Patellar tendinosis is characterized by inflammation and pain at the patellar tendon (the tendon below the kneecap). This structure is the tendon attachment of the quadriceps (thigh) muscles to the leg. This structure is important in straightening the knee or slowing the knee during bending or squatting. This is usually a Grade 1 or Grade 2 strain of the tendon. A Grade 1 strain is a mild strain. There is a slight pull without obvious tearing (it is microscopic tendon tearing). There is no loss of strength, and the tendon is the correct length. A Grade 2 strain is a moderate strain. There is tearing of tendon fibers within the substance of the tendon or at the bone-tendon junction. The length of the tendon is usually increased, and there is decreased strength. A Grade 3 strain is a complete rupture of the tendon.
Initial treatment consists of medication and ice to relieve the pain, stretching and strengthening exercises of the quadriceps and hamstring muscles, and modification of the activity that initially caused the problem. These all can be carried out at home, although referral to a physical therapist or athletic trainer for further evaluation and treatment may be helpful. Rarely, a leg cast may be recommended to 10 to 14 days to immobilize the tendon and allow the inflammation to settle down. This condition is usually curable within six weeks if treated appropriately with conservative treatment and resting of the affected area.
Uncommonly, crutches may be needed for the first few days to weeks until there is good control of the quadriceps muscles and no limp exists. An arch support (orthotic) or a patellar tendon brace may be prescribed to reduce stress to the tendon. Surgery to remove the inflamed tendon lining or degenerated tendon tissue is rarely necessary and is only considered after at least six months of adequate rehabilitation and rest.
Frequent Signs and Symptoms
- Pain, tenderness, swelling, warmth, or redness over the patellar tendon, most often at the lower pole of the patella (kneecap) or at the tibial tubercle (bump on the upper part of the lower leg)
- Pain and loss of strength (occasionally) with forcefully straightening the knee (especially when jumping or when rising from a seated or squatting position) or bending the knee completely (squatting or kneeling)
- Crepitation (a crackling sound) when the tendon is moved or touched