolonged, sudden or increasing, worsens with movement), redness and swelling of the affected joint (exudate is often released, causing the joint to change shape and size), limited movement (from slight impairment of functionality to complete immobility), crunching sound when moving. Crunching and swelling are signs of tendivitis and tenosynovitis.
Tendonitis can be acute or chronic. Tendonitis is also classified depending on the location of the inflammation. The most common of them are tendinitis of the knee joint or tendinitis of the patellar ligament. Diagnosis is difficult as it can be confused with other problems (for example, a common sprain). Tendinitis has 4 stages of development (from minor pain to rupture of the ligament above the knee, in which case surgery to replace the ligament is necessary). Knee tendinitis is common among track and field athletes.
Shoulder tendinitis. Shoulder discomfort worsens in the late hours and interferes with restful sleep. Without treatment, tendinitis progresses, making it difficult to lift your arm or simply fasten a button. If you do not work on the damaged joint, the shoulder muscles may atrophy.
Heel tendonitis. Heel pain, ankle swelling, skin redness. Moreover, symptoms may appear in the morning, then disappear and reappear after a while. Wild pain when rising on your toes means the last stage - tendon rupture.
Ossifying tendinitis. This type occurs most often in older people. At first (when the crystals are just deposited), the pain is slight (can occur on the tendon of any muscle). Over time, with tendonitis ossificans, the pain intensifies (especially at night), and the joint becomes impossible to move.
Tendinitis of the elbow joint. It is divided into lateral and medial. Lateral tendonitis affects the muscles that extend the wrist (called tennis elbow). Pain on the outer surface of the elbow, radiating to the shoulder; over time, the hand weakens so much that it is difficult to even hold an object in the hand. Medial tendinitis affects the muscles that flex the forearm (called golfer's elbow). It affects those who, due to their activities, often perform monotonous rotational movements with their hands. The pain is localized on the inside of the elbow.
Tendinitis of the hip joint. It develops slowly, but over time the gait changes and lameness may appear. A special symptom: pain in the joint during movement either decreases, then becomes stronger, then disappears again.
The first step is to prescribe analgesics and anti-inflammatory drugs. This will help make the patient feel better. Next, it is important to eliminate the cause of the disease. Without this, it is impossible to cure tendonitis. Rest, ice packs, and fixing bandages are indicated in the treatment of tendinitis caused by injury. These measures eliminate the destructive factor on the joint. To restore damaged and inflamed joint tissue, physiotherapy is indispensable in the treatment of tendon tendinitis. Exposure to ultrasound, laser or magnet, mud and paraffin baths relieve swelling and improve blood circulation. Massage and exercise therapy help stretch and strengthen muscles and their ligaments.
Hardware techniques are an important element in the treatment of tendinitis, acting at the causal level and helping to prevent relapses. With a competent approach to the treatment of tendonitis, improvement occurs within a couple of days. Belozerova’s clinic has techniques that allow you to relieve pain on the day of treatment. It takes about a month for complete recovery.
Anatomy of the knee joint and injuries that cause inflammation of the ligaments (tendonitis), ruptured ligaments, menisci, fractures, inflammation of the joints, etc. can be found in the “ Injuries ” section.
This is inflammation of the tendon. In this case, the tendon connecting the patella and the main bone of the lower leg (tibia) becomes inflamed. This tendon plays a key role in the straightening movements of the lower leg. The movements of the lower leg performed when hitting a ball, riding a bicycle and jumping high are carried out by the thigh muscles with the help of this tendon.
There are many reasons leading to inflammation of the ligament, among which injuries and their constant impact are of paramount importance. This is why patellar tendonitis occurs in athletes and in people engaged in intense physical activity involving the work of a group of muscles of the knee joint. A number of scientists imply the development of this pathological process as a complication of degenerative changes that are more typical in old age.
Like many other inflammatory processes in our body, the leading place in clinical symptoms is pain, taking into account varying intensity and duration. In the first stages, patients are bothered by barely noticeable pain, which often appears in the evening hours after excessive exercise. Gradually the pain intensifies and occurs in the midst of “complete well-being”, at rest. The temperature during tendonitis practically does not rise; most often this occurs when the inflammatory process generalizes and involves neighboring anatomical structures. It should be noted that a frequent and, unfortunately, very dangerous complication for the patient is rupture of the patellar ligament.
