Patellar tendonitis



Patellar Tendinitis




Most common in athletes

- especially if involved in running, jumping and kicking

- over use injury


Basketball players




Chronic overload v inferior patella impingement


Schmidt et al Am J Sports Med

- dynamic MRI in patients with jumper's knee v controls

- no evidence of impingemnt

- concluded that chronic overload main cause


Incidence of inferior patella spurs

- likely part of pathology


Clinical Features


Insidious onset of pain at inferior pole of patella

- initially after activity only, worse as cools down

- localised tenderness at inferior pole

- may progress to rupture




Usually normal


May see

- traction spurs

- calcification of patella tendon


Patella Tendon CalcificationPatella Spur




Cyst / Degeneration


Jumpers Knee MRI


Traction spurs / calcification / ossicles


Patella Tendonitis Calcification MRIPatella Tendon Calcification MRIPatella Spur MRI




Activity modification


Rest 6/52

- warm up & stretching

- ice & NSAIDS


Sport rehabilitation protocol


Concentration on eccentric exercises

- decline squats on a 25o decline board


Jonsson et al B J Sports Med 2005

- RCT of concentric v eccentric quads exercises

- superior results with eccentric


Engebretsen et al JBJS Am 2206

- RCT of eccentric rehab v surgery

- no advantage surgery

- recommended minimum 12 weeks non operative treatment in all cases






Platelet Rich Plasma


Fillardo et al Int Orthop 2010

- compared three injections PRP 2 weeks apart in 15 chronic patients

- compared wth 16 patients treated with physiotherapy alone

- significant improvements in PRP group


Charousset AJSM 2014

- 3 consecutive US guided PRP into tendon defect

- sucess in 21 / 28 athletes




Vulpiani et al J Sports Med Phys Fitness 2007

- 4 sessions every 2 days

- 73% successful in all patients

- 87.5% successful in athletes with return to sport at 6 weeks






Fails to resolve & interferes with activity






1.  Resection fat pad

2.  Resection posterior inflammed portion of tendon

3.  Careful burr resection of inferior pole patella

- 1 - 2 mm

- does't affect patella tendon insertion

- removes source of impingement

- likely stimulates healing process




Lorbach et al Arthroscopy 2008

- arthroscopic debridement inferior pole patella in 20 patients

- 18/20 good or excellent results


Pascarella AJSM 2011

- arthroscopic debridement undersurface of tendon / tendinopathy

- excise distal pole

- success in 66 / 73 knees

- RTS by 3 months