Pain in the patellar tendon
definition
Pain in the patellar tendon is an unpleasant, sometimes stabbing or pulling sensation in the area of the patellar tendon.
From an anatomical point of view, the patellar tendon lies as a firm ligament structure between the underside of the kneecap and the shinbone, more precisely on the tibial tuberosity, a roughened bone process on the front of the shinbone.
The patellar tendon is involved in movements in the knee joint because it is part of the joint capsule. The patellar tendon is particularly stressed during sudden stopping movements and / or rapid changes of direction.
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Causes of pain in the patellar tendon
Various diseases or injuries can cause pain in the patellar tendon.
In general, however, the patellar tendon itself, the patella or other structures in the vicinity are usually affected. Specific clinical pictures worth mentioning that typically trigger pain in the patellar tendon are patellar tip syndrome, retropatella arthrosis, a tear or partial tear of the patellar tendon and inflammation.
In addition, painful sensations in the patellar tendon are not uncommon after cruciate ligament surgery. In order to choose the right therapy in each individual case, an accurate diagnosis is essential, as there are several possible causes of pain in the patellar tendon.
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Patellar tip syndrome pain
Overloading the knee can lead to chronic wear and tear in the area of the patellar tendon, which is accompanied by severe pain. This clinical picture is called patellar tip syndrome when the pain is primarily located at the lower tip of the kneecap.
Synonyms for the patellar tip syndrome include the “kneecap tip syndrome”, the “jumper's knee”. Jumpers knee) and "Tendinitis patallae".
The cause of the disease is excessive tensile stress on the patellar tendon. As the synonym “jumper knee” suggests, some sports are predisposed to develop patellar tip syndrome. These include volleyball and basketball and, from athletics, long and high jump.
A patellar tip syndrome can, however, develop independently of the previously mentioned factors due to age or other primarily responsible pathologies in the knee and patellar tendon area. Typical symptoms are pain that initially occurs in a mild stage under heavy strain and occurs at a more advanced point in time with low exertion such as climbing stairs or even at rest. The pain is mostly localized in the lower area of the patella, i.e. at its distal pole. Exactly where the patellar tendon originates. In the case of pain in the patellar tendon, a doctor should therefore clarify whether a patellar tip syndrome is a possible cause and then treat it accordingly, if necessary.
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Pain from the tear or partial tear of the patellar tendon
A rupture of the patellar tendon as the reason for pain in the patellar tendon is rather rare, as this is a less common disease or injury pattern.
However, depending on the previous damage to the patellar tendon or depending on the strength of an overload and lifting effect, the tendon can tear. The crack, in medicine as Rupture can manifest in different places.
At a younger age, the patellar tendon tends to tear at the point of insertion in the area of the shin, but at an older age it tends to tear at the origin, i.e. at the lower edge of the kneecap.
In both cases, those affected complain of sudden onset of pain, which is primarily localized around the patella. In addition, the movement in the knee joint is restricted to the extent that complete extension is no longer possible.
In the case of a complete rupture of the tendon, the kneecap, i.e. the patella, is elevated compared to the healthy side. Various diagnostic measures can be used to evaluate whether the patellar tendon is only torn or completely torn. The treatment then depends on this.
Read more on the topic: Patellar tendon rupture
Pain after cruciate ligament surgery
Pain in the patellar tendon is often associated with cruciate ligament surgery or cruciate ligament surgery.
The reason for this is the fact that part of the patellar tendon is used as a transplant, i.e. as a replacement for the destroyed cruciate ligament.
The surgical procedure is done through a small incision in the front of the knee near the patellar tendon. A small part of the bone from the kneecap and a bone block from the lower leg are then removed, since the patellar tendon is stretched between the two bony parts.
This can then be used as a replacement for the cruciate ligament after modulation. Alternatively, part of the semitendinosus tendon can be selected as a graft, but the patellar tendon has greater tear resistance, so that it is preferred to use it.
