Patellar Tendonitis Diagnosis And Treatment

Introduction

Receiving a diagnosis of patellar tendonitis can be daunting. You may ask yourself – what are the treatment options? Will I have to stop doing the activities I love? Will I ever be pain-free? 

These are all normal questions, though the responses are, unfortunately, not a simple ‘one-size fits all’ answer, and it may take some time before you find something that works for you. Just because your Uncle Bob had great success with one particular method, or a company promotes the success of a specific product, it doesn’t mean it will necessarily work for you and your lifestyle. 

This article aims to talk you through the current research on patellar tendonitis and will help guide you through the management of the painful condition of tendonitis.

The definition of patellar tendonitis

Firstly, let’s start by defining patellar tendonitis. You might have come across the terms tendonitis, tendinosis or tendinopathy when looking up your symptoms, as they are often used interchangeably though they actually mean different things; so, what’s the difference? 

The term tendonitis refers to inflammation of a tendon, in this case, patellar tendonitis is inflammation of the tendon that sits just below your kneecap and connects all your thigh muscles to your shinbone.¹ Inflammation typically manifests as swelling and pain in a localised area, sometimes accompanied by reddening of the skin that feels warm to the touch. 

On the other hand, tendinosis refers to structural changes within a tendon, such as the thickening of the individual tendon fibres. 

Tendinopathy is a term that encompasses both tendonitis (pain and swelling) and tendinosis (structural changes to the tendon). Typically, both tendonitis and tendinosis occur simultaneously, so tendinopathy is usually the correct term to use.

However, due to the similarity of the terms, tendonitis is usually the term used when diagnosing patellar tendinopathy since the symptoms of patellar tendonitis are the most obvious ones e.g., swelling and redness can be seen with the naked eye. We will continue to use the term patellar tendonitis throughout this article.

Symptoms of patellar tendonitis

Symptoms of patellar tendonitis can include: 

• Pain at the front of your knee under your kneecap
• Increased pain when being active or shortly after exercise
• Pain when touching your kneecap
• Swelling below your kneecap
• Stiffness in your knee(s)
• Feeling weakness in your thighs
• A grinding or crunchy sound when you move your knee(s)

Importance of early diagnosis and treatment

As with many joint and muscular problems, early diagnosis and treatment of patellar tendonitis plays a pivotal role in the successful management of this condition.² Timely intervention can help prevent the progression of symptoms and reduce the risk of complications.

By addressing patellar tendonitis in its early stages, you can avoid prolonged pain and discomfort, as well as delay potential limitations that this condition may cause as its progression can reduce mobility and function. 

Overall, early diagnosis and treatment usually lead to better outcomes and will help you return to the activities and sports you love much faster.³ 

Diagnosis of patellar tendonitis

Patellar tendinopathy is usually diagnosed by a doctor, physiotherapist, or other registered primary healthcare musculoskeletal (MSK) practitioner, and is based on a physical examination and listening to your symptoms. 

Imaging such as scans or X-rays are not usually needed for a diagnosis unless there is suspicion that you have a tendon rupture. In this case, an ultrasound scan is most commonly used for a quicker result, though sometimes an MRI is requested which can result in a longer time to receive a diagnosis.

Causes and risk factors

Below, we have listed some risk factors for patellar tendonitis that can increase the likelihood of experiencing pain and swelling below your kneecap. However, meeting one or two points of the criteria doesn’t mean you will have patellar tendonitis – your symptoms could be related to something completely different. The best way to figure out what is causing your patellar tendonitis is to consult a GP, MSK primary healthcare practitioner or physiotherapist. 

Risk factors for patellar tendonitis

• Engaging in activities that involve high-intensity movement and jumping e.g., playing volleyball, handball, or basketball² 
• Being assigned male at birth (AMAB)⁴
• Regular high-intensity training^2,4 
• A sudden increase (in comparison to previous behaviour) in physical activity²

Overuse or repetitive stress of your patellar tendon, such as frequent jumping or running activities, is usually the primary cause of the condition. Anatomical abnormalities, such as having anisomelia (legs of different lengths) or having legs malaligned, can place excessive strain on the patellar tendon during movement. This increases the risk of inflammation around your kneecap. 

Additionally, a sudden increase in the intensity of physical activity, an inadequate warm-up, improper exercise technique, or inappropriate exercise duration can strain the tendon and make it more likely that you will develop patellar tendonitis. 

There is some evidence that reports that those with a higher BMI and weaker leg muscles on the front and back of their thighs could be at risk of developing patellar tendonitis as well, although this condition is not as frequently attributed to these factors.⁵ 

Wearing inappropriate or poor-quality shoes when training can exacerbate the biomechanical stress on your patellar tendon during physical activity; therefore, good quality footwear is very important whilst training as this will ensure you have adequate shock absorption. 

Treatment options 

• Rest – allowing yourself to rest when your knee(s) are sore is one of the quickest ways to reduce pain caused by patellar tendonitis in the short term
• Activity modification – reducing the frequency of the activities you engage in that cause your symptoms can allow your pain and swelling time to settle down. Slowly reintroducing the activities that cause your pain is less likely to cause you pain in the long term. A physiotherapist, registered MSK primary healthcare practitioner or qualified gym instructor can help you with this
• Ice and/or heat therapy – ice is thought to be better at reducing inflammation and swelling than heat. Otherwise, choose whichever option feels better to you⁶ 
• Physiotherapy – a physiotherapist can help you identify problematic activities and techniques that increase your knee pain and can provide you with exercises to help correct any muscle imbalances or overall weakness that can exacerbate your pain. Find a quick general reference guide written by a senior physiotherapist of an NHS-integrated MSK service here
• Medications – paracetamol and ibuprofen can help reduce your pain in the short term
• Knee taping – taping the painful area below your kneecap can sometimes help to offload and redistribute the high forces applied to your knee to the surrounding tissues, but the research evidence is limited and contradictory because it is a relatively new technique in physiotherapy. Therefore, case reports and clinical experience are the main sources of evidence¹
• Corticosteroid injections – have been shown to be beneficial in the short term, though can come with some negative side effects. Discuss this option with your doctor
• Surgery – when all the above options fail, surgical correction can have good results in the long term and allow you to return to previously painful activities. However, due to the risks involved in all surgical procedures, it is important to discuss surgery with your doctor^7,8

Summary

There are many things that you can try to manage your patellar tendonitis, such as making changes to the activities that cause you pain, investing in good-quality training shoes, having your knees(s) taped by a registered professional, resting, applying ice or heat, and taking medications. 

If those options are all ineffective, corticosteroid injections can provide some short-term relief, though they are often accompanied by negative side effects. Surgical correction can provide good results for some, though it is vital that you thoroughly discuss all of these options with your physician or MSK specialist.