🦵 Patellar Tendinopathy: Overview and Types

Definition: Patellar tendinopathy is a chronic overuse injury of the patellar tendon, characterized by pain and dysfunction at the inferior pole of the patella.

Common Types:

• Jumper’s Knee: Chronic insertional injury at the inferior pole of the patella.

• Sinding-Larsen-Johansson Disease: Apophysitis affecting the inferior pole of the patella, often seen in adolescents.

• Osgood-Schlatter Disease: Inflammation at the tibial tuberosity, common in growing adolescents. 

🧬 Pathophysiology and Classification

Histopathological Stages:

• Reactive Tendinopathy: Early stage with tendon swelling and increased cellularity.

• Tendon Dysrepair: Moderate stage with matrix disorganization and neovascularization.

• Degenerative Tendinopathy: Late stage with collagen disorganization and tendon degeneration. 

Functional Classification:

• Stage I: Pain after activity, no functional impairment.

• Stage II: Pain during and after activity, minor functional impairment.

• Stage III: Pain during activity, significant functional impairment.

• Stage IV: Chronic pain, significant functional impairment, possible tendon rupture. 

🦵 Common Signs and Symptoms

• Pain Localization: Anterior knee pain, localized to the inferior pole of the patella.

• Aggravating Activities: Pain worsens with activities involving knee extension, such as jumping, squatting, and running.

• Morning Stiffness: Stiffness and pain upon waking, improving with activity. 

• Tenderness: Palpable tenderness at the inferior pole of the patella.

• Functional Impairment: Difficulty with activities requiring knee extension. 

🏃‍♂️ Risk Factors

• Age: Common in adolescents and young adults.

• Sporting Activities: High prevalence in jumping sports like basketball, volleyball, and track and field.

• Training Errors: Sudden increases in training intensity or volume.

• Biomechanical Factors: Abnormal lower limb alignment and muscle imbalances. 

🩺 Diagnosis and Imaging

• Clinical Examination: Assessment of pain localization, tenderness, and functional limitations.

• Ultrasound: Detection of neovascularization and tendon thickening. 

• MRI: Evaluation of tendon structure and identification of tears. 

🧪 Treatment Approaches

• Conservative Management:

• Strengthening: ECCENTRIC :Decline squats to promote tendon remodeling. ISOMETRIC holds to decreae inhibitiona nd manage pain. Book in to see our entire strengthening plans

• Load Management: Gradual increase in activity to prevent overuse. 

• Stretching and Flexibility Exercises: To improve muscle balance and reduce strain on the tendon.

• Advanced Therapies:

• Platelet-Rich Plasma (PRP) Injections: To promote healing and reduce inflammation. 

• Shockwave Therapy: To stimulate tendon repair and reduce pain. 

• Surgical Intervention: Considered in cases unresponsive to conservative treatment.