Patellar tendinitis

People report anterior knee pain, often with an aching quality. The symptom onset is insidious. Rarely is a discrete injury described. Usually, the problem is below the kneecap but it may also be above. Jumper's knee can be classified into 1 of 4 stages, as follows: Stage 1: Pain only after activity, without functional impairment Stage 2: Pain during and after activity, although the person is still able to perform satisfactorily in his or her sport Stage 3: Prolonged pain during and after activity, with increasing difficulty in performing at a satisfactory level Stage 4: Complete tendon tear requiring surgical repair It begins as inflammation in the patellar tendon where it attaches to the patella and may progress by tearing or degenerating the tendon. People present with an ache over the patella tendon. Magnetic resonance imaging can reveal edema (increased T2 signal intensity) in the proximal aspect of the patellar tendon. ==Causes==

Patellar tendinitis is an overuse injury from repetitive overloading or repetitive stress of the patellar tendon of the knee leading to microtears and inflammation that do not have time to heal before the next use. Patellar tendonitis is common in athletes who participate in activities that include a lot of jumping, changing directions, or running. Risk factors for patellar tendonitis are low ankle dorsiflexion (stiff ankles) and ankle sprains, weak gluteal muscles, and muscle tightness, particularly in the calves, quadriceps muscle, and hamstrings. ==Diagnosis==

Diagnosis is generally based on symptoms and a physical examination. Ultrasound or magnetic resonance imaging may help clarify how severe the problem is. Having a clinical diagnosis is the preferred way to diagnose patellar tendonitis, due to ultrasonographic abnormality. ==Treatment==

Evidence for treatment is poor. Specific exercises and stretches to strengthen the muscles and tendons may be recommended, e.g. cycling or swimming. Use of a strap for jumper's knee and suspension inlays for shoes may also reduce the problems. NSAIDs are generally recommended. According to a systematic review comparing extracorporeal shock wave treatment to conservative treatment, it was found with low certainty that ESWT has a large treatment effect to reduce short term pain. Surgery Surgery may be tried if other measures fail. This may involve removal of myxoid degeneration in the tendon. This is reserved for people with severe pain for 6–12 months despite conservative measures. Novel treatment modalities targeting the abnormal blood vessel growth which occurs in the condition are currently being investigated. Knee operations in most cases have no better effects than exercise programs. ==Epidemiology==

It is relatively common with about 14% of athletes currently affected. Males are more commonly affected than females. ==References==