However, by removing part of the patellar tendon, those affected may feel pain in the patellar tendon area after surgery. These can sometimes only last a few months, but unfortunately also occur longer. As long as the pain in the patellar tendon is present, extreme flexing movements such as kneeling or sports that place heavy strain on the patellar tendon such as volleyball and basketball should be avoided.
Pain from inflammation
Inflammation of the patellar tendon is usually caused by overstressing the knee joint. Athletes are often affected, especially from stop-and-go sports, but runners can also suffer from patellar tendinitis.
The inflammation is primarily expressed by pain in the patellar tendon. In addition, there is often reddening and swelling of the affected region, and the knee is not infrequently overheated. The painful inflammation usually leads to a restriction of movement of the affected knee joint.
Inflammation of the Hoffa fat pad (Hoffitis)
The Hoffa fat body lies between the kneecap and the shin bone. The patellar tendon pulls over it.
Inflammation of the patellar tendon can spread to the Hoffa fat pad, and vice versa, the fat pad can first become inflamed and then transfer the inflammation to the patellar tendon.
Usually such inflammation is due to overuse of the knee. There is some friction between the Hoffa fat pad and the patellar tendon with every movement of the knee joint.
The more frequently this friction occurs, the greater the risk of irritation of the tendon or fat body. After a certain time this becomes noticeable as inflammation. Such hoffitis is usually accompanied by pain below the kneecap. Swelling, redness and overheating are also possible
Concomitant symptoms
In addition to the pain in the patellar tendon, other accompanying symptoms can occur, depending on the cause of the discomfort. These are then mostly typical for the respective disease, which among other things causes pain in the patellar tendon.
If the pain in the patella is based on a patellar tip syndrome, it even occurs on both sides in 20-30% of cases. Another characteristic is the movement dependence. In a mild form of the patellar tip syndrome, the pain only occurs at the beginning and at the end of exercise.
They may have disappeared during exposure. In the further course of the disease, the pain can manifest itself even with low stress, especially when climbing stairs or going downhill. Ultimately, the pain can worsen and even become chronic.
In the case of retropatellar osteoarthritis, the pain is also increased when climbing stairs and walking downhill. In addition, there is a so-called "start-up pain", which means that the pain in the patellar tendon is increased, especially after getting up from a long sitting position, due to the previous long flexed position.
If the patellar tendon has become inflamed, typical symptoms such as swelling and overheating and rarely reddening may occur in addition to the pain. In most cases, the pain is also accompanied by restricted mobility. Since the patellar tendon works in cooperation with the thigh muscle (lat. Quadriceps muscle) participates in the extension of the knee joint, this movement may be restricted or no longer possible if the patellar tendon is damaged in various ways.
Pain when climbing stairs
The pain when climbing stairs are typical movement-dependent pain associated with complaints of the patellar tendon. They are considered to be a characteristic pain in the advanced stage patellar tip syndrome and retropatellar arthrosis. The reason for this is the anatomical position of the patellar tendon and its connection with the thigh muscle (lat. Quadriceps femoris muscle).
The sinewy parts of the quadriceps femoris muscle radiate into the patella and then continue into the patellar tendon. Since this large thigh muscle plays a dominant role in the extension of the knee joint, it is obvious that the patella is also stressed with every extension movement.
Since climbing stairs involves a constant alternation of bending and stretching in the knee joint, pain in the patella can be understood with this movement pattern. Of course, only if there are any pathologies in the form of injuries or diseases on the patella or the patellar tendon itself.
diagnosis
First and foremost, a precise history-taking, i.e. a patient discussion in which the exact symptoms, their character, duration, connections with falls or other influences are inquired about, and a clinical examination, with the focus on the knee, in particular the patella and the patellar tendon, are indicative should.
Depending on the precise localization of the pain on the patellar tendon, the thigh or the knee joint must be included in the examination. For the respective possible suspected diagnoses, such as a rupture of the patellar tendon or retropatella osteoarthritis, there are special tests for diagnosis.