Patellar tendinitis does not immediately and unambiguously lead to rupture of the ligament, but the gradual inevitable progression of inflammation implies a weakening of those structures that were involved in the inflammation.
Treatment for patellar tendinitis depends on the stage of the disease. The first and second stages, as a rule, respond well to conservative treatment, i.e. non-surgical treatment. It includes:
If patellar tendonitis persists and pain persists despite adequate treatment, surgery may be required.
Of course, treatment of patellar tendonitis in this case seems to be more prognostically favorable, which promises a speedy discharge for the patient and a return to their previous work routine.
Many surgeons, when operating for chronic tendinitis, always prefer to resect, i.e. shorten the lower pole of the patella, assuming that there is always impingement (pinching) of the patellar ligament with tendinitis. In general, there is no need to be afraid of open knee surgery, although such treatment for patellar tendonitis is delayed and causes more noticeable discomfort for the patient. Again, if the situation is inevitable and clinical therapy is ineffective, it is necessary to prevent complications, namely rupture of the very ligament , which will inevitably require surgical intervention. Based on this, it is much more rational to prevent consequences than to treat them at the height of the disease.
You can view knee joint rehabilitation exercises
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The powerful patellar ligament runs from the patella ("kneecap") down and attaches to the tibial tuberosity. In its biomechanical essence, this ligament is a continuation of the tendon of the quadriceps femoris muscle, which extends the leg at the knee and raises the straightened leg. The quadriceps tendon attaches to the top of the patella, and the patellar ligament originates from the bottom.
When moving the knee joint, the patella begins to work as a block, increasing the efficiency of the extensor force of the quadriceps femoris muscle. Sometimes the patellar ligament is called the patellar ligament .
The blood supply to the patellar ligament comes from the infrapatellar fat pad (Hoff's body), as well as from the suspensory ligaments through the anastomoses of the lateral inferior knee artery.
As the leg bends at the knee joint, the patella slides upward along the intercondylar groove of the femur, turning the patellar ligament into a long lever arm. The points of attachment experience the greatest stress and deformation, not the middle part of the ligament.
Tendinitis is inflammation of a ligament. The term is derived from the Latin word tendo (tendon) and the ending itis, which means inflammation. From a philological point of view, inflammation of the patellar ligament should be called ligamentitis (from the Latin word ligamentum - ligament), and not tendinitis. Currently, both the terms tendonitis and ligamentitis can be found in the literature, and they occur with approximately the same frequency.
There are two types of patellar tendinitis. The first type occurs in athletes or young physically active people. The disease is then called "jumper's knee" or Blazina's disease, after the surgeon who coined the term "jumper's knee" in 1973. However, of course, they knew about patellar tendinitis even earlier, Blazina just suggested a good name for the disease. For example, in 1963, Maurizio described the association of patellar tendon inflammation with jumping sports. Initially, “jumper’s knee” meant inflammation of the patellar ligament only at the site of its attachment to the patella, but, although less frequently, inflammation can also occur in the lower part of the ligament - at the site of its attachment to the tibial tuberosity. Let us recall that during movements the attachment points experience the greatest stress and deformation, and not the middle part of the ligament, which explains the occurrence of inflammation in these places. In 1978, Mariani and Roels proposed to call “jumper's knee” inflammation not only in the upper, but also in the lower part of the ligament, since these conditions are very similar in their causes, principles of development and treatment, and differ only in the location of inflammation.
In 1986, Ferretti explained the causes of jumper's knee. The inflammation is based on repeated trauma to the ligament during stress, which is more common in jumping sports (running, volleyball, basketball, boxing), cycling and contact martial arts, where there are kicks. The disease occurs between the ages of 16 and 40 years, and is slightly more common in men. Flat feet with pronation of the foot can contribute to the occurrence of inflammation, since in this condition the lower leg twists slightly and the tension of the ligament increases. Patellar position, Q-angle, femoral and tibial rotation, and knee stability have been hypothesized to contribute to the condition (you can read about these conditions in the article on patellar tilt and subluxation), but scientific research has shown that there is no significant connection between these factors. factors and tendinitis no. It is believed that problems with the quadriceps and hamstring muscles (so-called muscle rigidity or tightness) can contribute to patellar tendinitis.
