Inflammation of the patellar tendon: what to do?

By Cristiano Antonino On May 13, 2023

Inflammation of the patellar tendon – also known as patellar tendonitis or patellar tendonitis – can be defined as a disorder involving the small portion of fibrous connective tissue called the patellar tendon, which connects the lower part of the kneecap to the tibia

Athletes, such as footballers, volleyball players, basketball players or track and field athletes are particularly affected, so much so that the condition is also known as jumper’s knee.

However, truck drivers, lorry drivers or forklift drivers are also often affected, because they subject the patellar tendon to a lot of stress every time they have to press the pedals with their foot while driving.

In any case, patellar tendon inflammation is by far the most common type of knee tendonitis

To better understand what this inflammation is, it is best to know more or less the anatomy of the affected area.

Specifically, the patellar ligament is – as we have seen – a small band of fibrous connective tissue that connects the underside of the patella to the tibial tuberosity, which is the typical outgrowth on the top of the tibia.

This small tendon is in continuity with the quadriceps femoris tendon assembly and has the function of holding the patella in the correct position and supporting the quadriceps femoris in the knee extension movement.

Patellar tendon: why is it inflamed?

There are several causes and risk factors for patellar tendonitis, and not just the functional overload we saw earlier.

First of all, there are some congenital causes, such as one leg being longer than the other (dysmetria of the lower limbs), in the case of a valgus or varus knee; but there are also external factors. In fact, the patellar tendon is stressed with every movement of the knee joint: in case of continuous overload, the tendon becomes inflamed.

Let’s look at a list of them:

Wearing footwear that is not suitable for the sport you practise.
Playing sports on too hard a ground.
Playing running sports with abrupt changes of direction, braking, jumping and bending over legs.
Hypotonicity of the quadriceps femoris.
Severe overweight or obesity.

It is also possible for the patellar tendon to become inflamed as a result of other diseases that tend to impair tendon health (e.g. SLE, rheumatoid arthritis) or as a result of improper use of corticosteroid infiltrations, which tend to weaken the tendons in the long run.

There are also inflammations of the patellar tendon that are caused by growth, such as Osgood-Schlatter’s disease: in this case, we see skeletal growth faster than musculo-ligamentous growth.

What are the symptoms?

This condition is definitely recognisable, as the symptoms complained of are peculiar, in particular pain and a sense of soreness in the anterior part of the kneecap.

Swelling of the area and stiffness of the entire knee joint may also be associated.

Another characteristic of patellar tendonitis is the differentiation of symptoms according to the severity of the pathology, we recognise three stages:

The patient feels pain after sporting activity, but has no problems during training.
The patient feels pain during training but it is not so intense that they have to interrupt their sporting activity.
The patient complains of pain both during physical activity – such that any exercise has to be interrupted – and at rest, even the most mundane daily activities become difficult.

It is easy for people suffering from inflammation of the patellar tendon to degenerate the pathology to the third stage, because in the first two the pain is intermittent and disappears with a little rest, not suggesting anything serious.

However, if one continues to ignore the problem, a tear in the tendon structure may occur as a result of the inflammation: the latter is much more difficult to treat and in most cases may require surgery.

Diagnosis

To diagnose an inflammation of the patellar tendon, a visit to the orthopaedist is usually sufficient. After a careful anamnesis and an objective test, he will be able to recognise the pathology.

The first part of the examination, therefore, will be occupied by the anamnesis: the causes and triggering factors of the inflammation will be identified, which will be useful for planning the best therapy.

Next comes the objective examination: the doctor will test the knee at specific points, then the patient will have to perform certain leg movements that evoke pain.

The specialist, however, may require instrumental tests to be certain of the clinical picture, such as ultrasound, to analyse the health of the muscles and tendons of the joint; MRI to get clear images of all the components of the knee; X-rays if bone problems related to inflammation of the patellar tendon are suspected.

What treatment is recommended?

In the vast majority of cases, the recommended therapies will be conservative and surgery will only be performed in extremely serious cases.

The first thing to do will be to stop sporting activity and keep the knee at rest so that the inflammation disappears.

In this first phase, ice applications, 4 or 5 per day for 15-20 minutes, may be recommended for its anti-inflammatory and pain-relieving power.

The function of the ice may be assisted by the use of NSAIDs, non-steroidal anti-inflammatory drugs, or by taking paracetamol.

Often the doctor will also recommend a specific brace for this disorder: it is a kind of semi-rigid bracelet to be applied around the knee that can reduce the load at the point where the tendon attaches to the bone. Corticosteroid infiltrations may also be prescribed.

In many cases, some physiotherapy sessions may also be advisable.

If the inflammation persists for more than 6-8 months despite treatment, it is likely that the pathological condition has evolved into damage to the patellar tendon or, worse, its rupture, in which case the option of surgery will be considered.

Currently, the operative technique used for tendon damage is arthroscopy.