Knee tendonitis is mostly a functional overload disease; this means that it arises from the continuous repetition of a movement that causes damaging stress to the tendon that is the protagonist of the inflammatory process.
There are three types of knee tendonitis: patellar tendonitis, quadriceps tendonitis, and popliteal tendonitis.
Knee tendonitis is typically responsible for local symptoms (therefore at the knee level), such as: pain, swelling, redness and heat.
In general, for the diagnosis of knee tendonitis, a physical examination and anamnesis are sufficient; however, sometimes tests of imaging.
Treatment of knee tendonitis is generally conservative; in fact, surgery is indicated only in extreme cases.
Tendons and Tendonitis: A Brief Review
Tendons - What Are They?
A tendon is a band of fibrous connective tissue, with a certain flexibility and high in collagen, which joins a skeletal muscle to a bone.
Tendonitis: What is it?
"Tendinitis" is the medical term for inflammation of a tendon.
Tendonitis is a condition that can result from acute trauma to damage to the inflamed tendon or from its functional overload.
Types of Knee Tendonitis
The tendons anatomically in contact with the bony elements of the knee and which are the possible protagonists of a knee tendonitis are:
- The patellar tendon (or patellar ligament or patellar ligament), which connects the lower part of the patella (or patella) to a prominence of the distal-anterior portion of the tibia, called the tibial tuberosity;
- The tendon of the quadriceps muscle, which connects the quadriceps femoris muscle (the main muscle of the anterior thigh) to the upper part of the patella;
- The tendon of the popliteal muscle, which connects the popliteal muscle (a muscle in the postero-superior portion of the leg) to the lateral condyle of the femur and to the joint capsule of the knee.
In light of this, there are three types of knee tendonitis:
- Patellar tendonitis, which affects the patellar tendon;
- Quadriceps tendonitis, which affects the tendon of the quadriceps muscle;
- Popliteal tendonitis, which affects the tendon of the popliteal muscle.
Of these three types of knee tendonitis, the most common is undoubtedly patellar tendonitis; the latter is also known as the "jumper's knee".
Did you know that ...
The patellar tendon is a very particular tendon: in fact, it connects two bones (the patella and the tibia), making it more of a ligament than a tendon.
However, the definition of patellar tendon is unanimously accepted, as this band of fibrous connective tissue is in continuity with the quadriceps muscle tendon, which is also connected to the patella.
Did you know that ...
The patellar tendon is responsible for keeping the patella in the correct position and supporting the quadriceps femoris in the knee extension action, an action that is fundamental in activities such as walking, running, jumping, kicking a ball, etc.
For further information: Patellar Tendon: Anatomy and Function
Quadriceps Tendonitis: Who Is Most at Risk?
Quadriceps tendonitis mainly affects those who practice sports that include: running at maximum speed alternating with abrupt braking, jumps, leaps and bending on the legs (the so-called squat).
It should be noted that the quadriceps muscle tendon is a very robust band, which is hardly the subject of inflammation.
Popliteal Tendinitis: Who is Most at Risk?
Popliteal tendonitis mainly affects runners and those who have a passion for hiking in the mountains (in this second case, it is above all walking downhill to cause inflammation).
Knee Tendonitis: Risk Factors
Knee tendonitis risk factors include:
- The practice of sports in which there are running with changes of direction and sudden braking, jumps, jumps and bending on the legs;
- The practice of work involving movements that stress the hamstrings;
- The use of inadequate footwear;
- A lack of firmness on the part of the thigh muscles;
- Lack of flexibility on the part of the joint (this factor may depend on advanced age or sedentary lifestyle);
- The absence of physiological alignment between the patella, leg, ankle and foot (eg valgus);
- The dysmetria of the lower limbs;
- Overweight / obesity;
- Repeated corticosteroid injections (when used improperly, these drugs weaken the tendons).
Knee Tendonitis in the Young
For growth-dependent reasons, young people can suffer from two particular forms of knee tendonitis: so-called Osgood-Schlatter disease and Sinding-Larsen-Johansson disease.
Osgood-Schlatter disease is due to an anomalous mechanism of traction of the patellar tendon against the tibial tuberosity, associated with an "immaturity of the latter"; this condition is characterized by a suffering not only of the patellar tendon, but also (and above all) of the tibial tuberosity (as it is subjected to continuous "tugging" by the patellar tendon).
Sinding-Larsen-Johansson disease, on the other hand, is associated with stressful phenomena that act on the portion of the patellar tendon connected to the lower part of the patella.
Osgood-Schlatter disease and Sinding-Larsen-Johansson disease are both the consequence of an imbalance between skeletal growth (faster) and muscle-ligament growth (slower).
that could lead to suspicion of tendonitis, it is advisable to immediately stop any physical activity at risk and immediately consult a doctor, to undergo a control examination.muscle-tendon. It allows to analyze the state of health of the inflamed tendon and the connected muscle;
Physical examination
During the physical examination which is used to identify a knee tendonitis, the doctor palpates the patient's knee in points significant to the diagnosis; moreover, he asks the patient himself to carry out, with the suffering knee, specific movements which, in case of tendonitis, would evoke pain (the presence of pain when performing these movements is, therefore, an alarm bell).
Anamnesis
In the path leading to the diagnosis of knee tendonitis, the anamnesis allows us to establish the causes and factors that favored the onset of inflammation.
Knowledge of the causes and risk factors of knee tendonitis is important when planning therapy.
The duration of rest varies from case to case, depending on the severity of the inflammation, certainly an important indicator of the benefits of rest is the total absence of pain during movements with the knee that once caused pain;
Generally, the indications for its use are: 4-5 compresses per day on the painful area (in the case of knee tendonitis, the precise area depends on which tendon is inflamed), for 15-20 minutes each (shorter applications or longer are ineffective);
Among the NSAIDs, the most commonly used by those suffering from knee tendonitis is ibuprofen;
The use of corticosteroids in the therapeutic management of knee tendonitis is rare, due to the possible side effects related to the use of the drugs in question.
Remember that corticosteroids must be taken with a medical prescription;
To know exactly what these exercises consist of, it is good to contact an expert in the field, with experience in hamstring problems.
Sometimes, to these conservative treatments, the treating physician could add instrumental therapies such as: ultrasound, tecartherapy, iontophoresis and / or TENS (English acronym which in Italian stands for: Transcutaneous Electrical Nervous Stimulation).
Surgery: when can it be useful?
Typically, knee tendonitis does not require surgery.
However, if the symptoms persist for months in spite of the conservative treatment reported above or if the condition has evolved into a tendon damage or even worse in its rupture, surgery becomes an obligatory therapeutic option.
The surgical technique used for the treatment of knee tendonitis is arthroscopy.
Popliteal and quadriceps tendonitis rarely result in complications, so they rarely require surgery.
For further information: Knee Arthroscopy: What is it and How Does It Work?.In sports, the prevention of knee tendonitis is based on: the planned rest, the dosage of the workload and the variation of the training.
How to avoid the aggravation of Knee Tendinitis
To prevent the worsening of knee tendonitis it is essential to immediately refrain from any activity that evokes pain, even if the latter is bearable or controllable with an NSAID.
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