A sharp increase in duration, intensity and changes in training methods can contribute to the occurrence of tendinitis in athletes.
In addition, the surface on which training or sports take place can contribute to inflammation of the patellar ligament. Thus, about more than half of the cases of the disease occur in people involved in sports or training on hard surfaces. Of course, excessively long training contributes to the development of the disease. The angle of flexion in the knee joint at which the load occurs is important: the ligament is most tense in the flexion amplitude from 30 to 60 degrees. Thus, all sports where frequent jumping and landing, acceleration and braking occur are at risk.
In the mid-1990s, Johnson suggested that when flexed at an angle of 60 degrees, the ligament could be pinched by the lower pole of the patella, proving his theory with several examples. However, this theory did not receive wide and generally accepted dissemination, and it was even found that in athletes with a long, low pole of the patella, the site of this bone pathology did not always correspond to the site of inflammation of the ligament. However, when surgically treating chronic tendinitis, many surgeons prefer to resect, i.e. shorten the lower pole of the patella.
Chronic stress or even overload of the patellar ligament can lead to micro-tears, inflammation and, accordingly, pain.
Sometimes patellar tendonitis or “jumper's knee” is called Sinding-Larsen-Johansson-Smillie disease, but this is not entirely true. In fact, Sinding-Larsen-Johansson-Smillie disease occurs only in adolescents and is associated with bony immaturity of the lower pole of the patella. It is very similar in nature to Osgood-Schlatter disease.
The second type of patellar tendinitis occurs not in athletes, but in ordinary people, usually over the age of 40. With age, degenerative changes accumulate in the tendon (the ligament “gets old”) and it can no longer withstand stress as successfully as before. Accordingly, micro-tears and inflammation occur.
Histological studies (examination of tissue under a microscope) have shown that with tendinitis there are classic signs of overload syndrome, consisting in the presence of two interrelated processes: degeneration (the process of “weakening”, “aging” of the ligament, manifested by mucoid and myxomatous restructuring, fibrinoid necrosis and the formation of pseudocysts) and regeneration (the process of “restoring” the ligament, manifested by the sprouting of new blood vessels, increased cellularity and angiofibroblastosis). There are no signs of acute inflammation in the ligament. These changes occur in both types of tendinitis: jumper's knee and degenerative tendinitis.
Typically, patellar tendonitis develops in only one leg, usually the pushing leg, but there are cases of bilateral tendinitis. The occurrence of tendonitis is promoted by systemic diseases that weaken connective tissue (for example, rheumatoid arthritis, diabetes mellitus, chronic renal failure, systemic lupus erythematosus, etc.) and long-term use of glucocorticoids.
Classification (proposed by Blazina in 1973, modified by Roels in 1978)
— Stage 1 : pain occurs only after sports activity;
— stage 2 : pain and/or discomfort occurs before and after sports activity;
— stage 3 : pain occurs during and after exercise;
Of course, inflammatory changes in the ligament are accompanied by a decrease in its mechanical strength, which can lead to complete or partial rupture of the patellar ligament.
Typically, patients complain of pain in the area of the lower part of the patella, that is, at the site of attachment of the ligament. In addition, pain can also occur at the site of fixation of the ligament to the tibial tuberosity, although this symptom is less common. In the early stages, pain after physical activity is typical. As the disease progresses or becomes chronic, pain may occur during and before exercise. Usually the pain is dull, localized along the ligament or slightly to the sides of it. With progressive tendinitis, attacks of more intense pain may occur during exercise.
In addition to pain, the disease can manifest itself as stiffness, tension, or weakness of extension in the knee joint.
An examination by a doctor plays an important role in diagnosis. The superficial location of the patellar ligament, including its attachments to the patella and tibia, simplifies inspection. With a thorough examination, it is usually easy to detect typical symptoms. Pain is typical when palpated in the area where the ligament attaches to the patella. Often the process is localized in the deep parts of the ligament adjacent to the joint; in such cases, pain occurs when deep pressure is applied to the ligament. In some cases, pain and swelling are noted along the entire ligament, which indicates peritendinitis or tendovaginitis, i.e. a condition in which inflammation is concentrated not only in the ligament, but also in its membranes.
