Tendinopathies

General information

Patellar tendinopathy is a common overuse injury with those involved in sports involving running and jumping (hence the term Jumper’s Knee) most likely to be affected.

Irritation occurs at the proximal attachment of the patellar tendon with pain and tenderness just distal to the distal pole of the patella.
Can affect growing children involved in sports: as their body mass increases, more stress is placed on the tendon.
Risk factors include corticosteroid use / abuse, rheumatoid arthritis and chronic renal failure.

Quadriceps tendinopathy may be due to overuse or may be secondary to age-related tendon degeneration

Symptoms and signs

Patellar tendinopathy

Tenderness tends to be greater with the knee extended.

Quadriceps tendinopathy

Pain and tenderness may be experienced at the insertion of the quadriceps tendon into the proximal pole of the patella.

Initial management

Physiotherapy is the mainstay of treatment.
Activity modification may be required for more severe cases where increasing pain may indicate impending rupture.
Analgesia as appropriate/ NSAIDs may also help if no contraindications.
Corticosteroid injection is not advised due to increased risk of tendon rupture.
As with other tendinopathies, there is no good clinical evidence to support the use of alternative injection therapies (e.g PRP, stem cells, prolotherapy), Ultrasound therapy or Shock wave therapy. These are therefore not offered

Primary Care diagnostics

The diagnosis is usually clinically apparent with imaging not usually required

Who to refer

• There are no good surgical solutions for patellar/quadriceps tendinopathy. Primary care/MSK physio management only.

Useful resources

NHS Lanarkshire 'Patellar Tendinopathy' patient leaflet