Understanding A Patella Tendon Injury
The patella tendon is a large tendon connecting the kneecap to the lower leg. It is a continuation of the quadriceps tendon which connects to the upper part of the knee cap and the quadriceps muscles in the front of the knee. Injury to the tendon can be problematic for athletes in a variety of sports. Due to significant stresses with sprinting sports as well as with lower body exercises such as squats, the patella tendon is susceptible to several injuries such as tendonitis, tendon strain or tendon rupture. If the injury is acute and sudden, such as during a slide or jumping movement, the tendon can be strained or even completely torn. Typically tendonitis or tendinopathy will be more chronic, with overuse to the quadriceps muscle in sports.
Evaluation OF Patella Tendon
With overuse to the patella tendon, one can develop irritation and inflammation of the tendon, called patella tendonitis, which is also referred to as jumper's knee. Over time, typically within 1 to 3 months, if the tendonitis persists, the tissue can undergo changes that cause the tendon to develop a more chronic pain. The underlying changes to the tendon do not usually have definitive inflammation, and so the name changes to tendinopathy, rather than tendonitis. Athletes will usually have no notable swelling over the front of the knee, rather pain directly over the tendon. If there is swelling, it is usually concentrated over the tendon rather than throughout the entire knee such as in an ACL tear or Meniscus tear. Tenderness is typically seen with deep pressure directly over the patella tendon (pictured below). Pain may also be reported at the patella tendon with extension of the knee against resistance, as well as with exercises like lunges or squats.
Treatment and Return to Play
In general, a patella tendonitis is relatively straightforward if given the proper time to heal. In general, I would recommend the athlete to weight bear as tolerated based on pain. An acute diagnosis typically can resolve on its own or with basic routine care such as limited activity, icing and stretching. In the initial stages, some providers will recommend soft tissue stimulatory techniques, such as ASTYM, Graston or Dry Needling to help stimulate healing. Usually within 2- 3 weeks if the pain has largely resolved, athletes can start more aggressive activity. Return to play is generally based on pain, however it depends upon the sport. If an athlete chooses to play through this injury it can be difficult to treat and convert into a long term issue called patella tendinopathy.