The pain intensifies when the knee joint is extended with resistance and when pressure is applied to the patella. A similar pattern of pain can occur with partial or complete ruptures of the quadriceps tendon and patellar ligament. In young athletes, osteochondropathy of the lower part of the patella (Sinding-Larsen-Johansson-Smillie disease) and tibial tuberosity (Osgood-Schlatter disease) should also be excluded.
Anterior knee pain may not only occur with patellar tendonitis, so your doctor should rule out other causes of knee pain.
To clarify the diagnosis, in addition to the examination, the doctor may prescribe radiographs in frontal and lateral projections. Radiographs will help identify possible stress or avulsion fractures, as well as possible calcification (ossification) within the ligament. If patellar ligament calcification is detected or other bone problems are detected, a CT scan may be required.
Sometimes, to rule out other causes of knee pain, such as pain from injuries and tears of the menisci, especially in the anterior parts, magnetic resonance imaging (MRI) can be useful, which allows you to see soft tissues (menisci, ligaments, tendons, cartilage , muscles, etc.). In patients with patellar tendonitis, MRI often shows increased signal at the inferior pole of the patella and in the ligament itself, but the signal intensity does not always correspond to the severity of symptoms. In some cases, with tendonitis, the ligament may be thickened on MRI.
Magnetic resonance imaging for patellar tendonitis. The ligament itself (the dark cord from the patella to the tibial tuberosity) at the site of attachment to the patella has an area of increased signal (marked by a red arrow). The ligament itself is thickened.
Due to its superficial location, the patellar ligament is accessible for ultrasound. An experienced physician can detect ligament thickening, degenerative changes, and partial and complete tears. During the regeneration stage, an increase in blood flow can be recorded on ultrasound with Doppler sensors.
Conservative treatment. Treatment for patellar tendinitis depends on the stage of the disease. The first and second stages, as a rule, respond well to conservative treatment, i.e. non-surgical treatment. This includes changes to your training regimen, ice packs, and a short course of anti-inflammatory drugs (indomethacin, ortofen, etc.) that relieve symptoms, but there is no evidence that these drugs affect the development of tendinitis. Anti-inflammatory drugs should be used with caution in elderly patients and should not be used in patients with concomitant diseases of the gastrointestinal tract.
Local injections of glucocorticoids (kenalog, diprospan, hydrocortisone) for patellar tendonitis are not recommended due to possible atrophy of the ligament and its subsequent rupture.
An important role in the treatment of stage 1 and 2 tendonitis is played by physical exercises aimed at strengthening and stretching the quadriceps muscle, which allows for a gradual return to sports activities, but this can take from several weeks to several months.
After the acute period of pain passes as a result of stretch exercises and modifications of training loads, it is advisable to add squats on an inclined surface - on a squat - to the exercises.
Squat squats with weights - an element of rehabilitation for professional athletes
In addition to exercises, taping can be very effective - gluing special tapes onto the knee that relieve the load on the patellar tendon. Taping is a special branch of sports traumatology. The essence of taping comes down to the fact that a special sports tape is glued - tape, which relieves the load on the patellar ligament. If tape is not available, then a wide adhesive plaster, for example from Hartmann, can be used.
Unloading the patellar ligament with tape can be done by sticking the tape across the ligament, on the sides of it, crosswise with fixing the long ends of the tape at the top or bottom. The tape can also be applied along the ligament with the tape being fixed below the normal attachment point of the ligament to the tibial tuberosity. Of course, combinations of taping methods are also possible.
Transverse taping is the easiest way to relieve the patellar ligament. The tape is glued with moderate force
On the left - taping on the sides using a specially shaped tape. On the right is combined taping. There are transverse, cross-shaped and longitudinal tapes. Notice the band running down along the anterior edge of the tibia.
A classic version of combined taping, combining transverse and cross-shaped tapes.