Imaging methods can also be used to clarify the diagnosis reliably. First of all, ultrasound is particularly suitable for this. Changes in the tendon can be detected with the help of ultrasound. Magnetic resonance tomography (= MRT) is a more precise method. The MRT image is suitable for more precise localization and assessment of the severity of the pathology. An x-ray can also be useful to rule out bone injuries. There are special recordings here, such as the so-called "Patella Defilee Record", in which the knee must be in a certain bent position at the time of the recording.
Therapy for pain in the patellar tendon
In general and regardless of the exact cause, symptomatic therapy for pain relief is always useful and indicated. Painkillers from the substance group NSAIDs ("non-steroidal anti-inflammatory drugs") are available for this purpose.
Among other things, they have a pain-relieving and inflammation-relieving effect, so that this alone can reduce the main complaints, namely the pain in the patellar tendon. Further therapeutic measures then depend on the respective causal illness or injury.Patellar tip syndrome can be treated with special therapies such as cold and heat treatment, but also shock wave and electrotherapy.
In addition, there is a recommendation for both regular physiotherapy and physiotherapy.
In addition, there is the possibility for those affected to do stretching exercises themselves with the aim of reducing the internal muscle tension of the thigh muscle and the pressure load on the patella. In this way, the thigh muscle can be strengthened, which is associated with greater stability of the knee joint and the patella.
Sitting against the wall is a very simple exercise: you lean your back against the wall and bend your legs as if you were sitting on a chair, but instead hold the position with pure static tension of the muscles. These exercises and also the physiotherapy or physiotherapy have a positive influence on the healing process of a patellar tip syndrome.
Retropatella osteoarthritis, on the other hand, can be treated with an injection of various substances into the knee joint. In addition to the most commonly used cortisone, hyaluronic acid or glycosaminoglycan can also be injected, as they are a natural component of the joint cartilage.
Depending on the severity and response to initial conservative measures, surgical treatment may be necessary in the case of retropatella osteoarthritis. In the worst case, a prosthesis may have to be used. In most cases, if the patellar tendon is painful, a bandage or taping of the knee joint can be helpful.
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Cooling or warming?
In acute cases, pain in the patellar tendon is mostly due to inflammation of the structures.
The patellar tendon itself is usually affected, but the Hoffa fat pad, surrounding muscles, tendons and ligaments or even the bones can be inflamed.
In the acute phase of inflammation, cooling should be used for pain relief. The inflammation is accompanied by swelling and overheating; both phenomena can be counteracted by cooling the affected knee.
After a while, however, warming the joint can be more comfortable. Often, warmth helps the body to improve blood circulation, which is why the metabolic activity increases in the warmed areas and the body's self-healing powers are supported. When you switch from cooling to warming varies from person to person.
Taping as a treatment option for patellar tendon pain
Taping or, alternatively, wearing a bandage is therapeutically useful in connection with pain in the patellar tendon.
The bandage can reduce pain and stimuli with a simultaneous stabilizing function. Since the bandages are very elastic and hard-wearing, those affected are not restricted in their mobility, but only supported.
A correct fit is therefore always important - the bandage must neither be too tight nor too loose. In the case of patellar tip syndrome, there is even a very special bandage, the so-called "Kasseler bandage". This is a proprioception bandage because the slight pressure exerted on the back of the patella by the tight-fitting bandage stimulates proprioception, i.e. the sense of position.
The application of tapes should usually be left to the trained staff in order to achieve an optimal effect, namely pain relief and promotion of the healing process. This can be achieved with the help of the tape by increasing the blood flow and reducing the tensile load on the patellar tendon.
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Duration of pain in the patellar tendon
How long the symptoms persist in the form of pain in the patellar tendon varies from person to person and depends on the cause. In the case of pure irritation of the patellar tendon, for example, those affected can be symptom-free again after a few days to weeks.
A rupture of the patellar tendon or a patellar tip syndrome are rather protracted injuries or illnesses that take several weeks to heal completely. Individual criteria such as age, previous illnesses, physical fitness and compliance, i.e. adherence to the prescribed therapy, always have an influence on the duration of the healing process.
With all pain on the patellar tendon, the greatest risk is generally a chronification of the pain. This must be prevented by timely and consistent therapy.