Similar to taping, patellar tendinitis is treated with a brace that is tightened across the ligament (rather than across the patella). The brace relieves stress on the ligament and helps relieve the symptoms of tendonitis. There are many manufacturers of such orthoses, but we consider preferable those orthoses that have a silicone pad on their inner surface in contact with the skin covering the patellar ligament.
Unloading the patellar ligament with an orthosis
In any case, fast sudden movements and jumps should be avoided. At the third stage, treatment begins in the same way as in earlier stages. If the ligament ruptures (stage 4 tendonitis), of course, surgery is required.
Surgery. If patellar tendonitis persists and pain persists despite adequate treatment, surgery may be required. Arthroscopic (through 1-2 centimeter punctures) or open (through a traditional incision) removal of chronically altered tissue is performed, usually in the area of the apex of the patella. The choice of arthroscopic or traditional open surgery depends on which parts of the ligament are damaged. If there is a bone growth on the patella that leads to impingement (pinching of the ligament), then it can be removed arthroscopically. If cysts or other volumetric changes have formed in the ligament itself, then they can only be corrected with open surgery. In addition to removing the altered areas of the ligament, in most cases, during surgery, curettage (scraping) of the lower part of the patella is performed to cause tissue repair (restoration process) through inflammation. Sometimes, additionally, partial excision of the ligament, wide excision with re-fixation of the remnants of the ligament, and multiple longitudinal tenotomies (incisions on the ligament) are performed. However, any of these operations is fraught with rupture of the ligament in the future. At stage 4, timely surgical reconstruction of the ligament allows you to restore quadriceps strength and range of motion and return to the previous level of activity, and a delay of several weeks significantly reduces the strength of the quadriceps femoris muscle.
Many surgeons, when operating for chronic tendinitis, always prefer to resect, i.e. shorten the lower pole of the patella, assuming that there is always impingement (pinching) of the patellar ligament with tendinitis.
Elements of the operation may include partial resection (removal) of the Hoffa fatty body, transfer of the site of attachment of the patellar ligament in case of violation of the axis,
Regardless of treatment method, rehabilitation is fundamental to returning to sport and preventing relapse. After resting and changing your training regimen, you should gradually increase the tone of the quadriceps muscle. The four-step program includes static stretching of the hamstrings, quadriceps, and eccentric stretching exercises with icing after stretching. Sport-specific exercises are introduced gradually as quadriceps strength and flexibility increase. Return to previous loads is allowed after restoration of range of motion, increase in the strength of static contraction of the quadriceps muscle to at least 90% of the original and in the absence of pain or discomfort during exercise.
Patellar tendonitis usually has a favorable prognosis with adequate treatment and rehabilitation. If the treatment rules are not followed, the already mentioned rupture of the patellar ligament is possible, which requires prompt surgery.
A rare complication such as calcification (ossification) inside the patellar ligament against the background of chronic inflammation in it. This condition may also require surgery to remove calcified areas of the ligament with plastic (strengthening) with synthetic or other materials (tendons from other parts of the body, etc.).
Ossification of the patellar ligament - areas of ossification of the patellar ligament are marked with red arrows (clinical observations by H. Matsumoto, M. Kawakubo, T. Otani, K. Fujikawa. In this case, ossification occurred after trauma
The article is intended exclusively for comprehensive information about the disease and its treatment tactics. Remember that self-medication can harm your health. See your doctor.
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When writing the article, the following literature was used:
Panni AS et al: Patellar tendinopathy in athletes: outcome of operative and nonoperative management. Am J Sports Med 2000;28:392.
Peers KH et al: Cross-sectional outcome analysis of athletes with chronic patellar tendinopathy treated surgically and by extracorporeal shock wave therapy. Clin J Sport Med 2003; 13:79.
Warden SJ, Brukner P: Patellar tendinopathy. Clin J Sport Med 2003;22(4):743.
Matsumoto, M. Kawakubo, T. Otani, K. Fujikawa. Extensive post-traumatic ossification of thepatellar tendonA REPORT OF TWO CASES. From Keio University and the National Defense Medical College, Tokyo, Japan
Patellar tendinitis is a knee injury that affects the kneecap tendon. This is common among athletes who jump and land with force. The knee is made up of several parts that can be easily damaged. If a person experiences pain or tenderness around the knee, it is recommended to rest and avoid strenuous exercise. Talk to your doctor or physical therapist about persistent knee pain or discomfort. In this article, we will look at the causes, symptoms and treatment of patellar tendonitis. Clicking in the knee when bending.
Patellar tendinitis occurs when the patellar tendon becomes overstrained, which can happen when jumping or landing hard. The condition is often called jumper's knee. Patella is the medical term for the kneecap, and the patella tendon connects the kneecap to the shinbone.
Tendons are made of strong tissue and connect muscles to bones. If a person applies additional stress to the tendon, tiny tears can develop in the tissue. This causes inflammation, but the injury often heals quickly. However, repeated stress can cause tears faster than the body can repair them.
Patellar tendonitis develops gradually. The condition becomes more severe each time the tendon is strained, so it is important to rest the knee after each injury. This will give the body time to heal patellar tendonitis. What is osteoarthritis?
Patellar tendonitis has several other names:
Tendonitis describes gradual damage that causes repeated movement or aging in the tendon. It is common in the knee, wrist and elbow.
Tendonitis and tendinitis refer to inflammation of the tendon. Tendon inflammation is very rarely the cause of knee pain.
While research suggests spinal tendonitis is the more accurate term, knee tendonitis is still the most commonly used.
Patellar tendinitis usually occurs when repetitive activities gradually damage the knee. This often affects athletes who jump and land hard, such as basketball players.
Other activities that may increase the risk of developing patellar tendinitis include sudden exercise or training on hard surfaces such as concrete. The condition is most common among people in their teens, 20s, and 30s. People who are taller and heavier may be at greater risk, as more weight can increase pressure on the knees. Treatment of knee ligament injuries.
The main symptom of patellar tendonitis is pain and tenderness just below the kneecap. The pain usually begins after exercise, and continued exercise will likely increase the discomfort. Jumping, running and landing will likely make the pain worse.
A person may begin to notice weakness in the knee, especially during exercises that put pressure on that part of the body. When the leg is straight, the area under the knee may feel soft to the touch. The area around the knee may also feel tight or stiff, especially first thing in the morning.
A large patella tendon tear is a serious injury, and a complete tear will separate the tendon from the kneecap. The person may hear a tearing sound and feel significant pain. The knee may also swell and bruise. Walking may be difficult and the person may be unable to straighten the leg.
Persistent knee pain or discomfort should not be ignored. Treatment for early patellar tendinitis can ensure a quick and complete recovery.
A doctor or physical therapist diagnoses this condition by asking about symptoms, medical history, and exercise. They will also perform an examination, during which the person may be asked to move or straighten the leg. The doctor will apply gentle pressure to the area around the knee, as the tendon often feels thicker on the affected side.
The doctor may also request a magnetic resonance imaging (MRI) or X-ray to examine a serious tear and determine whether the kneecap is in the correct position. The meniscus of the knee joint is damaged.
Treatment for patellar tendinitis usually focuses on reducing pain. The person will need to rest the affected leg, apply ice to the area, and take over-the-counter anti-inflammatory medications.
Further treatment will depend on the injury, the person's age and how active they are. Small or partial tears can often be treated with rest and gentle exercises.
Your doctor may suggest wearing a knee brace to keep your knee straight and help the tendon heal. The person must wear a brace for 3 to 6 weeks and may need to use crutches to support their weight.
Physical therapy can help gradually restore movement as the tendon heals. A physical therapist may also recommend strengthening and stretching exercises to do at home.
A complete tear may require surgery to reattach the tendon to the kneecap. Full recovery may take 6 months. What to do if your knee is swollen?
Once a person has recovered from patellar tendinitis, they can take steps to try to prevent future injuries.
Anyone who plays a sport in which jumping and hard landings are common, they can take the same steps to avoid getting injured in the first place.
Some ways to prevent patellar tendonitis include:
Patellar tendonitis can develop gradually, so it is not always easy to recognize. Anyone experiencing knee discomfort or pain should see a doctor for a diagnosis. Rest and bracing of the knee gives the tendon time to heal. If the pain continues, your doctor or physical therapist may recommend additional treatment options. Walking with arthritis.